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How is death determined?

Diagnosing brain death based on the guidelines of the Swiss Academy of Medical Sciences (SAMS)

Donors after brain death (DBD) are deceased persons whose brain is no longer functional due to a lack of blood flow. The most frequent causes are cerebral haemorrhage, a lack of oxygen supply or severe craniocerebral injuries.

Brain death is the irreversible cessation of all brain functions (of both the cerebrum and the brain stem). It is diagnosed in accordance with the guidelines of the Swiss Academy of Medical Sciences (SAMS) by two specialists who do not belong to the transplantation team (compare the guidelines The Determination of Death in the Context of Organ Transplantation, SAMS).

Donors after cardio-circulatory death (DCD) are persons with a terminal prognosis for whom a decision is taken in the ICU to discontinue their medical treatment and let them die according to Swiss Medical Association (FMH) guidelines.

If brain death has not occurred, an organ donation may be possible after cardio-circulatory death. For patients for whom there are no exclusion criteria for organ donation and who would be expected to experience cardiac and circulatory arrest within two hours of discontinuation of treatment, the question of organ donation may be raised. Any necessary clarifications regarding the usability of organs are carried out and treatment is stopped – usually in the presence of relatives, if they so wish. The breathing tube is removed, medications supporting circulation are discontinued, and the process of dying then begins.

If cardiac and circulatory arrest occurs within two hours and the electrical activity of the heart has failed, a cardiac ultrasound will also be carried out to establish whether the heart is no longer pumping blood for at least five minutes. If this is the case, death is determined and confirmed by two independent specialists in accordance with SAMS guidelines. At this point, the deceased person is considered to have experienced both circulatory death and brain death. Subsequently, preparations for organ removal take place and the organs allocated to recipients are removed in the operating theatre under sterile conditions. After removal, the wound is closed. If the process of dying lasts more than two hours, no organs will be removed. Relatives will be informed about the process in advance.