Page 7 - Ministerial Decree No. 550 of 2017 on the Declaration of Death

Indications for imaging Cerebral Arteriography:

The following conditions constitute reasons for conducting cerebral arteriography:

1. The absence of an EEG machine or the impossibility of imitating it due to technical problems,
in which case a clinical examination and an apnea test should be performed before the
arteriography;
2. Inability to exactly and precisely determine the cause of death;
3. The presence of metabolic disorders, shock, or hypothermia and inability to treat any of them
despite providing the appropriate intensive treatment;
4. Difficulty in persuading the family of the brain-dead person of his/ her death using cerebral
guides;

The lack of cerebral perfusion and cerebral blood flow constitutes evidence of irreversible brain
damage.

Proving the lack of cerebral blood flow (CBF) using other means:

In all fields, the lack of cerebral blood flow can be proven using brain arteriography or Transcranial
Doppler (TCD) and they all confirm the presence of irreversible brain damage.

2.4 Apnea test:

This test is performed as a last step after performing the two clinical examinations, as previously
mentioned, and confirming the absence of brain stem reflexes. It is performed by two specialists
only once after performing one of the other confirmation tests and ensuring their compatibility
with the reasons of death through cerebral guides.

How to perform the test?

This test demonstrates the existence of apnea (absence of spontaneous respiration); therefore, the
following precautions must be taken before performing this test:

General considerations:

a. The apnea test (AT) should be performed for a body with temperature of 36.5 °C or higher;
b. Avoid lack of oxygen that can further damage the brain;
c. Ensure that the partial pressure of carbon dioxide (PCO2) has reached level of 8.1 - 6.7
kilopascals (50-60 mmHg) at the end of the period of separating the patient from the ventilator,
as the aforementioned concentration constitutes a sufficient stimulus for the respiratory centers
in the living brain stem;
d. If the patient is in a critical condition that does not allow performing the apnea test, the test
can be replaced by the aforementioned cerebral perfusion tests.

Steps of performing the test:

a. Raising the Oxygen concentration for the patient at 100% for ten minutes. (The oxygen
concentration is increased without changing the ventilation rate);

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