Page 3 - Ministerial Decree No. 550 of 2017 on the Declaration of Death

2.2.2 Exceptions:
a. The patient should not be hypothermic and the internal body temperature must be more
than 34 °C before the brain death is diagnosed, if it is less than that degree, the patient’s
body must be warm to raise the temperature;
b. It must be excluded that the patient is under the influence of sedatives, hypnotics, drugs,
nervous system depressants, muscle relaxants and antidepressants. The blood levels of such
substances or the patient's medical history file must not indicate the presence of explicit
levels of sedative drugs or muscle relaxants and the patient did not receive sedative
treatment in the past five days. A toxicological test should be performed, especially in cases
of traffic accidents, drug poisoning and cases of unknown coma, and in all cases that the
doctor thinks there is an indication for that. In case this is not available, the clarification of
death must be made after five days;
c. Exclude patients with metabolic and endocrine disrupting;
d. The patient does not make any action indicating cerebral activity, such as seizures,
decerebrate and decorticate posturing;
2.3 How to diagnose death through cerebral criteria?
After making sure that the prerequisites are met and exceptions are excluded, it is necessary
to proceed to the clinical examination as per the death diagnosis document through cerebral
criteria and record the clinical findings in that document. After that, the examining physician
signs that document and the case shall be re-examined after the specified monitoring period
is passed and the death diagnosis document shall be signed again.
2.3.1 Initial Clinical Examination:
1. Ensure that the patient is a state of coma;
2. Assess the patient in terms of the presence of brain activity, such as seizures or
movements indicating the presence of decerebrate and decorticate posturing as the
patient with brain death does not show any of that. The presence of spinal reflexes and/
or myoclonus does not preclude brain death;
3. Examine the motor response to painful stimuli; for example, pressing on the frontal
sinus area does not lead to any kind of furrowed brow or grimacing (Figure 1).

Figure (1): Examining the motor response to painful stimuli

2.3.2 Brainstem reflexes test

After carrying out the aforementioned initial assessment, the necessary tests must be performed to
ensure the absence of brainstem reflexes according to the following order (the presence of any of
following reflexes obviate the need to complete the remaining examinations):

*In case of any misinterpretation, the Arabic version of this legislation prevails.