MP Ssegirinya: When heart beats, but the brain is dead

“According to the doctors, Hon Ssegirinya Muhammad is brain dead, most of his organs have shut down but he is not yet declared dead. When the mother was told that, she immediately announced his passing,” he posted again on X (formerly Twitter) at 10.09am in an update.

Before Mr Kyagulanyi’s post, the Speaker of Parliament while leading the Parliament session told MPs at 10.02am that the Kawempe North MP had not been pronounced dead but that he was “in a critical condition”.

Ms Among told MPs that upon consulting doctors at Lubaga Hospital where Ssegirinya was admitted, it was established that his“organs had collapsed but his heart is still on, so ethically they cannot pronounce him dead.”

At around the same time, the facility’s medical director, Dr Grace Nanyondo, told journalists that Ssegirinya was “critically sick” and that he “needs our prayers”. 

However, these updates attracted mixed reactions from Ugandans, with some using social media to convey their prayers for a miracle while others held that brain death is irreversible.

But could the doctors have saved him at this point?

In an interview before the hospital confirmed the death, Dr Joel Mirembe, the secretary general of the Uganda Medical Association, acknowledged that the available information was confusing.

“Being critically ill doesn't mean brain death; you can be critically ill and you recover completely, you can go back to your normal life where you were even later,” Dr Mirembe explained.

"But when your brain is dead, you cannot wake up from a coma.” Dr Mirembe also explained that one
can be brain dead when their heart and kidneys are functioning.

“For it to be confirmed that the brain is dead, three categories of doctors examine you and they are from different departments. If their examinations match, then you are confirmed as brain is dead.

At that point, your heart can still be beating, but the issue is that the centre coordinator is not available,” he explained further.

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Dr Mirembe also noted that this beating heart can only be sustained when one is on a life support machine (breathing aid) “until when your family takes it in that actually you can't come back”.

“When your family agrees, they remove you from the machine and then the other organs also shut down slowly by slowly and you are taken for burial,” he added.

The Lubaga Hospital management later in the afternoon issued a statement, confirming the death of the 36-year-old legislator.

"Hon Ssegirinya has been under the dedicated care of our medical team at Lubaga Hospital. Despite all efforts to ensure his recovery, he passed away today, Thursday, January 9, 2025, at 12:10 pm,” the statement reads.

“On behalf of the hospital, we extend our heartfelt condolences to the Parliament of Uganda, the Speaker, the Deputy Speaker, Hon Members of Parliament, his family, and the people of Kawempe North, whom he represented with passion and commitment,” the management adds.

Ssegirinya has largely spent his days in hospitals since his release from prison where he and his Makindye West counterpart, Allan Ssewanyana, spent more than 500 days on remand after they were arrested over alleged connection to machete attacks in the Greater Masaka Sub-region, which left 20 people dead.

He sought treatment at different hospitals in Uganda, Kenya and the Netherlands.

Although there have been rumours that he was poisoned, the available report indicates that his travel abroad for treatment was approved by Parliament after tests found that he had lung diseases which couldn’t be treated in Uganda.

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Last September, when his condition improved a bit, the optimistic legislator, commonly known as Mr Update, told journalists that he was “battling lung diseases, hypertension, skin cancer, among
others.”

Commenting about the confusion, Dr Erasmus Okello, an intensive care specialist and a lecturer at Makerere University, acknowledged in another interview that death is a reality that people always find hard to accept.

“When we mention death, of course, it’s a scary thing, so people always look for something that gives them hope. And so that's usually the source of the confusion, because death is such a fearsome thing that people don't want to confront it, to accept it, and we try to look for explanations that can heal,” he observed

How does death happen?
Dr Okello described death as an irreversible cessation of life.

“In other words, there is no more life. Life is an organism that is able to exist, is able to breathe, is able to recognise the environment, be able to reproduce, be able to do all the basic things that a living animal does,” he explained.

“Irreversible cessation of life means that you no longer have the most vital functions of the body. Our body organs are organised in a complex way, but the most important organ in all our bodies is called the brain and all organs in the body are controlled by the brain one way or another,” he added.

The intensivist said the brain is served by all organs in one way or another. 

“This means that when one organ in the body is sick, one way or another, the brain might suffer. That's why when you have, an injury in your toe, your brain recognises it. And so, you're having restlessness, confusion, among other emotions, all that affects the brain because your toe is sick. Similarly, when your
brain is disturbed, you know, you can have problems, your heartbeat, your breathing and so on,” he said.

“Now, there is a part of your brain called the brainstem. It's at the back of the head –the medulla oblongata and then the pons. Those two areas contain what you call the life centre, the centre which controls breathing, wakefulness, appetite for food, temperature, and heartbeat,” he added.

Dr Okello said in medicine, it is known that all organs function to keep the brain alive.

"So, if the brainstem is irreversibly damaged, directly by injury to it or indirectly by an injury to another organ, that secondary affects the brain, in medicine, it means life is gone because, unlike other
organs you can revive, you cannot revive the brain,” the intensivist explained.

“You can transplant other organs, but you cannot transplant the brainstem. So, basically, say somebody gets involved in an accident and they get a major injury because of brain swelling, they can be revived until a point where the swelling affects the brainstem irreversibly. Once the brainstem is irreversibly affected, all the other organs might function fine. But as long as the brainstem is gone,the person is declared clinically brain dead,” he added.

When does resuscitation work? 

Dr Okello explained that there is also cardiocirculatory death when there is ir-
reversible cessation of heartbeat.

“What is called a cardiac arrest is where the heartbeat stops. So, if it's recognised in time and the body has been quite healthy, a person might be resuscitated, and the heart can be restarted. And if it restarts on time, when other organs are still safe, then you can reverse that. So, that's why in medicine we are not very firm on this, on describing death by the cessation of the heartbeat, because a person who gets a cardiac arrest might still be revived if they are got on time,” he said.

However, in resuscitation, the revived person may die after a short time if the brain is irreversibly affected.

“If a person's heart stops and we start doing CPR (cardiopulmonary resuscitation), that intervention to restart the heart, we start counting time from the time it started. And if several minutes elapse, we assume that there has been inadequate blood flow to the brainstem.

And at that point it's irreversibly damaged, meaning that even if the heart re-started 30 minutes later, it might be too late already,” he said.

“So, many times we stop CPR within about 15 to 20 minutes for most people. And many people who get revived several minutes later, generally even if the heart restarts, the brain is irreversibly
damaged and within a few days you will hear that the person has been declared dead.That is because all organs, especially the heart, function to serve the brain,” he added.

Every heartbeat is meant to push blood with oxygen to the brain to keep the brainstem alive. “That is why you can sense that you skipped a heartbeat.

There are those times when you feel like you've skipped a heartbeat. Your brain recognises immediately because for that one missed heartbeat, the brain lacked oxygen,” Dr Okello further revealed.

What causes brain death?

“Now, our brain can only survive for about four minutes from the time you cut off blood supply. So, that means when your heart stops or when someone blocks your breathing and stops you from breathing or suffocate, you've got about four minutes within which to restore good blood flow to the brain otherwise, there will be total brain damage,” Dr Okello explained.

“So, the key thing is that death medically means irreversible damage to the brainstem. It might happen primarily due to brain-related problems when other organs are still functioning, for example, in the case of trauma, in the case of suffocation, in the case of toxins, infections of the brain, cancer of the brain, or it can be secondary due to failure of other organs,” he added.

Dr Okello said when the heart fails, or one gets a cardiac arrest that prolonged lack of blood supply to the brain can lead to reversal brain damage.

“When your liver fails, the brain can swell and end up damaging your brainstem, even if the heart, the lungs, the kidneys are still okay. When your kidneys fail, they can cause swelling in the brain, which can affect the brain even if even if the heart is still okay,” he said.

“So, brain death basically is that condition where there's irreversible damage, particularly the brainstem. And the person will never be able to wake up, will never be able to breathe, they will never come back,” he added.

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