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# Brain death: the ethical and legal criteria in Colombia

- Topic

Brain death is the irreversible loss of brainstem function; in Colombia it is the death of the person.

Updated Nov 5, 2026

## Key points

- Decree 2493 of 2004, art. 2: brain death = irreversible absence of brainstem function, confirmed by clinical examination.
- Diagnosis: two or more doctors who are not interdependent and not part of the transplant programme; at least one a neurologist.
- Seven signs: no spontaneous breathing, persistently dilated pupils, no pupillary light, corneal, oculovestibular, gag or cough reflex.
- Reversible causes are excluded first: toxins, metabolic disturbances, nervous-system depressants and muscle relaxants, and hypothermia.
- The death certificate is not signed by a doctor from the transplant programme.

## What it is

Brain death is the irreversible absence of brainstem function, confirmed by clinical examination. Even if the heart keeps beating with support, the person is dead. In Colombia it is defined and regulated by Decree 2493 of 2004: it requires two doctors independent of the transplant programme, one of them a neurologist, and seven clinical signs. Keeping the diagnosis of death separate from the transplant team protects public trust in donation.

## Key facts

- Art. 12: if any sign cannot be confirmed, a confirmatory test is applied.
- Art. 13: keeping life support after the diagnosis does not invalidate brain death.
- Art. 14: in children under 2, observation periods and repeated examinations by age are also required; from age 2 the adult criteria apply.
- Law 1805 of 2016, art. 8: level II providers with an ICU and level III and IV providers must be able to diagnose brain death and maintain the donor.
- Brain death is not a vegetative state: in the latter the brainstem works and the person breathes on their own.

## Diagnosing brain death under Decree 2493 of 2004

| Aspect | Adults and children over 2 (art. 12) | Children under 2 (art. 14) |
| --- | --- | --- |
| Who diagnoses | Two or more non-interdependent doctors outside the transplant programme; at least one a neurologist | At least two members of the care team |
| Prerequisite | Exclude toxins, reversible metabolic disturbances, nervous-system depressants and hypothermia | Irreversible coma of known cause and a destructive lesion of the central nervous system |
| Findings | Seven clinical signs of absent brainstem function | Absent brainstem reflexes and repeated examinations |
| Observation | A confirmatory test if a sign cannot be confirmed | Observation periods by age; cerebral blood flow tests may shorten them |

## In clinical practice

- Say «death», not «brain death» as if it were something different: the family needs to know the person has died.
- Explain to the family that the support maintains the organs, not the person's life.
- The diagnosis is recorded with the date, time and result of each sign in the medical record.

## Legal framework in Colombia

- Decree 2493 of 2004 (4 August 2004): partly regulates Laws 9 of 1979 and 73 of 1988 on anatomical components; it amended Decree 1546 of 1998. According to the Gestor Normativo, it was not compiled into Decree 780 of 2016 and remains in force.
- Law 1805 of 2016 widened presumed donation and required diagnostic capacity in providers with an ICU (art. 8).
- The World Medical Association (Declaration of Sydney) asks that death be confirmed by a doctor not involved in the transplant.

## Test yourself

Think of the answer, then tap the question to see it.

## How does Decree 2493 of 2004 define brain death?

As the irreversible absence of brainstem function, confirmed by clinical examination.

## Who must diagnose brain death in an adult in Colombia?

Two or more doctors who are not interdependent and not part of the transplant programme; at least one must be a neurologist.

## Which conditions must be excluded before diagnosing brain death?

Toxic and reversible metabolic disturbances, the effect of nervous-system depressant drugs or muscle relaxants, and hypothermia.

## May a doctor from the transplant team sign the donor's death certificate?

No. Decree 2493 of 2004 forbids it; a treating doctor or a forensic doctor signs it.

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## Connections

## Related 3

- [Ley 1805 de 2016: presumed consent for organ donation](https://durgical.com/en/medical-ethics/ley-1805-de-2016-presumed-consent-for-organ-donation/)
- [Breaking bad news: the SPIKES protocol](https://durgical.com/en/medical-ethics/breaking-bad-news-the-spikes-protocol/)
- [Limiting life-sustaining treatment: withholding and withdrawing](https://durgical.com/en/medical-ethics/limiting-life-sustaining-treatment-withholding-and-withdrawing/)

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Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.

Sources: [Decreto 2493 de 2004](https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=14525) (Función Pública, Gestor Normativo, 2004); [WMA Declaration of Sydney on the Determination of Death and the Recovery of Organs](https://www.wma.net/policies-post/wma-declaration-of-sydney-on-the-determination-of-death-and-the-recovery-of-organs/) (World Medical Association, 2016); [Ley 1805 de 2016](https://www.secretariasenado.gov.co/senado/basedoc/ley_1805_2016.html) (Secretaría General del Senado, 2016).

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Source: https://durgical.com/en/medical-ethics/brain-death-the-ethical-and-legal-criteria-in-colombia/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/medical-ethics/brain-death-the-ethical-and-legal-criteria-in-colombia/