Code of Practice for the Diagnosis and Confirmation of Death
The Academy of Medical Royal College has published an update to its 2008 Code of Practice for the Diagnosis and Confirmation of Death. The updated version is available on the Academy of Medical Royal Colleges' website.
The change over to the updated 2025 Code occurred on 1 January 2025.
2025 Update
The 2025 update from the Academy accounts for advances in medical practice and technologies, particularly in the fields of resuscitation, intensive care, neurosurgery and organ donation.
Additionally, the 2025 Code incorporates lessons learnt from individual clinical cases in both adult and paediatric practice in the UK and internationally. For this reason the eight 'red flag' patient groups, which were present on the endorsed testing forms, but not in the 2008 Code, have now been fully incorporated and described in more detail in the 2025 Code.
The Academy is very clear that the updated 2025 Code does not represent any alteration in the validity of historic diagnoses of death. It is entirely best medical practice to update a 17-year-old Code of Practice.
Of benefit, the update aligns the UK, where possible, to the growing world-wide medical consensus in diagnosing death. The update was particularly influenced by:
- The 2020 work of the World Brain Death Project.
- The 2021 Australian and New Zealand Intensive Care Society's Statement on Death and Organ Donation.
- The multiple evidence-based publications in the 2023 Canadian Journal of Anesthesia Special Issue: Defining and Determining Death in Canada.
- The 2023 Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline from the American Academy of Neurology and the American Academy of Pediatrics.
Finally the 2025 Code incorporates updated guidance from the Royal College of Paediatrics and Child Health (RCPCH) which supersedes their 2015 recommendations for the Diagnosis of death by neurological criteria in infants less than two months old, and their 1991 report for children older than two months, Diagnosis of brain-stem death in infants and children: a working party report of the British Paediatric Association (which was reproduced in the 2008 Code, Appendix 4). This means that the 2025 Code will be applicable for all ages.
It’s the diagnosis of death documents we want to direct people to, which is further down on the Faculty’s webpage.
Forms and guidance for intensivists have been developed jointly by and is endorsed by Faculty of Intensive Care Medicine, Intensive Care Society, Northern Ireland Intensive Care Society, Scottish Intensive Care Society, Welsh Intensive Care Society, Neuro Anaesthesia & Critical Care Society and Paediatric Critical Care Society. They are are available from the FICM website.
