World Medical Association, Declaration of Sydney [on death] (1968; 1983)

Adopted by the 22nd World Medical Assembly Sydney, Australia, August 1968, and amended by the 35th World Medical Assembly Venice, Italy, October 1983


1. The determination of the time of death is in most countries the legal responsibility of the physician and should remain so. Usually the physician will be able without special assistance to decide that a person is dead, employing the classical criteria known to all physicians.
2. Two modern practices in medicine, however, have made it necessary to study the question of the time of death further:
a) the ability to maintain by artificial means the circulation of oxygenated blood through tissues of the body which may have been irreversibly injured and
b) the use of cadaver organs such as heart or kidneys for transplantation.
3. A complication is that death is a gradual process at the cellular level with tissues varying in their ability to withstand deprivation of oxygen. But clinical interest lies not in the state of preservation of isolated cells but in the fate of a person. Here the point of death of the different cells and organs is not so important as the certainty that the process has become irreversible by whatever techniques of resuscitation that may be employed.
4. It is essential to determine the irreversible cessation of all functions of the entire brain, including the brain stem. This determination will be based on clinical judgment supplemented if necessary by a number of diagnostic aids. However, no single technological criterion is entirely satisfactory in the present state of medicine nor can any one technological procedure be substituted for the overall judgment of the physician. If transplantation of an organ is involved, the decision that death exists should be made by two or more physicians and the physicians determining the moment of death should in no way be immediately concerned with performance of transplantation.
5. Determination of the point of death of the person makes it ethically permissible to cease attempts at resuscitation and in countries where the law permits, to remove organs from the cadaver provided that prevailing legal requirements of consent have been fulfilled.