Page 6 - Ministerial Decree No. 550 of 2017 on the Declaration of Death

Figure 6: The GAG Reflex Test

2.3.3 Observation Period (the intervals between the two clinical examinations):
After completing the first clinical examination, the second examination should be performed after
the necessary observation period specified in the protocol is passed. The results of the two tests
should be duly recorded in the brain death document and signed by the examining physicians.

The following table shows the time interval that is required between the first and second clinical
examination according to different age groups:

Table of the observation period required between two clinical examinations according to
the age groups
* Infants (7 days - 60 days) 48 hours
*Infants (> 60 days - 1 year) 24 hours
**Children (> years to adulthood) 12 hours
**Adults 6 hours

*Two electroencephalogram (EEG) tests may only be performed with a time interval between
them equivalent to the observation period;

**One electroencephalogram (EEG) test may only be performed after completing the first clinical
examination.

2.3.4 Confirmation tests:

If it is proven that all of the aforementioned brainstem reflexes are absent, the physician can
proceed to performing the confirmation tests, which are either:

 Electroencephalogram (EEG)
This should show electro cerebral silence (ECS), and the recording must be made for at least 30
minutes according to the medically recognized principals, noting that if the patient has a
hypothermia, his body temperature must be raised before doing the EEG.

 Cerebral angiography:

The lack of blood-cerebral flow when imaging the four cerebral arteries constitutes a confirmation
test for diagnosing death in children and adults. Isotopic cerebral angiography is considered a
confirmation test for death in children as it shows the lack of cerebral-arterial blood flow and the
stop of carotid artery blood flow at the base of the skull even if it shows a part of venous sinuses
inside the brain.

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