South African Guidelines on the Determination of Death

Abstract

Death is a medical occurrence that has social, legal, religious and cultural consequences requiring common clinical standards for its diagnosis and legal regulation. [1] There is no documented case of a person who fulfils the preconditions and criteria for brain death ever subsequently developing any return of brain function. [2,3] Clear medical standards for death certification augment the quality and rigor of death determination. [4][5][6] Currently there are no clinical guidelines on death determination in South Africa (SA), with clinicians using available international guidelines, which vary markedly and are not always applicable to the SA context. [7][8][9][10] The World Federation This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Diagnosis of death guidelines for South Africa – timely and necessary

“…The publication of the multi-society-endorsed South African (SA) Brain Death Guidelines in this issue of the SAJCC are both comprehensive and well timed. [1] …”

“…Furthermore, the document discusses these matters in both adults and children, highlighting the exclusions that apply. [1] …”

“…Finally, it is important that the criteria for circulatory death have been discussed in detail in the new guidelines. [1] This is because the possibility of so-called deceased cardiac donor is being explored more commonly in SA, particularly in the context of non-brain-dead traumatic brain injury cases who are facing therapy withdrawal. The family can consent to donation and once circulatory death is declared, the transplant team have around 30 minutes to harvest the vulnerable kidneys and liver.…”

Relever les défis mondiaux liés à la détermination du décès : le leadership canadien en matière de création de consensus

“…25,40 The specific diagnostic criteria outlined in the Clinical Practice Guideline, which physicians must follow to determine death in Canada, reflect and build upon the increasing consensus occurring in national and international circulatory and neurologic diagnostic criteria. 17,37,[41][42][43] The process of the Clinical Practice Guideline development also showcases how consensus can be achieved through government support, professional medical societies and associations, and the involvement of individuals from diverse health care backgrounds, such as ethicists, lawyers, patient family members, and public partners. While not every worldwide guidance needs to follow Canada's lead in using the Grading of Recommendations, Assessment, Development and Evaluation methodology, the fact that Canada has done so represents a scientific rigor from which the rest of the world can only benefit.…”

“…Cette de ´finition re ´unit les deux ensembles « alternatifs » de crite `res de de ´ce `s couramment utilise ´s, soit les crite `res circulatoires et neurologiques, 31,38,39 et met l'accent sur les fonctions ce ´re ´brales de la conscience et de la respiration comme celles dont il faudrait tenir compte pour de ´terminer le de ´ce `s. 25,40 Les crite `res diagnostiques pre ´cis e ´nonce ´s dans les Lignes directrices de pratique clinique, que les me ´decins doivent respecter pour de ´terminer le de ´ce `s au Canada, refle `tent et s'appuient sur le consensus croissant qui se de ´gage en matie `re de crite `res diagnostiques circulatoires et neurologiques nationaux et internationaux. 17,37,[41][42][43] Le processus d'e ´laboration des Lignes directrices de pratique clinique montre e ´galement comment le consensus peut e ˆtre atteint gra ˆce au soutien du gouvernement, aux socie ´te ´s et associations me ´dicales professionnelles et a `la participation de personnes de divers milieux des soins de sante ´, comme des e ´thiciens, des avocats, des membres des familles des patients et des partenaires publics. Bien que toutes les directives mondiales n'aient pas besoin de suivre l'exemple du Canada en utilisant la me ´thodologie GRADE (Grading of Recommendations, Assessment, Development and Evaluation), le fait que le Canada l'ait fait est le signe d'une rigueur scientifique dont le reste du monde ne peut que be ´ne ´ficier.…”