How do they make sure someone has really died before declaring them dead?

Question

What is the way they determine someone died before declaring them dead? There are stories I've heard of over the years, people who's heart stopped, were brain dead, fell under ice rivers for half an hour and miraculously survived. So there are many instances of unexplained recoveries. How do the medical teams or doctors determine then that this person won't all of sudden get a heart beat back?

Answer 1

This is a very good question. It varies based on the scenario. Say for example, the patient is expected to die in the hospital, he is a cancer patient and on hospice, and is a complete DNR. If the nurse assesses that after checking vitals on the patient, checking for a carotid pulse, auscultating the lungs and heart, the patient has passed, he or she will call or notify the attending physician, or if not available, the hospitalist or physician on call. The physician will then make a physical examination which includes a neurological examination of reflexes and pupillary response, before pronouncing the patient dead. The time the physician completes this examination is the legal time of death, even if the nurse assessed the patient had died before this. Then the nurse will begin completing the dealth checklist which involves several phone calls and documentation. In a case of a code, usually after an extended period of alternating CPR and giving various medications, with no sign of progress, the physician in charge, after determining that there are no other ideas to save the patient, declares the patient dead. If for example, it is a complicated case where the patient is on a ventilator but suspected brain dead, the physician must obtain physical evidence through examination and also testing such as an MRI to prove brain dysfunction, exclusion of any criterias that might be masking an accurate examination, a neurological examination which includes the testing of reflexes and pupillary response, a test of the response of the heart with atropine, and a respiratory apnea test. For more detailed description of these tests that the physician preforms, check out nih.gov.