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Last Updated: Thursday, 1 March 2007, 12:27 GMT
How do you diagnose death?
WHO, WHAT, WHY?
The Magazine answers...

Woody Lander
Woody has no lasting brain damage
Two-week-old Woody Lander "came back to life" half an hour after being pronounced dead by medical staff. So how do you diagnose death?

His parents call him their "little miracle" and those in the medical profession say the case is "amazing".

Woody Lander - now a healthy 14 months old - was pronounced dead at Leeds General Infirmary after frantic attempts to save him by medical staff apparently failed. He had stopped breathing following a heart attack.

He was handed to his parents so they could say goodbye but when nurses started removing tubes from his body he began "twitching". Staff tried again to resuscitate him, this time successfully starting his heart 30 minutes after he was pronounced dead.

The case highlights how it is not always as straight forward as it may seem to tell if someone has died. So how do you know if someone is dead?

WHO, WHAT, WHY?
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A regular feature in the BBC News Magazine - aiming to answer some of the questions behind the headlines

Diagnosing death is about excluding all possible signs of life, say Doctor Rodger Charlton. But as a body's organs and tissues do not die simultaneously there can be doubt about the actual moment of death.

In hospital someone is usually considered dead when there is no electrical activity from the heart or brain, he says. However, even these measurements are not completely reliable indicators of death.

Circumstances play a big part in each case, but hospitals have guidelines and procedures to follow in certain situations, says the Royal College of Physicians.

These include the Glasgow Coma Scale (GCS), a standardised points system based on eye movements, spoken responses and other physical movement.

Reversible

All three things are tested and considered separately, then added together. The lowest possible score on the scale is 3, but even that is not definitive as it can indicate a deep coma as well as death.

When attempts are made to resuscitate someone after a heart attack - as in Woody's case - there are specific steps that must be taken. Eight reversible causes have to be checked one at a time before someone is pronounced dead.

These include:

  • Hypoxia
  • - lack of oxygen

  • Hyperkalemia
  • - high potassium

  • Hypothermia
  • - low body temperature

    Checking all the possible causes can take time, anything up to 45 minutes in extreme cases. The cut-off point for resuscitation - when a person is pronounced dead - is when all eight have been checked and there are still no signs of life.

    "Sometimes death is diagnosed quickly and in other cases it can take much longer, usually when the person is in hospital and there is more equipment to try and restart the heart," says nurse and resuscitation trainer, Alan Samuels.

    "Normally the longer resuscitation goes on, the less chance there is of someone surviving, which is what makes the baby's case even more remarkable."

    Patients who have hypothermia or are drugged can seem dead. It can be difficult to feel a pulse if the heartbeat is very slow.

    Phobia

    Size is also a factor, as it is sometimes harder to hear a heart beat of a heavier person as there is more fat and muscle between the medical apparatus and the heart.

    "A lot of people have a phobia of being wrongly diagnosed as dead," says Mr Samuels.

    "I think that stems from centuries ago when medicine was less sophisticated and most people did not die in hospital. In this day and age it is very rare to misdiagnose death.

    "Death usually takes place in a hospital setting, where sophisticated equipment is used to revive the person and test for vital signs. In a hospital it is generally very obvious when someone has died."


    Add your comments using the form below.

    This is a well-known interview question for applicants to medical school. Even leaving aside the scientific response, they get asked about the moral side as well. If someone is "medically dead" but is being kept "alive" so their organs can be harvested, at what stage does that person die?
    Someone who knows

    In the UK people think being dead equates to being cold. The phrase "stone cold dead" springs to mind. In scandinavian countries however, where hypothermia is more common, medical staff often say, "They're not dead until they're warm and dead."
    David S, London

    If you have read John Krackauer's 'Into Thin Air' i think there is a chapter entitled 'Dead Man Waving' that describes a sherpa, left for dead suddenly waving his arm. He talks how the cold can slow your heartbeat down to "below the death line", and that life and death are not black and white but a spectrum, and mean very little in extreme circumstances.
    Gabriela Staniszewska, London

    ...which is the reason I want to be cremated. I remember watching a programme when I was younger which had a man waking up to find he was in his own coffin, 6 feet under. At least if they make a mistake and I'm alive, it won't take long to prove them right and me wrong.
    Sarah, Cannock, Staffs

    ...and if you watched the recent popular tv programme, "Mythbusters", you'd have seen that you wouldn't survive an hour in a sealed coffin regardless. Embarassingly however, your cause of death would be "screwing the lid down"
    Jon, Caerphilly

    Exactly why i carry a donor card - at least if they take my organs i KNOW i'm dead...
    sara, norwich

    What a horrible though, to be alive but diagnosed as dead!
    Leanne, Brighton

    The one good thiing that has come out of this story is is that the parents are not pointing fingers and blaming the hospital staff and are not threating people with law suites. Mr Lander is hoping to thank Leeds General Hospital by running in the Leeds 10k Run for All, which is an admirable way to say thanks, and has restored my faith in humanity (for now anyway!)
    John Simpson, Portsmouth

    Blimey, Sarah. If I'm going to wake up in my own coffin, I REALLY don't want either to find I've been buried 6 ft under and can't get out, or to be burned alive. Think I might request a very long lying-in-state.
    Tom, London, UK

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