New research suggests that doctors are, fortunately, adept at correctly identifying a person’s time of death – a crucial aspect of ensuring healthy organs for donation. At the same time, the body can sometimes experience fluctuations in cardiac activity, even after death has become truly irreversible, according to the study published in the New England of Medicine.
There is no lack of morbid curiosity about death. But, according to the researchers behind this project, known as the Study of Prediction and Physiology of Death after Removal from Therapy, or DePPaRT, there is a lot we don’t know for sure about a person’s last few minutes.
Since 2014, they have collected vital sign data from dying patients in Canada, the United Kingdom and the Czech Republic as part of their work. Its main purpose is to document as much as possible about the dying process, especially in critically ill people who are withdrawn from life support. They have also studied how and why families decide to donate their loved ones’ organs before death and how the donation affects them. The people in the study – about 600 in total – were only included after their families’ express consent. The project received funding from the Canadian government, as well as from the Canadian Donation and Transplant Research Program.
While some organs, such as the kidneys, can be kept viable for more than a day before being transplanted, others, such as the heart, need to be transplanted within hours. Any delay can literally be the difference between life and death for organ recipients. But people are understandably sensitive to death, and many families and some doctors can hope for a miraculous recovery, even after a person is removed from life support.
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“We recognize that there are stories about people coming back to life, even from members of the medical community. So, we really wanted to provide scientific evidence about the dying process, to dispel any potential myth for people, ”project lead researcher Sonny Dhanani, a pediatrician at the CHEO Research Institute in Ontario, told Gizmodo by phone.
Today, doctors in Canada are said wait at least five minutes after interrupting blood flow after the end of life support before officially calling a person’s time of death (in the US, two to five minutes are recommended). In the patients this team studied, there were no cases where doctors were wrong about determining death. That said, the ideal death signal for movies – an immediate straight line on an EKG monitor – was also not quite right.
Sometimes, in about 14% of patients, there were moments of activation and deactivation of cardiac activity. However, it is important to note that these moments generally lasted for a few seconds and did not result in the heart restarting completely or people suddenly waking up. The longest time it takes for a heart to stop completely was around four minutes, indicating that the five-minute rule is really a good amount of time to wait for death to be determined (if the heart restarts during that time, doctors will wait another five minutes before declaring the time of death).
“Doctors and family members must be aware that this happens 14% of the time. But they must also be sure that it does not mean that the person will come back to life, ”said Dhanani.
This guarantee is very important for families, especially when it comes to decisions about organ donation. Of course, people can also offer this permission on their own, by registering preemptively as a organ donor.
Dhanani and his team were surprised by the number of families that chose to participate in the project when asked (93%). And he hopes that his team’s work will help people better recognize the benefits of organ donation, while relaxing about the process.
“Ultimately, we want our research to help open up conservation around death, death and donation, which are topics that can be uncomfortable,” he said. “And we hope that this research can reassure people who are concerned about the idea of being donors, perhaps because they fear that their organs will be removed before they die. There is a clear donation process and our research has shown that people will not be mistreated ”.