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Abstract
There is a potential for many death diagnoses in hospitals to not satisfy a philosopher's definition of irreversibility. It is estimated there are 360,000 deaths in UK hospitals each year. Our results of death diagnosis practices in a modern hospital indicates that in the UK over 133,000 patients each year would have to have the way their deaths were diagnosed to satisfy a 60 minutes standard and 300,000 (83% of all UK hospital deaths) to satisfy a three hour standard. The radicalness of an insistence on irreversibility as impossible to reverse has not been appreciated and is inconsistent with what is regarded as normal hospital practice. We note that physicians use permanence, being the chance that something will happen rather then could happen (impossible to reverse) to make their death declarations. This is a dignity-consistent approach to making a diagnosis of death, as it is both safe and timely. The five-minute observation standard, as first proposed by Eugene Bouchut in 1846, remains the most valid physiological and patient-centered criteria for modern doctors to employ when diagnosing death after cardio-respiratory arrest.
Keywords: Death, Dead donor rule, death certification
Introduction
Concern has been expressed that the diagnosis of death, used in donation after circulatory death (DCD), will not satisfy the Dead Donor Rule. (1) Since the USA Uniform Declaration of Death Act requires irreversible cessation of circulatory and respiratory functions, then the typical observation period before confirming death in DCD and organ donation commencing, of 2-10 minutes, would not appear to satisfy this criterion because were Cardio-Pulmonary Resuscitation (CPR) instituted, reversal of cardiac function may well be possible. This is to say that the standard of irreversibility required to meet this criterion should be 'impossible to reverse. ' [1,2] Others have argued that there is a distinction between irreversible and permanent 'will not reverse' and the Dead Donor Rule is satisfied. [3-5]
How long doctors typically wait before confirming death after cardio-respiratory arrest is unknown. Most medical textbooks and curricula are silent on this matter and it was only in 2008 that in the UK the Academy of Medical Royal Colleges offered guidance suggesting a five-minute standard. [6] The Lazarus phenomenon of auto-resuscitation described in the literature appears to occur only in the context...