posted on Dec, 11 2016 @ 12:10 PM
Hi, I'm a hospice nurse and previous ICU nurse. I believe I can weigh in here.
First of all, death is a process that some might say begins at conception. We are all aging continuously and, in a sense, degrading slowly. However,
there is an "active" dying phase. That means one is actively dying, meaning they stop being able to communicate, their respiratory rate changes, they
may become agitated or experience pain or anxiety. Most become comatose, but it appears as though they're dreaming and not totally comatose. They say
that hearing is the first sense that babies acquire and the last sense that leaves us when we die. This all, of course, is in the case of a death that
you see coming, such as in the case of terminal illness.
Now, legally in the U.S., hospice nurses declare death after auscultating for heart sounds after one full minute and conducting other tests, such as
the "great toe press." A doctor then is notified, sometimes a coroner, and signs the death certificate. When I was in ICU, the telemetry monitors
would show asystole, then I'd auscultate for heart sounds and a pulse, and then I'd have to call a physician to declare time of death. Respirations
tend to cease long before the heart ceases beating, so that's not a good indicator. Also, respiratory rate can decrease to the point where it stops
for long periods of time, but then it can start back up again. Likewise, brain activity has been seen after the heart stops, but it doesn't last much
longer afterwards, as the brain requires oxygen (which the blood pumped by the heart supplies) in order to function and can only survive for about six
minutes after the heart stops. The body should continue to be treated with respect, and we still talk to them and warn them of what we're about to do
(typical nursing care, you never touch a patient without explaining what you're going to do first), and it takes a while before the funeral home comes
for pick up.
Unfortunately, in the case of harvesting organs, they need to take them ASAP, so I know there are times when the heart and respirations have ceased
and the six minutes are not waited to ensure complete brain death before patients are quickly wheeled to the OR to harvest. What we call "terminal
weans" are done in the case of brain death and when the heart is still beating, but ventilators are necessary to keep someone alive and the family
decided to take them off of the machines that are keeping them breathing. This is a more cut and dry case because the brain is already dead. Once off
of the machines, one simply has to wait for the heart and respirations to cease, then it is safe to harvest organs.