When should a person be pronounced dead?

When is a person actually dead?

This is the question Kenyans have raised following incidents of people collapsing on the streets or in public vehicles while going about their daily duties then later being pronounced dead.

While Covid-19 is known to cause someone to pass out due to happy hypoxia caused by low oxygen blood levels, these incidents have caused a scare among Kenyans, with some wondering if those being suited up in body bags after collapsing on the streets were actually dead.

So if someone stops breathing or their heart stops beating are they dead?

"Death is not a lack of cardiac activity or breathing. The medical definition of death is the death of the brain stem," says Dr Stephen Okelo, the chairperson to the Kenya Society of Anaesthesia.

Okelo says a person is pronounced dead when the brain stem is dead. He says a person could be dead clinically but their heart is still beating.

"That is why in some countries where they have laws on organ harvesting they will still keep the person heart’s beating so that the organs can be harvested while still viable," he explained.

So how do you check if someone is dead?

One of the ways is pupillary light reflexes.

Science Daily, a medical journal, explains that when a flash of light is shone in the eyes, naturally the pupil should reduce in size.

"It is a normal response and dependent on the function of the optic nerves and oculomotor nerves," it explains.

The other is the pulse – in this case, carotid pulse – which is checked on the neck as shared by Dr Mercy Korir, The Standard Group Lead Health Editor.

The others are heartbeat and chest movement to determine if one is still breathing.

So what happens if someone drops on the street or passes out in a public vehicle?

Okelo says a cardiopulmonary resuscitation (CPR) should be performed to try and revive the person by either a Good Samaritan or a paramedic. This should be done for 30 to 40 minutes before checking if the patient has gained any signs of life.

At times CPR performed by medics will take longer than the usual 30-40 minutes and will be done until they (medics) are exhausted. This, Okelo says, depends on the reason why the patient became unconscious.

If the CPR is being done by a Good Samaritan, then it should be done until the medics arrive.

"This is because the person doing the CPR or the environment where it is being done there are no those monitors to tell if someone has died," said Okelo.

It is, however, different if the CPR is being done in a facility as there are monitors and to tell if the pulse is back no matter how faint and to check other reflexes.

"And as you do the CPR, you should try to find out the causes behind the person getting a cardiopulmonary arrest," he said.

A cardiopulmonary arrest, he added, can happen in case of medical conditions like low blood sugar level, low blood level, alcohol or drug intoxication; as a result, it is not wise to pronounce someone dead just because they cannot breath or their heart is no longer beating.

Due to the Covid-19 pandemic, however, it might be unsafe to do a CPR for a stranger who goes lifeless on the streets which Okelo agrees.

"Even before Covid-19, we discouraged mouth to mouth resuscitation because of infectious diseases. That is why paramedics instead do mouth to mouth using breathing bags. Unless it is your wife, daughter or someone you closely know it is better to consider your safety first," he said.