South African guidelines on the determination of death
Authors:   Division of Critical Care, Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa, D Thomson , Joubert I ,   Division of Critical Care, Department of Anaesthesia and Peri-operative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa, De Vasconcellos K ,   Department of Critical Care, King Edward VIII Hospital, Durban, South Africa; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa, Paruk F ,   Department of Critical Care, University of Pretoria, South Africa, Mokogong S ,   Department of Neurosurgery, University of Pretoria, South Africa, Mathiva R ,   Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, McCulloch M ,   Paediatric Intensive Care Unit and Transplant Unit, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa, Morrow B ,   Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa, Baker D ,   Department of Adult Critical Care, Livingstone Hospital and Faculty of Health Sciences, Walter Sisulu University, Port Elizabeth, South Africa, Rossouw B ,   Paediatric Intensive Care Unit, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa, Mdladla N ,   Dr George Mukhari Academic Hospital, Sefako Makgatho University, Johannesburg, South Africa, Richards G A ,   Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Welkovics N ,   Netcare Unitas Hospital, Centurion, South Africa, Levy B ,   Netcare Rosebank Hospital, Johannesburg, South Africa, Coetzee I ,   Department of Nursing Science, University of Pretoria, South Africa, Spruyt M ,   Busamed Bram Fischer International Airport Hospital, Bloemfontein, South Africa, Ahmed N ,   Consolidated Critical Care Unit, Tygerberg Hospital, Department of Surgical Sciences, Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Gopalan D ,   Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
Published: April 2023

Death is a medical occurrence that has social, legal, religious and cultural consequences requiring common clinical standards for its diagnosis and legal regulation. This document compiled by the Critical Care Society of Southern Africa outlines the core standards for determination of death in the hospital context. It aligns with the latest evidence-based research and international guidelines and is applicable to the South African context and legal system. The aim is to provide clear medical standards for healthcare providers to follow in the determination of death, thereby promoting safe practices and high-quality care through the use of uniform standards. Adherence to such guidelines will provide assurance to medical staff, patients, their families and the South African public that the determination of death is always undertaken with diligence, integrity, respect and compassion, and is in accordance with accepted medical standards and latest scientific evidence. The consensus guidelines were compiled using the AGREE II checklist with an 18-member expert panel participating in a three-round modified Delphi process. Checklists and advice sheets were created to assist with application of these guidelines in the clinical environment (https://criticalcare.org.za/resource/death-determination-checklists/). Key points • Brain death and circulatory death are the accepted terms for defining death in the hospital context. • Death determination is a clinical diagnosis which can be made with complete certainty provided that all preconditions are met. • The determination of death in children is held to the same standard as in adults but cannot be diagnosed in children <36 weeks’ corrected gestation. • Brain-death testing while on extra-corporeal membrane oxygenation is outlined. • Recommendations are given on handling family requests for accommodation and on consideration of the potential for organ donation. • The use of a checklist combined with a rigorous testing process, comprehensive documentation and adequate counselling of the family are core tenets of death determination. This is a standard of practice to which all clinicians should adhere in end-of-life care.