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activation-induced cell death; automatic implantable cardioverter-defibrillator.



Permanent cessation of all vital functions including those of the heart, lungs, and brain. See: table; brain death; euthanasia; life


The principal clinical signs of death are apnea and asystole. Other indications, including loss of cranial nerve reflexes and the cessation of the electrical activity of the brain, may be necessary for those receiving mechanical life support.

Patient care

Legal procedures and institutional protocols should be followed in the determination of death. The times of cessation of breathing and heartbeat are documented, and the physician or other legally authorized health care professional is notified and asked to certify death. The family is notified according to institutional policy, and emotional support is provided. Auxiliary equipment is removed, but the hospital identification bracelet is left in place. The body is cleansed, clean dressings are applied as necessary, and the rectum is packed with absorbent material to prevent drainage. The deceased is placed in a supine position with the limbs extended and the head slightly elevated. Dentures are inserted, if appropriate; the mouth and eyes are closed; and the body is covered to the chin with a sheet.

The deceased's belongings are collected and documented. Witnesses should be present, esp. if personal items have great sentimental or monetary value. The family is encouraged to visit, touch, and hold the patient's body as desired. In some situations (as in neonatal death or accidental death) and according to protocol, a photograph of the deceased is obtained to assist the family in grieving and remembering their loved one. A health care professional and a family member sign for and remove the patient's belongings.

After the family has gone, the body is prepared for the morgue. Body tags, imprinted with the patient's identification plate or card information (name, identification number, room and bed number, attending physician), along with the date and time of death, are tied to the patient's foot or wrist as well as to the outside of the shroud. The body is then transported to the morgue and placed in a refrigerated unit according to protocol.

activation-induced cell death

Abbreviation: AICD
Destruction of T or B lymphocytes that would otherwise be activated by contact with self-antigens. AICD maintains immunologic tolerance; it is enhanced by interleukin-2 (IL-2) and inhibited by interleukin-15 (IL-15).

assisted death

Help that enables a person who wants to die to do so. The help may be counseling or providing the physical means or instruments that allow the person to commit suicide. The legal and ethical questions concerning such acts, esp. if the assisting person is a health care professional, are topics of active debate.
See: assisted suicide; euthanasia

biological death

Death due directly to natural causes.

black death

A colloquial term for bubonic plague.

brain death

The cessation of brain function. The criteria for determining brain death include lack of response to stimuli, lack of all reflexes, absent respirations, and an isoelectric electroencephalogram that for at least 30 min will not change in response to sound or pain stimuli. Other criteria sometimes used include loss of afferent cerebral evoked potentials, loss of isotope uptake during brain scans, or absence of cerebral perfusion on Doppler sonography. Before making this diagnosis, two physicians, including one experienced in caring for severely brain-damaged patients, should examine the patient. It is inadvisable for physicians associated with transplant procedures to participate in the review. The patient's body may be kept “alive” briefly by life-support devices if the patient is an organ donor.


Some drugs (such as barbiturates, methaqualone, diazepam, mecloqualone, meprobamate, trichloroethylene) can produce short isoelectric periods on encephalograms. Hypothermia must also be excluded as the cause of apparent brain death. Preterm infants whose gestational age is less than 37 weeks should not be diagnosed with brain death.

Patient care

The determination of brain death has both medical and legal consequences. It establishes a criterion for the withdrawal of life support from the critically ill who no longer have measurable brain function. At the same time it may initiate a discussion with family members of the deceased about organ donation. Those who have unequivocally specified that they would like to donate their organs at death currently make up a very small percentage of the population. Most of those who die have not made plans for organ donation, and some (such as those who die from trauma) may have never considered making a living will, a directive to physicians, or plans for organ donation. Discussions with family members in the immediate postmortem period may be emotionally challenging both for health care professionals and the grieving.

Brain death differs from the death of the heart, lungs, or other internal organs, and family members may often be confused about its meaning. They may wonder why they can still observe evidence of cardiac activity or effective mechanical ventilation. Family members may be unwilling to consent to withdrawal of ventilator support even when clinicians recognize that continued treatment will be of no benefit. There is a procedure to protect the rights of patients and their families in resolving disputes when family members do not agree with clinicians’ decisions regarding discontinuance of life support in situations of medical futility. It is important for health care providers to explain that the brain-dead patient may still have an active heart rhythm but no longer has the ability to think, see, hear, or feel. The pulse and breath of the brain-dead patient can be artificially maintained for a short time. The central nervous system has already failed. If organ donation is being considered, an expert counselor should discuss this with the next of kin and help make the necessary arrangements. For some families, organ donation by the deceased provides some solace at a time of deep loss. If time is needed for a significant loved one to be present with the patient before he or she is removed from life-support, the involved physicians should be notified and a time arranged. It is often helpful for families to do this. If a close family member cannot be present and the family is concerned about this, it may help them to have a photograph of the patient once he or she has died that can be shared with others. After life support has been withdrawn, it is considerate to provide private time for the family to be with the deceased, supporting them as necessary. A hospital chaplain or the patient’s or family’s priest, rabbi, minister, or pastor will often provide spiritual comfort for survivors in addition to the support and comfort provided by professional staff.

Synonym: death by brain criteria

cot death

The British term for
sudden infant death syndrome.

crib death

Sudden infant death syndrome.

death with dignity

Death that is allowed to occur in accordance with the wishes of a patient. An individual may choose to withdraw from chronic medical therapies, as when there is little expectation of cure. Patients who choose death rather than active treatment often have advanced malignancies, poor performance status, major depression, poor social support, or a desire for a palliative approach to end-of-life care.

early neonatal death

Death of a newborn infant in the first seven days after delivery. See: intrapartum death; stillbirth.

fetal death

Spontaneous death of a fetus occurring after the 20th week of gestation. The cause is often unknown, but fetal death is often associated with maternal infection, diabetes mellitus, fetal and placental abnormalities, and preeclampsia.

functional death

Central nervous system death with vital functions being artificially supported.

good death

Death in which the rights of the person have been respected and during which the dying person was made as comfortable as possible and was in the company of persons he knew and loved.
See: living will

interphase cell death

The death of a cell before its next mitosis.

intrapartum death

Death of an infant occurring during its delivery.

local death

Gangrene or necrosis of a part.

man-made death

Death due to something other than natural causes, e.g., murder, war, violence.

molecular death

Death of cell life.

neocortical death

Persistent vegetative state.

pregnancy-related death

The death of a woman occurring within 6 weeks after pregnancy, conception, or termination of pregnancy.

sudden death

Death occurring unexpectedly and instantaneously or within 1 hr of the onset of symptoms in a patient with or without known preexisting heart disease. Sudden death due to cardiac conditions occurs in the U.S. at the rate of one a minute. It may be caused by cardiovascular conditions, including ventricular fibrillation or tachycardia, ischemic heart disease, aortic stenosis, coronary embolism, myocarditis, ruptured or dissecting aortic aneurysm, Stokes-Adams syndrome, stroke, pulmonary thromboembolism, and other, noncardiovascular-related, disorders, such as electrolyte imbalance and drug toxicity.

wrongful death

Loss of life caused by negligent, illegitimate, or illegal acts.
SOURCE: National Vital Statistics Report, Vol. 58, No. 19, May 20, 2010 *Total number of deaths: 2,423,712
Cause of DeathNumber of Deaths in 2004Percent of Total Deaths
Heart disease 616,06725.4
Cancer (malignant neoplasms) 562,87523.2
Stroke (cerebrovascular diseases) 135,952 5.6
Chronic lower respiratory disease 127,9245.3
Accidents 123,7065.1
Alzheimer disease 74,6323.1
Diabetes mellitus 71,3822.9
Influenza and pneumonia 52,7172.2
Nephritis, nephrotic syndrome, and nephrosis 46,4481.9
Septicemia 34,8281.4
Suicide (intentional self-harm)34,5981.4
Chronic liver disease and cirrhosis29,1651.2
Essential hypertension and hypertensive renal disease23,9651.0
Parkinson disease20,0580.8
Assault (homicide)18,3610.8

activation-induced cell death

Abbreviation: AICD
Destruction of T or B lymphocytes that would otherwise be activated by contact with self-antigens. AICD maintains immunologic tolerance; it is enhanced by interleukin-2 (IL-2) and inhibited by interleukin-15 (IL-15).
See also: death


(de-fib'ri-lat?or) [ de- + fibrillat(ion)]
A device that delivers an electrical shock that completely depolarizes the myocardium, producing a brief period of asystole. The goal of defibrillation is to let the sinoatrial node recover control of the heart's electrical activity and terminate potentially fatal heart rhythms, such as ventricular tachycardia and ventricular fibrillation. See: cardioversion

A defibrillator may be used with conductive pads applied to the chest wall or may be surgically implanted in the chest, e.g., in patients who have previously been resuscitated from sudden death.

automated external defibrillator

Abbreviation: AED
A defibrillator that performs all functions by computer (analyzes rhythm, selects an energy level, charges the machine, and shocks the patient). The operator applies adhesive paddles and turns the machine on, then makes certain that no one is in contact with the patient.
Synonym: automatic defibrillator

automatic defibrillator

Automated external defibrillator.

automatic implanted cardioverter defibrillator

Abbreviation: AICD
A defibrillator surgically implanted in patients at high risk for sudden cardiac (arrhythmia-induced) death. The device automatically detects and treats life-threatening arrhythmias.

automatic implanted ventricular defibrillator

A defibrillator surgically implanted in patients at high risk for sudden cardiac death from ventricular arrhythmias. This device is capable of automatically restoring normal heartbeat by generating an electrical stimulus to the heart.

manual defibrillator

A defibrillator that requires the operator to assess the need for defibrillation (by reviewing monitor data and the patient's clinical condition), select an energy level, charge the machine, and deliver shock.

semi-automatic defibrillator

A defibrillator that assesses rhythm and gives voice prompts to the operator concerning the patient's condition, the energy level, charging, and shocking the patient.

automatic implanted cardioverter defibrillator

Abbreviation: AICD
A defibrillator surgically implanted in patients at high risk for sudden cardiac (arrhythmia-induced) death. The device automatically detects and treats life-threatening arrhythmias.
See also: defibrillator
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