The 4 Stages of Death Explained by a Forensic Doctor from Romania

Terms such as coma, vegetative state, and brain death are often used interchangeably, despite describing entirely different medical conditions. Marius Neagru, a forensic physician and lecturer at the Faculty of Medicine and Pharmacy in Galați, explained on Facebook the four distinct stages of death and the reasons why some patients recover whilst others do not.

"There are a few words we hear often – coma, vegetative state, brain death – and which we use as though they mean the same thing. They don't," the specialist wrote in his post.

Clinical death: a few minutes in which the brain can still be saved

This stage occurs when the heart stops beating, yet the brain can survive for a further 3–5 minutes without oxygen. During this window, cardiopulmonary resuscitation can restore blood circulation before the neurons are irreversibly damaged, with cardiac massage effectively taking over the heart's function. At low temperatures or in the case of newborns, this window may be extended. It is the only stage in which recovery through resuscitation is possible.

Vegetative state: the brainstem is functioning, but consciousness is absent

In this case, the brainstem remains active, allowing spontaneous breathing and the presence of certain reflexes; however, the patient has no consciousness – they do not track objects, do not respond to commands, and cannot communicate. Although it was previously believed that the chances of recovery disappear after a few months, research shows that up to 20% of patients may achieve minimal responses, and some even regain consciousness. Recovery is possible, but rare and limited.

Minimally conscious state: moments of lucidity, but inconsistent

Patients in this state can sometimes respond to commands, recognise people around them, or utter isolated words. Consciousness exists, but comes and goes, making it difficult to identify without specialised medical equipment. The forensic physician points out that many cases incorrectly classified as a "vegetative state" actually fall into this category. Progress is possible.

Brain death: a stage with no way back

This is the only irreversible stage of the four. All reflexes controlled by the brainstem disappear entirely, the apnoea test confirms that the patient can no longer breathe independently, and medical investigations reveal a complete absence of cerebral blood circulation. Checks are carried out repeatedly at rigorously defined intervals, and the final diagnosis must be confirmed by two consultant physicians who have no connection whatsoever with the transplant teams.