ABSTRACT
Previously, death could be signified by the cessation of heartbeat and respiration, and this was easily verified by physical examination. Now, technology can keep people living longer, or at least prolong the point of death. If technology keeps a patient going when his heart continues to beat on the machine but breathing has stopped and the brain has been irreversibly damaged, this can be very distressing to relatives, is bad for morale among the nursing staff, is costly, and might also be depriving someone of access to the life-support machine who might benefit more from it. The rapid development in transplantation programmes led to the need for speedy diagnosis of death, so that once death was established, organs could be quickly removed from the body for transplantation, while they were still ‘fresh’. In certain brain stem death cases, there appears to be a cessation of spontaneous respiration and, instead of being followed by cardiac arrest, when supported by artificial ventilation, the heartbeat can continue for days; this will enable organs such as the liver and kidneys to be maintained.
