When exactly comes the moment of death? An international study brings the answer

‘From the perspective of biology, death is a process. From a legal and ethical perspective, however, death cannot be considered a process, which is why there is a sort of social contract to consider death a moment in time,’ says MUDr. MgA. Kateřina Rusinová, Ph.D., head of the Department of Palliative Medicine of the First Faculty of Medicine of the Charles University and General University Hospital. 

The aim of the DePPaRT international study, which brought together two dozen intensive care units from Canada, The Netherlands, and the Czech Republic, including the Department of Palliative Medicine of the First Faculty of Medicine of the CU and General University Hospital, was to determine this particular moment. Good understanding of the process of dying is extraordinarily important for transplantation medicine. Alongside donors with brain death, there also develops in the Czech Republic a programme of organ donation after death due to irreversible arrest of circulation, and the study focused on this donor group. 

Researchers in Canada, Netherlands, and the Czech Republic asked over 600 families to allow physicians to follow the basic functions of their loved ones during the process of dying. Results of this study, presented in the New England Journal of Medicine, show that during this process, heart activity quite often can, after a while of inactivity, once again resume. The longest span between a heart arrest and short-term resumption of heart activity was four minutes and twenty seconds. 

Researchers did not, however, find any case where circulation would, after such heart arrest, resume in a long-term or a case where the patient would regain consciousness. This study provides support for the approach according to which physicians wait for five minutes after heart arrest before calling the time of death. Data from this study can be used to formulate principles for organ donorship on both national and international level.

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Resumption of Cardiac Activity after Withdrawal of Life-Sustaining Measures

New England Journal of Medicine (IF 74.699) 2021 January 28;

DOI: 10.1056/NEJMoa2022713; PMID: 33503343