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In the Name of Allah, the Compassionate, theMerciful
Statement of The Islamic Organization
for Medical Sciences About the
Medical Definition of Death

In 1985, the Islamic Organization for Medical Sciences held a symposium to study "The End of Human Life", participating in which were a select group of top religious jurists, medical scholars, legal experts and authorities in the humanities. After meticulous discussion, the symposium endorsed the following conclusions:

( 1) Usually as in the great majority of cases, when death happens, there is no difficulty in its diagnosis, upon its publicly known features or an external clinical examination delineating the dead from the living.

(2) In some (very few) cases, usually under close observation in the intensive care units or similar specialized hospital wings, the need is intense to establish the diagnosis of death, even at the phase when life-like phenomena persist, either spontaneously or by means of artificial life support machinery .

(3) The time old books of jurisprudence were scrutinised in search of the signs that prove death. These were mainly human interpretations based on available medical know ledge at their time, in view of the absence in the Quran and the Traditions of the prophet (PBUH) of a clear cut definition of death. Since the diagnosis of death and Its signs has always been I in the medical domain, upon which the jurists based there ruling, the medical side presented to the symposium the current medical opinion on the definition of death.

(4)  After the medical scholars presented the case, the  following points became clear:

-  The death of that part of the brain responsible for the primary vital functions, which is called the brain stem, is a reliable indicator of the occurrence of death.

- That the diagnosion of brain stem death is based on clear cut and reliable evidence, having excluded well known clinical entities that might give a false if  positive diagnosis.

-  A vital organ or function like the heart or respiration might stop temporarily but can sometimes be saved with restoration of life: but only if the brain stem is alive. If the brain stem has died, there is no (prospect of such rescue, and the person's life has practically come to a conclusion, even if other organs or systems have not died yet, but will inevitably also die after a period of time.

(5) Upon these medical data, the religious jurists based the view that if a person has reached, with certainty, the state of brain stem death, then such a person has departed from his life, and some of the rulings concerning death are applicable to him. This is in analogy -although not similarity -to the juridical ruling about the person that reached the stage of "movement of the slain". Concerning the applicability of the other rulings, the jurists preferred to defer discussing them for a future occasion.

( 6) In view of all this, there was a consensus that if death of the brain stem is diagnosed with certainty, then disconnecting the person from artificial life support apparatus may be carried out.

The Islamic Organization for Medical Sciences, keen on pursuing any scientific developments on the matter, and feeling the duty to address a recent campaign in the lay press and public media discrediting the standard universal acceptance of brain death with brain stem death as diagnostic of death, decided to hold this symposium.  Some doctors participated to that campaign, which added to the urgency of the situation. Two decisions were taken:

(i) In view of the scientific front being essentially mobile, the Organization deputed three of its members to participate in the November 1996 international conference held in San Francisco,
U. S.A., by the American Association of Bioethics, the International Association of Bioethics and the network death by brain death together with brain stem death. No case where brain and brain stem death was correctly diagnosed ever came back to life, and none of the cases that came back to life carried an established diagnosis of brain and brain stem death. Issues of novelty were confined to philosophical views or the relative evaluation of confirmatory procedures after the diagnosis was established.

 (ii) To hold this symposium in Kuwait from 17 to 19 December 1996, a distinguished group of scholars in the specialities of neurology, neurosurgery, anesthesiology, intensive care, neurophysiology, cardiac surgery , organ transplantation, medicine, pediatrics, obstetrics and gynecology, general surgery , medical  jurisprudence; who came from Kuwait, Saudi Arabia, Egypt, Lebanon, Turkey and the United States of America, was invited. It was also attended by the Director of the East Meditaranean Regional Office (EMRO) of the World Health Organization.

The subject was comprehensively discussed over a three days, including a meticulous appraisal of the clinical cases presented in support of the dissent no case properly be diagnosed as brain + brain stem death ever regained life,and all the cases that regained life had an obvious and flagrant fault in making such diagnosis, omitting, misreading or violating the standard criteria.

Reviewing the global situation and the regional experiences and safeguards taken (the contribution of the as Saudi team was particularly commendable) and in full awareness of the scientific and religious dimensions, the Organization found no reason to discard, modify or alter the recommendations of its previous symposium on or "Human Life: Its beginning and its end" held in Kuwait in 1985, or the rulings issued by the Congress of Islamic Jurisprudence (a department of the Organization of the Islamic Congress) in Makkah in 1986, both of which have been reaffirmed.

The following standards, criteria and safeguards were spelt out by the Symposium, and the Organization herewith presents them for the benefit of formulating legislation and by laws regulating this subject.

First -Signs which signify deat:
An individual is considered dead in one of the following two situations:

a- Complete irreversible cessation of respiratory and cardiovascular systems.
b- Complete irreversible cessation of the functions of the r brain including the brain stem.

This should be confirmed upon by the accepted i medical standards.

Second -Guidelines for diagnosing brain and brain stem death:

-The presence of a reliable medical specialist well experienced in the clinical diagnosis of brain and brain stem death and the various implications of such diagnosis.
-Prescribed observation necessitates complete medical coverage in a specialized suitably equipped institution.
-Second opinion should be accessible whenever sought.

Preconditions necessary before considering the diagnosis of brain death:

I. The person must be in continuous deep uninterrupted coma.
2. The cause of the coma can be explained by extensive damage to the structure of the brain, such as severe traumatic concussion, massive intracranial hemorrhage, after intracranial surgery, a large intracranial   tumor or obstructed blood supply to the brain: confirmed by adequate diagnostic measures.
3. At least six hours have passed since the onset of coma.
4. There is absence of any attempt at spontaneous breathing.

The diagnosis of complete irreversible cessation of brain and brain stem function necessitates :
I. Deep coma with complete unreceptivity and unresponsivity.
2. The clinical signs of absence of brain stem functions including absence of the pupillocornial reflex, .absence of occulocephalic reflex, absence of occulovestibular reflex, absence of the gag reflex and absence of the cough and vomiting reflexes.
3. Absence of spontaneous breathing as confirmed by the apnea test when the respirator is temporally disconnected. It should be borne in mind that:

- Some spinal reflexes may persist for some time after death. This is not incompatible with the diagnosis of brain death.
- Conclusions ensuing upon "decortication" or "decerebration", and also "epileptic seizures", are incompatible with the diagnosis of brain death.

All cases should be excluded which may be reversible or curable such as:

1. If the patient is under sedatives, transquilizers, narcotics, poisons or muscle relaxants; or if in hypothermia below 33°C; or in an untreated cardiovascular shock.
2. Metabolic or endocrine disturbances that might lead to coma.
3. There should be certainty of complete cessation of brain function over a period of observation of:

-12 hours since the onset of irreversible coma.
-24 hours if the coma is due to cessation of circulation (such as cases of cardiacarrest).
-   in children under 2 months of age, the observation period is extended to 72 hours,followed by repetition of electroence phalograpy or tests for cerebral circulation.
- children between 2 and 24 months of age require a longer observation period of 24 hours followed by repeatence phalography.
- children over one year of age are handled like adults.

Specifications of the team authorized to diagnose brain death:

1. The team comprizes two specialists with experience in diagnosing brain death. A neurologist's opinion is also sought if necessary .
2. One of the two doctors of the team should be a , specialist in neurology, neurosurgery or intensive care.

No member of the team should be  --

1. a member of the organ transplantation team,
2. a member of the family of the deceased person,
3. have any special interest in the declaration of death (such as inheritance or bequeath),
4. blemished by any accusation by the family of the deceased that he had committed any professional misconduct.

Proposed Form For Issuing a Brain Death Certificate by
(A space for the signature of every member of the
for medical team against each item is preferable )

With all this, the Islamic Organization for Medical Sciences, with an immense sense of duty towards theIslamic Shariah and the public welfare which the Shariah aims at, appeals to all concerned to confine the discussion of such a sensitive issue within the relevant medical and scientific circles, instead of taking it out in a sensational way to. the lay media shattering the confidence and trust of the public that was not given the complete correct data.

It would also behoove the relevant authorities in Muslim countries to issue legislation defining, regulatingand safeguarding the diagnosis of death and the practice of  organ donation and transplantation based upon the Islamic Sharia, for a legal  vacuum is only conducive of confusion or malpractice.

The creation of a venue enabling the organ transplantation centers in Arabic and Islamic countries to communicate, network and exchange views and experiences, should be given appropriate priority.

May God bless our efforts and guide our footsteps.

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