⚖️ There are regional differences across the UK, but the core legal and professional principles remain the same. ⏱️ A careful assessment must be performed, lasting at least 2 minutes.

🩺 Procedure when called to see a patient who has died
☑️ Assume this is an expected death (not for resuscitation / failed resuscitation). 👨‍👩‍👧‍👦 If family are present, you may ask them to wait outside - but their presence should not prevent a respectful, calm assessment. 📅 Record date, time, location (ward/setting). 🧾 Record who called you and at least one staff witness. 📝 Document the circumstances and proceed to check for signs of death: 🫁 Confirm the patient is apnoeic (no breathing) for at least 2 minutes. 💓 No palpable carotid or femoral pulse for at least 2 minutes. 🎧 No heart sounds on auscultation for 2 minutes. 👁️ Pupils fixed and dilated (test with bright light). 🕰️ These assessments can often be conducted together over a 5-minute period. 📡 Check for a cardiac pacemaker (palpation or recent chest X-ray) and record if present. ✍️ Sign your entry with date, time, and GMC number. ⏰ State the exact time death was confirmed. ☎️ Check that family have been informed and offer condolences.

🩺 Procedure when called to see a patient who has died

☑️ Assume this is an expected death (not for resuscitation / failed resuscitation).
👨‍👩‍👧‍👦 If family are present, you may ask them to wait outside - but their presence should not prevent a respectful, calm assessment.
📅 Record date, time, location (ward/setting).
🧾 Record who called you and at least one staff witness.
📝 Document the circumstances and proceed to check for signs of death:
🫁 Confirm the patient is apnoeic (no breathing) for at least 2 minutes.
💓 No palpable carotid or femoral pulse for at least 2 minutes.
🎧 No heart sounds on auscultation for 2 minutes.
👁️ Pupils fixed and dilated (test with bright light).
🕰️ These assessments can often be conducted together over a 5-minute period.
📡 Check for a cardiac pacemaker (palpation or recent chest X-ray) and record if present.
✍️ Sign your entry with date, time, and GMC number.
⏰ State the exact time death was confirmed.
☎️ Check that family have been informed and offer condolences.

ℹ️ About

💀 Death is a process involving the cessation of physiological functions. The determination of death is the final event in that process.
❤️🫁 For most, this is confirmed by irreversible cessation of cardiorespiratory function. For some (e.g. on ITU ventilators), brainstem testing is required.
🫀 Being ventilated does not necessarily equate to being alive if brainstem function is lost.
🔄 Brain death and circulatory death are not separate entities but two routes to identifying the same endpoint: death.

📝 Confirming Death in Usual Clinical Practice

🧼 Wash hands, identify the patient, draw screens around. Take time. Be sensitive to family presence.
⏳ Assess over ~5 minutes (some steps simultaneously):

🫀 Absence of carotid/femoral pulse.
🎧 Absence of heart sounds on auscultation.
🫁 Absence of breathing/respiratory effort.
👁️ Absence of pupillary responses to light (usually fixed and dilated).

📖 Record the time of death as the time these criteria are met. Document findings, date, time, GMC number. Speak with family, offer condolences, and direct them to bereavement services.

🧪 Instrumental Tests (if indicated)

📉 Asystole or pulseless electrical activity on continuous ECG.
📊 Absence of pulsatile flow on intra-arterial monitoring.
🖤 Absence of cardiac contractility on echocardiography.
⚠️ These are not mandatory, but may be required in patients on advanced life support or in critical care when withdrawing therapy.

🧠 Brain Death Criteria

Definition: Coma + absent brainstem reflexes + apnoea (with confirmed aetiology of catastrophic brain injury).

🚫 Exclude confounders: depressant drugs, neuromuscular blockade, severe metabolic/acid-base disturbances, hypothermia (<32°C).
🧾 Confirm known aetiology (structural brain damage, imaging, clinical context).
❌ Brainstem reflexes absent: pupillary, corneal, vestibulo-ocular, facial motor, gag, cough.
🫁 Apnoea confirmed in presence of raised PaCO₂ (>6 kPa / 60 mmHg, pH <7.30).
👩‍⚕️👨‍⚕️ Two examinations ≥2 hours apart, each by separate, appropriately trained doctors (registrar grade or above).
🧪 Angiography or ancillary tests if assessment incomplete (e.g. ocular injury).
👶 Modified criteria apply for children under 1 year due to greater recovery potential.

📚 References

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Confirming Death

ℹ️ About

📝 Confirming Death in Usual Clinical Practice

🧪 Instrumental Tests (if indicated)

🧠 Brain Death Criteria

📚 References

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