The definition death as we know it, was not approved by the American Medical Association or by the American Bar Association in until 1980 and 1981. The definition is the end-of-life, cessation-of-life, and the permanent cessation of all vital bodily functions. The common law standard for determining death is the cessation of all vital functions, traditionally demonstrated by “an absence of spontaneous respiratory and cardiac functions.” The uniform definition of death, is determined by the irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain.   Moreover, a determination of death must be made in accordance with accepted medical standards. Physicians determined death by examining people for total unresponsiveness; as in the lack of any spontaneous movements, including breathing, absence of papillary light reflexes, and the absence of a heartbeat.

In order to fully understand health care personnel individualized roles, (in the presence of death) one must first acknowledge the fact that death has many faces, based off many different factors. There are various signs of death, and various recognizable features when death is imminent. Five major changes occur in patients as death begins to near their back door. First, is the loss of muscle tone. Skilled medical personnel observe increase signs of weakness, decrease movements, and incontinence from loss of sphincter control. Second, is the noticeable decreased ability to swallow, followed by a gradual loss of gag reflex. Thirdly, as circulation through out the body starts to wane, cyanosis of the extremities are seen. Medical personnel might even notice that the patient’s skin feels cool and clammy to the touch. The forth sign comes, as respirations become difficult, labored, irregular and slow. Some patient’s have a notable “death rattle,” caused by increase secretions, which then creates very noisy respirations. Finally the fifth stage in obtained as death approaches ever more closely. As the approach increases, decreasing sensations such as loss of consciousness, possible mental cloudiness, blurred vision, and altered sense of hearing are soon to follow. As it worth mentioning, all medical staff must be aware that hearing is the last sense to be affected by the different stages of death. At the time of death, pupils become fixed and dilated. The patient’s breathing will fall into a Cheyne-Strokes pattern, blood pressure will drop, and with the next breath, the heart rhythm stops.

Livor mortis occurs twenty to thirty minutes after death. Livor mortis is the appearance of purple blotches on certain dependent areas of the patient’s body. It is the direct result of gravitational affects on uncirculated blood. Rigor mortis is the natural stiffening of a dead body, which is the result of chemical changes occurring in the muscle protein. It is apparent first in the muscles of the jaw and progresses downward toward the legs. The feet are the last to be affected. Rigor mortis usually begins appearing two to three hours after death, and completed between six and eight hours after death. Postmortem care is done with respectful handling of the body. The best position to place the patient’s body is in the supine position, with their arms at the side, or folded across their chest. If the family wishes to participate in postmortem care, and before they’re brought into the room, have the patient’s eyes closed and dentures replaced. Be sure to put in the dentures before livor mortis, or rigor mortis begins to take place. Too much handling of the patient’s jaw can cause unnecessary bruising, and added stress undertaker.

All medical staff must be in tune with their own, personal emotions, and defense mechanisms acquired when dealing with a dead patient. Defense mechanisms such as laughter, rough handling, and joking can particularly distressful to possible observers, during the time postmortem care is initiated. The nurse circulator, surgical technologist or surgical orderly should remove any tubing such as intravenous equipment, and catheters. The patient’s body should be placed on clean bedding, and in a natural position as earlier stated. Place absorbent pads under the body to adsorb leakage of urine or feces, which can occur as sphincter muscles begin to relax. The medical staff should also beware, and remind other people in the room that upon moving the body, the last bit of air in the lungs may be expelled and cause a deep sigh sound upon exhaling out of the body. This body sound can be very disconcerting to those present at that time, and for those not expecting it.

ORGAN TRANSPLANTATION:

The organ procurement and transplantation process begins at the hospital, as soon as a patient is identified as a potential organ donor. Most organs come from patients who are pronounced brain dead as a result of disease, brain hemorrhaging, motor vehicle accident, gunshot, stab wound, asphyxiation or other bodily injury. If the family consents to donation, OPO staff coordinates the rest of the procurement activities, from organ recovery and preservation to transport to a transplant center for transplantation.

Under current law, a coroner has the duty to investigate any death where the person is believed to have died: (1)by violence; homicide, suicide, or accident, (2)by criminal abortion, (3)by some unforeseen sudden occurrence where the deceased had not been attended by a physician during the thirty-six hours preceding death, (4)in any unusual or suspicious manner, or (5)by any injury or illness while in the custody of the law or while an inmate in a public institution.

Most US county health departments report a one percent death rate in each county per year. Of this total, the coroner investigates about 12 percent of these cases. An example of a coroner’s case is any deaths of transplant surgery donors that are the result of some type of trauma Furthermore, deaths of individuals who die of a disease that might constitute a threat to public health are also reviewed.