In what order do organs shut down when dying?
Your heart stops beating. Your brain stops. Other vital organs, including your kidneys and liver, stop. All your body systems powered by these organs shut down, too, so that they're no longer capable of carrying on the ongoing processes understood as, simply, living.
The first organ system to “close down” is the digestive system. Digestion is a lot of work! In the last few weeks, there is really no need to process food to build new cells. That energy needs to go elsewhere.
Decompensation progresses over a period of minutes even after the pulse is lost. Even when vascular collapse is the primary event, brain and lung functions stops next. The heart is the last organ to fail.
Active dying is the final phase of the dying process. While the pre-active stage lasts for about three weeks, the active stage of dying lasts roughly three days. By definition, actively dying patients are very close to death, and exhibit many signs and symptoms of near-death.
Physiological death occurs when the vital organs no longer function. The digestive and respiratory systems begin to shut down during the gradual process of dying.
The brain and nerve cells require a constant supply of oxygen and will die within a few minutes, once you stop breathing. The next to go will be the heart, followed by the liver, then the kidneys and pancreas, which can last for about an hour. Skin, tendons, heart valves and corneas will still be alive after a day.
- abnormal breathing and longer space between breaths (Cheyne-Stokes breathing)
- noisy breathing.
- glassy eyes.
- cold extremities.
- purple, gray, pale, or blotchy skin on knees, feet, and hands.
- weak pulse.
- changes in consciousness, sudden outbursts, unresponsiveness.
The heart may beat a few minutes after breathing stops, and a brief seizure may occur.
- Lung - 4 to 6 hours.
- Heart - 4 hours.
- Liver - 24 hours.
- Pancreas - 24 hours.
- Kidney - 72 hours.
- Cornea - 14 days.
- Bones - 5 years.
- Skin - 5 year.
Your Nose and Ears Are the Only Body Parts That Don't Stop Growing | The Healthy.
How do you know when someone is transitioning to death?
- Your loved one may sleep more and might be more difficult to awaken. Hearing and vision may decrease.
- There may be a gradual decrease in the need for food and drink. Your loved one will say he or she doesn't have an appetite or isn't hungry.
Visions and Hallucinations
Visual or auditory hallucinations are often part of the dying experience. The appearance of family members or loved ones who have died is common. These visions are considered normal. The dying may turn their focus to “another world” and talk to people or see things that others do not see.

Does everyone get pain when they are dying? No – not everyone gets pain in their last weeks, days or hours of life. Some people have no pain at all. However, we know that many people with a terminal illness do experience pain.
For some people, the dying process may last weeks; for others, it may last a few days or hours.
If the patient's experience of breathlessness does not improve, oxygen therapy should be stopped.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
Agonal breathing or agonal gasps are the last reflexes of the dying brain. They are generally viewed as a sign of death, and can happen after the heart has stopped beating.
According to a research most hospital deaths occur between 3am to 4am. This is the time in a day when the body tries to prepare for the activities of the next day while the brain tries to dispose some information to give space to the future happenings of the next day.
As the blood pools, patches appear on the skin within 30 minutes of death. About two to four hours postmortem, these patches join up, creating large dark purplish areas towards the bottom of the body and lightening the skin elsewhere. This may be less apparent on darker skin. This process is called livor mortis.
- Becoming drowsy. You'll start to feel more tired and drowsy, and have less energy. ...
- Not wanting to eat or drink. Not wanting to eat is common in people who are dying. ...
- Changes in breathing. Your breathing may become less regular. ...
- Confusion and hallucinations. ...
- Cold hands and feet. ...
- More information.
Do end of life patients sleep a lot?
People often become more drowsy and sleep more towards the end of life. This is one of many signs that a person may have when they are in their last few days and hours of life, but not everyone will experience this.
What are noisy chest secretions? In the last days of a person's life, secretions (fluid) might build up in the airways as they become too weak to cough and clear them. This causes a gurgling or rattling sound when the person breathes in and out and is sometimes called 'the death rattle'.
As the moment of death comes nearer, breathing usually slows down and becomes irregular. It might stop and then start again or there might be long pauses or stops between breaths . This is known as Cheyne-Stokes breathing. This can last for a short time or long time before breathing finally stops.
Is sudden cardiac death painful? Some people have chest pain during the initial seconds of sudden cardiac arrest. However, once you lose consciousness, you don't feel pain.
They concluded that the dying brain responds to sound tones even during an unconscious state and that hearing is the last sense to go in the dying process.
For approximately the first 3 hours after death the body will be flaccid (soft) and warm. After about 3-8 hours is starts to stiffen, and from approximately 8-36 hours it will be stiff and cold. The body becomes stiff because of a range of chemical changes in the muscle fibres after death.
Decomposition begins several minutes after death with a process called autolysis, or self-digestion. Soon after the heart stops beating, cells become deprived of oxygen, and their acidity increases as the toxic by-products of chemical reactions begin to accumulate inside them.
Currently, there is no drug or therapy that can reverse organ failure. However, organ function can recover to some degree. Doctors have discovered that some organs recover better than others. Multiple organ failure recovery can be a slow and challenging process.
The appendix may be the most commonly known useless organ.
Many years ago, the appendix may have helped people digest plants that were rich in cellulose, Gizmodo reported. While plant-eating vertebrates still rely on their appendix to help process plants, the organ is not part of the human digestive system.
Once the soft tissues have fully decomposed, all that remains is the skeleton. The skeleton and teeth are much more robust. Although they undergo a number of subtle changes after death, they can remain intact for many years.
What is the hardest organ to find?
Appendix is hardest organ to find, but 45% also can't find their own rectum.
When someone is dying, their heartbeat and blood circulation slow down. The brain and organs receive less oxygen than they need and so work less well. In the days before death, people often begin to lose control of their breathing. It's common for people to be very calm in the hours before they die.
The important findings, along with observations of long-time palliative care doctors and nurses, show: Brain activity supports that a dying patient most likely can hear. Even if awareness of sound cannot be communicated due to loss of motor responses, the value of verbal interactions is measurable and positive.
Pulse and heartbeat are irregular or hard to feel or hear. Body temperature drops. Skin on their knees, feet, and hands turns a mottled bluish-purple (often in the last 24 hours) Breathing is interrupted by gasping and slows until it stops entirely.
Hospice has a program that says that no one should have to die alone, and yet this hospice nurse is telling me to take a break? Some patients want to die when no one else is there. Hospice professionals know that companionship while dying is a personal preference.
Seriously ill patients encountered by hospice and palliative care clinicians are at risk for thirst due to dehydration, electrolyte disturbances, hypotension, xerostomia, and immobility which can impede access to water.
Considering the many variables, people may wonder how long someone can live without food in hospice. As a result of discontinuing eating, patients can die in as early as a few days. For most people, this period without food usually lasts about 10 days, but in rare instances, it can last several weeks.
Weakness, faintness or fatigue. Drowsiness or loss of consciousness. Difficulty concentrating, confusion. Loss of appetite.
The pain is caused by the overwhelming amount of stress hormones being released during the grieving process. These effectively stun the muscles they contact. Stress hormones act on the body in a similar way to broken heart syndrome. Aches and pains from grief should be temporary.
Once a patient on hospice care dies, we stay in touch with the patient's family for 13 months following the death. Because that year will include many “firsts,” on-going support is vital to help survivors on their path to healing.
How do you know when a hospice patient is transitioning?
When a patient is transitioning, they are typically bedbound due to exhaustion, weakness, and fatigue. They are less responsive and sleeping most of the time. They may sluggishly rouse when you tap them on the shoulder. They may have a more difficult time waking up.
They might close their eyes frequently or they might be half-open. Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing.
It refers to the final stages of a person's life. It is recognized by trained hospice personnel by the changes in a patient's body that signal that the patient is likely approaching death within a few hours to days.
There are no specific best practice guidelines on the use of oxygen at the end of life. The first distinction that must be made is between the use of oxygen in unconscious and conscious patients. Frequently, oxygen is continued in patients who are deeply unconscious and in their final hours of life.
Hospice doctors are concerned that the use of i.v. fluids gives confusing messages to relatives about the role of medical intervention at this stage in a patient's illness. A drip may cause a physical barrier between a patient and their loved one at this important time.
A reduction in appetite is one sign that someone may be in the last days of their life. They may no longer wish to eat or drink anything. This could be because they find the effort of eating or drinking to be too much. But it may also be because they have little or no need or desire for food or drink.
Your hospice team's goal is to help prepare you for some of the things that might occur close to the time of death of your loved one. We can never predict exactly when a terminally ill person will die. But we know when the time is getting close, by a combination of signs and symptoms.
This difficult time may be complicated by a phenomenon known as the surge before death, or terminal lucidity, which can happen days, hours, or even minutes before a person's passing. Often occurring abruptly, this period of increased energy and alertness may give families false hope that their loved ones will recover.
Due to the lack of fluid intake, urine output decreases and becomes more concentrated. Bloating, water retention and swelling can also occur. Changes in strength and awareness are other signs of death. The person may drop things or experience twitching and jerking of their hands and legs.
Once the patient reaches end stage renal disease (ESRD), death usually occurs within a few weeks. This can be longer or shorter depending on the patient's overall health, and how much kidney function they have left.
Does a person know when they are dying suddenly?
They Know They're Dying
Dying is a natural process that the body has to work at. Just as a woman in labor knows a baby is coming, a dying person may instinctively know death is near. Even if your loved one doesn't discuss their death, they most likely know it is coming.
They might close their eyes frequently or they might be half-open. Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing.
Most people with kidney failure experience pain, most often in their bones and muscles. But the pain is usually due to a complication of kidney failure. It may also be due to the type of treatment. Kidney failure occurs when your kidneys no longer function well enough to meet your body's needs.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
Transitioning is a very specific term in hospice care. It refers to the final stages of a person's life. It is recognized by trained hospice personnel by the changes in a patient's body that signal that the patient is likely approaching death within a few hours to days.
At the end of life, urine output may decrease significantly or stop altogether. These symptoms are caused by reduced fluid intake and kidney function. In some cases, a catheter may be appropriate for preventing urinary retention, obstruction and skin breakdown, which can be very uncomfortable and trigger agitation.
“First hunger and then thirst are lost. Speech is lost next, followed by vision. The last senses to go are usually hearing and touch.”
“Our data shows that a dying brain can respond to sound, even in an unconscious state, up to the last hours of life.”
References
- https://hospicecarelc.org/what-to-expect-through-the-hospice-palliative-care-experience/
- https://www.nytimes.com/2017/06/20/well/live/the-symptoms-of-dying.html
- https://www.businessinsider.com/how-human-bodies-decay-2016-11
- https://www.healthline.com/health/kidney-health/is-renal-failure-painful
- https://www.mariecurie.org.uk/help/support/terminal-illness/preparing/final-moments
- https://www.forbes.com/sites/bryanrobinson/2020/07/13/what-happens-as-were-dying-the-first-and-last-things-to-go/
- https://www.ethoslife.com/life-insurance/end-of-life-expenses/
- https://www.mariecurie.org.uk/help/support/terminal-illness/preparing/pain-when-dying
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822394/
- https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/symptom-control/oxygen-therapy
- https://www.palliativedrugs.com/download/UseofOxycodoneinPalliativeCare%5B1%5D.pdf
- https://www.rgcirc.org/blog/silent-deaths-at-night-why/
- https://guardianangelhospice.com/medical/the-last-few-days/
- https://www.ncbi.nlm.nih.gov/books/NBK568753/
- https://www.who.int/news-room/fact-sheets/detail/palliative-care
- https://www.sciencefocus.com/the-human-body/when-we-die-does-our-whole-body-die-at-the-same-time/
- https://www.futurelearn.com/info/courses/forensic-archaeology-and-anthropology/0/steps/67858
- https://kokuamau.org/the-last-stages-of-life/
- https://www.nursechoice.com/blog/news/explaining-the-death-surge-to-patient-families/
- https://www.crossroadshospice.com/hospice-resources/end-of-life-signs/terminal-restlessness/
- https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/symptom-control/noisy-secretions
- https://theconversation.com/the-human-body-never-truly-disappears-finding-the-remnants-of-a-tragic-end-can-help-us-uncover-atrocities-122817
- https://www.bethcavenaugh.com/blog/end-of-life-signs-how-to-tell-when-a-hospice-patient-is-close-to-the-moment-of-death
- https://www.pharmacytimes.com/view/what-drugs-are-used-in-end-of-life-care
- https://hospicefoundation.org/Hospice-Care/Signs-of-Approaching-Death
- https://www.cqc.org.uk/guidance-providers/adult-social-care/end-life-care-planning-medicines-optimisation
- https://www.bbc.com/future/article/20150508-what-happens-after-we-die
- https://www.mypcnow.org/fast-fact/thirst-in-palliative-care/
- https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/symptom-control/anticipatory-medicines
- https://en.wikipedia.org/wiki/Brompton_cocktail
- https://my.clevelandclinic.org/health/diseases/17522-sudden-cardiac-death-sudden-cardiac-arrest
- https://www.newsweek.com/hospital-nurse-reveals-hardest-thing-witness-dying-patients-julie-mcfadden-tiktok-1687248
- http://www.ozemedicine.com/wiki/doku.php?id=sedation_rapid
- https://www.nia.nih.gov/health/providing-comfort-end-life
- https://www.pharmacytimes.com/view/medication-for-aggression-what-works-and-where
- https://www.jems.com/patient-care/death-with-dignity-when-the-medical-aid-in-dying-cocktail-gets-into-the-wrong-hands/
- https://www.alzheimers.org.uk/sites/default/files/pdf/factsheet_end-of-life_care.pdf
- https://hospice.org/steroids-in-hospice-care/
- https://pubmed.ncbi.nlm.nih.gov/19227708/
- https://www.businessinsider.com/human-useless-body-parts-2019-1
- https://www.healthline.com/health/elderly-end-of-life-symptoms
- https://www.hhhc.org/caregiver-resources/caring-for-the-bedbound-patient/
- https://www.theatlantic.com/health/archive/2016/09/what-it-feels-like-to-die/499319/
- https://courses.lumenlearning.com/wm-lifespandevelopment/chapter/the-process-of-dying/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006107/
- https://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/For+Professionals/For+Professionals/Quick+Consults/Symptoms/Does+oxygen+usage+prolong+life+or+is+it+for+comfort+care_.aspx
- https://www.crossroadshospice.com/hospice-palliative-care-blog/2018/september/27/how-to-use-your-hospice-comfort-kit/
- https://www.pallimed.org/2016/03/time-of-death-some-patients-prefer-to.html
- https://deathwithdignity.org/resources/options-to-hasten-death/
- https://www.ncbi.nlm.nih.gov/books/NBK470545/
- https://www.nhs.uk/conditions/end-of-life-care/withdrawing-treatment/
- https://www.thehealthy.com/ear-nose-throat/body-parts-dont-stop-growing/
- https://www.crossroadshospice.com/hospice-resources/end-of-life-signs/kidney-failure/
- https://www.diffordsguide.com/cocktails/recipe/3769/elixir-de-longue-vie-elixir-of-long-life
- https://oasishospice.us/does-hospice-give-iv-fluids/
- https://www.vitas.com/family-and-caregiver-support/what-to-expect-from-hospice/when-a-hospice-patient-stops-eating-or-drinking
- https://www.healthdirect.gov.au/the-physical-process-of-dying
- https://www.merckmanuals.com/home/fundamentals/death-and-dying/when-death-is-near
- https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=34&contentid=23507-1
- https://www.donatelife.org.in/time-of-organ-donation
- https://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/Support/Support/Asked+and+Answered/Medications/Does+morphine+make+death+come+sooner_.aspx
- https://www.verywellhealth.com/my-loved-one-is-dying-do-i-have-to-tell-him-1132508
- https://lenitylighthospice.com/2021/06/13/what-does-transitioning-mean/
- https://www.verywellhealth.com/what-is-the-hospice-comfort-kit-1132481
- https://www.vitas.com/for-healthcare-professionals/making-the-rounds/2020/march/signs-of-active-dying
- https://www.nhs.uk/conditions/end-of-life-care/what-it-involves-and-when-it-starts/
- https://victoriahospice.org/wp-content/uploads/2019/07/food_and_fluids_brochure_2017.pdf
- https://hearttohearthospice.com/can-a-dying-person-still-hear/
- https://www.webmd.com/palliative-care/journeys-end-active-dying
- https://resources.amedisys.com/treating-terminal-agitation
- https://www.nhs.uk/conditions/end-of-life-care/changes-in-the-last-hours-and-days/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065504/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712906/
- https://www.helpguide.org/articles/end-of-life/late-stage-and-end-of-life-care.htm
- https://www.abc.net.au/news/health/2017-05-26/what-to-expect-when-someone-is-dying/8550490
- https://www.nhsinform.scot/care-support-and-rights/palliative-care/preparing-for-death-and-bereavement/body-changes-at-the-end-of-life
- https://www.hospiceuk.org/information-and-support/death-and-dying-what-expect/last-moments
- https://www.crossroadshospice.com/hospice-resources/hospice-caregiver-support/common-hospice-medications/
- https://parentishealth.com/what-is-terminal-restlessness/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913952/
- https://www.crossroadshospice.com/hospice-resources/education-for-families/what-in-the-world-is-dexamethasone/
- https://my.clevelandclinic.org/health/diseases/24679-organ-failure
- https://www.liebertpub.com/doi/10.1089/jpm.2012.0205
- https://hospiceofcincinnati.org/terminal-agitation-training-sheet/
- http://burnabyhospice.org/the-dying-process-final-hours/
- https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care
- https://www.walesonline.co.uk/news/health/appendix-hardest-organ-find-45-26016062
- https://pubmed.ncbi.nlm.nih.gov/7582178/
- https://en.wikipedia.org/wiki/Palliative_sedation
- https://pubmed.ncbi.nlm.nih.gov/32215374/
- https://www.goodtherapy.org/blog/when-loss-hurts-6-physical-effects-of-grief-0520187
- https://pubmed.ncbi.nlm.nih.gov/25188966/
- https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/symptom-control/sleep-issues
- https://www.crossroadshospice.com/hospice-palliative-care-blog/2022/september/07/end-of-life-rally-how-to-make-the-most-of-it/
- https://www.kindredhospitals.com/our-services/ltac/conditions/multiple-organ-system-failure
- https://www.aafp.org/pubs/afp/issues/2000/0201/p755.html
- https://www.agingcare.com/articles/end-of-life-care-signs-that-death-is-near-443741.htm
- https://samaritannj.org/hospice-blog-and-events/hospice-palliative-care-blog/common-hospice-medications/
- https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/symptom-control/agitation
- https://palliativedoctors.org/palliative/doctor
- https://www.crossroadshospice.com/hospice-resources/end-of-life-signs/what-is-active-dying/
- https://samaritannj.org/hospice-blog-and-events/hospice-palliative-care-blog/end-life-signs-changes-expect-end-life/