Abstract
Introduction and MethodsThis report summarizes the results of the first phase in the development of international guidelines for death determination, focusing on the biology of death and the dying process, developed by an invitational forum of international content experts and representatives of a number of professional societies.Results and ConclusionsPrecise terminology was developed in order to improve clarity in death discussion and debate. Critical events in the physiological sequences leading to cessation of neurological and/or circulatory function were constructed. It was agreed that death determination is primarily clinical and recommendations for preconditions, confounding factors, minimum clinical standards and additional testing were made. A single operational definition of human death was developed: ‘the permanent loss of capacity for consciousness and all brainstem functions, as a consequence of permanent cessation of circulation or catastrophic brain injury’. In order to complete the project, in the next phase, a broader group of international stakeholders will develop clinical practice guidelines, based on comprehensive reviews and grading of the existing evidence.
Highlights
Introduction and MethodsThis report summarizes the results of the first phase in the development of international guidelines for death determination, focusing on the biology of death and the dying process, developed by an invitational forum of international content experts and representatives of a number of professional societies
The 32 invited events in the dying process of patients who have suffered participants included delegates from a broad range of a catastrophic brain injury that will lead to death deternational and international professional societies involved mined on a neurological basis
The inextricable link between circulation and brain based terms such as ‘‘brain death’’ or ‘‘cardiac death’’ that function means that the neurological and circulatory erroneously imply the death of that organ and confuse the sequences integrate at several points in the dying process general public, health professionals, and policymakers of patients who have suffered a circulatory arrest (Fig. 3)
Summary
On 30–31 May 2012, an invitational forum sponsored by Findings Health Canada and Canadian Blood Services in collaboration with the WHO was held in Montreal, Canada, as Neurological sequence in the dying process part of the planning, scoping, and needs assessment phase in the process of guideline development (see ‘‘Appendix Forum participants identified several major sequential 1’’ for forum committees and participants). In the context of death discussions, this may be primary and lead to a subsequent cardiac arrest, or it may be secondary to the loss of brainstem function A procedure performed in diagnosis or detection A complementary test or an alternative test to one that otherwise, for any reason, cannot be conducted or is unreliable A bedside test typically based on physical examination of the patient, but may include the use of a stethoscope and vital signs monitors A test performed to confirm a previously conducted test A technical test requiring use of elaborate equipment and medical technologies, e.g. blood testing, diagnostic imaging A test performed in addition to an already conducted test The combination or arrangement of parts into a whole A condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles that causes the cessation of circulation. Neuroimaging that explains the continuing deterioration and lesion capable of causing death by severity of brain injury progressive loss of brain neurological criteria
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