MEDICO LEGAL ASPECTS OF DEATH AND TRANSPLANTATION OF ORGANS

The Medico legal study of death comes within in the purview of Forensic thanatology (Thanatos= death; logos=science) Death occurs in two stages viz;(1) somatic, systemic, or clinical (2) cellular or molecular. The term death as commonly employed means somatic death. It is due to complete and irreversible cessation of the vital functions of the brain, heart and lungs. In somatic death, though life ceases in the body as whole, it persists in its component parts viz, the tissues and cells, which respond to chemical, thermal or electrical stimuli. It signifies loss of life in the component parts of the body, and it is accompanied by cooling, and changes in the eye, skin, muscles etc.Molecular death is generally complete within three to four hours of somatic death. Testing the response of skeletal muscles to electrical stimuli easily establishes if molecular death has set in or not.
Diagnosis of somatic or clinical death is not always easy in the following conditions;(1) soon after the death when the body is likely to be warm (2)suspended animation (3) coma following excessive doses of sedatives or hypnotics especially barbiturates, and (4) hypothermia particularly in the old.
The distinction between somatic and molecular death is importantly for two reasons ( 1) Disposal of the body; In rare instances, when the body cremated soon after somatic death, spontaneous movements of the hands and feet may occur on the funeral pyre and may give rise to the apprehension that the person was not actually dead but was prematurely disposed of, and (2) Transplantation; The visibility of transplantable organs falls sharply after somatic death- a liver must be taken within fifteen minutes, a kidney within forty five minutes, and a heart within a hour.
A person whose brain may have been irreversibly injured can now be kept alive by maintaining the circulation of oxygenated blood to the brain stem by artificial means.
There is no legal definition of death. For the purpose of transplantation, it is necessary to remove organs in as fresh a condition as possible. Therefore, it is desirable to remove organs when the process leading to death has become irreversible. When there is irreversible damage to the brain as shown by a flat ECG tracing for five minutes, the probability that useful brain function will be re-established is most unlikely and the person can be legally presumed to be dead. At this stage there can be no objection to the removal and preservation of organs for transplantation purposes.