What Is Clinical Death?

This post was written by contributor, Derek Fuchsberger, RN.

Medical terminology can be confusing and googling certain words or phrases for answers can lead to a wide range of definitions, sometimes contradicting each other and further adding to the confusion. In this article, we’re sharing our definition of the term “clinical death,” how it relates to other definitions of death, and organ donation.

Definitions of Death

Clinical Death

Clinical death is a term that describes the cessation (stopping) of a patient’s heart pumping blood through the body and, inevitably, is paired with a lack of breathing. Clinical death is a medical emergency, without immediate intervention, the window to reverse the condition will close, and legal death will be declared.

Brain Death

Brain death is the cessation of brain activity and the inability for the brain to carry out the proper functions necessary to sustain life. Brain death is irreversible.

Legal Death

Legal death involves irreversible cardiac and respiratory cessation or irreversible brain death function and requires the examination, determination, and sign off of a qualified medical professional. 

One Example, Three Scenarios

These are not the only possible outcomes for this scenario but an example to illustrate the difference between the types of death listed above:

A nurse walks into a patient’s room and finds that patient unresponsive and not breathing. The nurse then checks for a pulse and discovers that the patient does not have one. At this point, the patient would be considered clinically dead because their heart is not pumping blood. What happens next depends on a number of factors…

Scenario One

The nurse will call a code and CPR will be initiated. If the team is successful and bring back the patient’s heart beat, that patient can be put on ventilated support and is no longer considered clinically dead and critical care would continue with interventions like mechanical ventilation, specific medications, and external heartbeat pacing, to name a few.

Scenario Two

The nurse calls a code and CPR is initiated. If CPR is not working and the medical team has exhausted all efforts, the appropriate examinations are done, brain death is determined, a doctor will give an official time of death and sign off on a death certificate (Legal Death).

Scenario Three

Sometimes, patients have signed a medical form declaring their decision not to be resuscitated under these circumstances (often referred to as a DNR). If this is the case, the nurse would respect the decision of the patient and would not provide medical interventions. Without blood flowing through the body, Brain Death and deterioration of all other tissue will quickly occur. The appropriate examinations are done, death is determined, a doctor will give an official time of death and sign off on a death certificate (Legal Death).

Legal Death is Not Always Clinical Death

With advances in medicine and technology, such as mechanical ventilation, specific medications, and external heartbeat pacing, hospitals are able to keep patients breathing and their heart beating even if there is no brain activity. So a person could be brain dead but still have a heart beat and be pumping oxygenated blood through the body because of the medical interventions taken to save their life. Once a qualified medical professional administers the appropriate examinations and determines Brain Death, the patient can be pronounced Legally Dead even if they are not Clinically Dead.  

This is one of two extremely rare situations (1% of registered donors) where the opportunity to save the lives of others thorough organ donation is possible.

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Derek Fuchsberger is a Registered Nurse with three years of ICU experience. His background includes coaching soccer, graphic design, technology and communications. Currently, he is working as an ICU Nurse while pursuing a career in medical writing.

In his free time, Derek is an award-winning winemaker.