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 / Updated By Maggie Fox 
 
 Pneumonia, a blood clot, kidney failure or sepsis could have killed Otto Warmbier, but he almost certainly never had a chance of recovering, neurologists said Monday. 
 
 Warmbier’s family said he died Monday afternoon, just days after he was returned unconscious and unresponsive from North Korea. 
 
 American student Otto Warmbier, center, is escorted at the Supreme Court in Pyongyang, North Korea on March 16, 2016. Jon Chol Jin / AP 
 
 North Korean officials said he had been in a coma for more than a year — right after he was sentenced to 15 years of hard labor in prison for allegedly having taken a propaganda poster off a wall. North Korean authorities said the strapping, 21-year-old college student had taken a sleeping pill after he fought a bout of botulism. 
 
 Doctors who examined Warmbier said they found no evidence of botulism, a kind of food poisoning that can be deadly but that usually does not cause brain damage. Warmbier’s father Fred said he didn’t believe that’s what happened to his son. 
 
 Related: Otto Warmbier Dies Days After His Return from North Korea 
 
 What doctors at the University of Cincinnati hospital did find was extensive brain damage that looked like it could have been caused by a long period of oxygen deprivation – the kind caused when something stops someone’s heart. 
 
 “Why would you die suddenly after 15 months in a persistent vegetative state?” 
 
 "His neurological condition can be best described as a state of unresponsive wakefulness," Dr. Daniel Kanter, director of the hospital’s neurocritical care program, told a news conference last week. 
 
 There’s not much hope for someone after that, neurologists agreed. 
 
 “If they are in that state from a lack of oxygen to the brain ... and it has been more than three months ... the chance of anyone having a meaningful recovery — I don’t know if any of us have ever seen it happen,” said Dr. Lori Shutter, professor of critical care medicine, neurology and neurosurgery at the University of Pittsburgh Medical Center. 
 
 Related: Three Americans Still Held by North Korea 
 
 A "state of unresponsive wakefulness" is the more modern way of describing a persistent vegetative state — when the brain stem keeps people breathing, waking and sleeping, but there’s no conscious brain function, Shutter said. 
 
 “Patients who are in a persistent vegetative state after a cardiac arrest have a very low rate of recovery,” added Dr. Andrew Naidech, neurocritical care physician at Northwestern Memorial Hospital in Chicago. 
 
 Warmbier’s quick death suggested something happened to change his apparently stable condition, Naidech and Shutter agreed, although his doctors in Cincinnati said Thursday he showed no signs of any infection when he arrived. 
 
 Doctors also agreed it was unlikely his family decided to withhold food and water — a perfectly valid decision for someone with such a poor prognosis, but they said it takes patients more than just a few days to die from dehydration. 
 
 “The fact that he died so quickly suggests he was getting some sort of medical treatment that could be withheld,” Naidech told NBC News. 
 
 “If this young man was in this state for an extended time period, once the family heard everything, they may have started to focus on quality of life,” Shutter speculated. 
 
 “Patients who are in a persistent vegetative state after a cardiac arrest have a very low rate of recovery." 
 
 If he developed pneumonia, a urinary tract infection or a bloodstream infection, the family may have decided to withhold antibiotics. Pneumonia is possible because people in unwakeful states can easily aspirate saliva into the lungs, where it can cause infection. Urinary infections can be caused by prolonged use of a catheter, and they can become serious. 
 
 Related: Warmbier Has Extensive Brain Damage 
 
 “They may have felt that this quality of life would not be of the type that they would feel Otto would have wanted,” Shutter said. “They may have ‘let’s make him comfortable’.” 
 
 But Dr. Daniel Laskowitz, a professor of neurology at Duke University, said something sudden could have happened — such as a pulmonary embolism. 
 
 “Why would you die suddenly after 15 months in a persistent vegetative state?” Laskowitz asked. There are usually two reasons why you pass away in that setting. One is infection,” he said. 
 
 The second would be a blood clot. 
 
 “If you are in a persistent vegetative state and you are just immobile for a prolonged period of time, you have a propensity to form a clot,” he said. “That can be catastrophic and precipitous.” 
 
 The long flight from North Korea to Ohio could have made a blood clot even more likely to form or break off and travel to the lungs, Laskowitz said. 
 
 No matter what it was, Warmbier’s state almost certainly resulted from poor care in North Korea, Laskowitz said. He said it’s somewhat feasible that Warmbier could have suffered from botulism and that if he was given a sleeping pill while already paralyzed from the botulinum toxin, that could have caused him to stop breathing and his heart to stop, leading to brain damage. 
 
 Shutter, who trained several members of Warmbier’s medical team when she was at the Cincinnati medical center, said he would have been given the best care possible at the Ohio facility. 
 
 “I do feel for this family,” she said. “But I do feel they had one of the best teams in the country to help them with that.” ||||| news 
 
 Warmbier had been detained in North Korea for 17 months, and he was released less than a week before he passed away. 
 
 Former University student Otto Warmbier, who was detained in North Korea for over a year, died Monday afternoon at 2:20 p.m. surrounded by family. 
 
 After 17 months of imprisonment in North Korea, Warmbier was released from the isolated country last Tuesday — but returned to the United States in a state of “unresponsive wakefulness.” Doctors said he had suffered a severe loss of brain tissue. 
 
 His parents, Fred and Cindy Warmbier. released a statement to the Washington Post Monday thanking the University of Cincinnati Medical Center for doing everything they could to help their son while recognizing the “awful torturous mistreatment” he received in North Korea. 
 
 “When Otto returned to Cincinnati late on June 13, he was unable to speak, unable to see and unable to react to verbal commands. He looked very uncomfortable — almost anguished,” the statement read. “Although we would never hear his voice again, within a day the countenance of his face changed — he was at peace. He was home and we believe he could sense that.” 
 
 Warmbier was detained in North Korea in January 2016 and was accused of attempting to steal a political banner from the Yanggakdo International Hotel in Pyongyang. In March of the same year he was sentenced to 15 years of hard labor. 
 
 At the University, Warmbier was a member of the Theta Chi Fraternity and an Echols Scholar. A Commerce student at the time of his imprisonment, Warmbier would have graduated this past spring. Graduates noted his absence with #FreeOtto stickers at Final Exercises in May. 
 
 “It would be easy at a moment like this to focus on all that we lost — future time that won’t be spent with a warm, engaging, brilliant young man whose curiosity and enthusiasm for life knew no bounds. But we choose to focus on the time we were given to be with this remarkable person,” his parents said in the statement. 
 
 University President Teresa Sullivan expressed her condolences in a statement Monday afternoon. 
 
 “It is with great sadness that we learned of Otto’s passing this afternoon,” Sullivan said. “Our thoughts and prayers continue to be with his family and friends during what has been an incredibly difficult time. He will be missed by all those who knew and loved him.” 
 
 President Donald Trump also released a statement expressing his condolences to Warmbier’s family and friends. He condemned North Korea in his statement. 
 
 “Otto’s fate deepens my Administration’s determination to prevent such tragedy from befalling innocent people at the hands of regimes that do not respect the rule of law or basic human decency,” Trump said in a statement. “The United States once again condemns the brutality of the North Korean regime as we mourn its latest victim.” 
 
 Governor Terry McAuliffe tweeted his condolences Monday afternoon. 
 
 Our hearts go out to the Warmbier family, the @UVA community, and all the people whose lives Otto touched. He was taken too soon. https://t.co/cOv0OgiaIs — Terry McAuliffe (@GovernorVA) June 19, 2017 
 
 The Korean Student Union posted a statement on Facebook Monday evening expressing its condolences and offering support to the University community. 
 
 "This is a situation that greatly saddens us and forces many of us to remember the lasting effects that North Korea and its regime has had on our friends and our families," the statement read. "The division between North and South Korea has separated loved ones for centuries and forced many innocent people to succumb to communist rule. It is important to recognize and reflect on how our beliefs and our choices have come to perpetuate this same regime and that there are still people experiencing, daily, similar unimaginable levels of brutality that Otto did." 
 
 Student Council also issued a response and will hold a vigil Tuesday, June 20, at 9 p.m. at the Rotunda. 
 
 "The thoughts and prayers of the University of Virginia Student Body are with the Warmbier family and all those who loved Otto," the statement read. ||||| South Korean President Moon Jae-in said North Korea has “heavy responsibility” in the death of U.S. student Otto Warmbier. 
 
 South Korea’s new president partially blamed North Korea for Warmbier’s death in an interview with CBS This Morning on Tuesday. The 22-year-old American student arrived home in Cincinnati in a coma last week after being detained in North Korea for more than a year. 
 
 “This had happened while Mr. Warmbier was in the detention of North Korean authorities,” Moon said. “We cannot know for sure that North Korea killed Mr. Warmbier. But I believe it is quite clear that they have a heavy responsibility in the process that led to Mr. Warmbier’s death.” 
 
 Moon did not go as far as some U.S. politicians who said Kim Jong Un’s regime murdered Warmbier, but he strongly condemned the “unjust and cruel treatments to Mr. Warmbier.” 
 
 “Even today, there are many Korean nationals and American citizens who are detained in North Korea,” he said. “I also urge North Korea to return these people to their families.” 
 
 Warmbier’s family announced his death on Tuesday — a week after he was released. Doctors in Cincinnati said he had “severe injury to all regions of the brain” and was in a state of “unresponsive wakefulness.” 
 
 Before returning to the U.S., Warmbier had been serving a 15-year long prison sentence with hard labor for allegedly trying to steal a propaganda poster from Pyongyang while visiting North Korea on an organized tour. North Korean officials declared it a “hostile act.” 
 
 President Donald Trump, Vice President Mike Pence and a number of other U.S. politicians have condemned North Korea in response to Warmbier’s death. 
 
 “Otto’s fate deepens my Administration’s determination to prevent such tragedies from befalling innocent people at the hands of regimes that do not respect the rule of law or basic human decency,” Trump said in a statement Tuesday. “The United States once again condemns the brutality of the North Korean regime as we mourn its latest victim.” ||||| (Reuters) - An Ohio coroner, abiding by family wishes, has performed an external examination instead of a full autopsy on the body of the U.S. student who was held prisoner in North Korea for 17 months and sent home in a coma, the agency said on Tuesday. 
 
 The Hamilton County Coroner’s Office was still conferring on Tuesday with doctors at a Cincinnati hospital who were treating Otto Warmbier, 22, before reaching any conclusions about his death a day earlier, investigator Daryl Zornes said. 
 
 Investigators also were continuing to review radiological images and awaiting additional medical records requested by the coroner, Zornes told Reuters. 
 
 He declined to estimate how long it would take for the coroner’s office to complete its inquiry. Preliminary autopsy findings had been expected later on Tuesday or on Wednesday. 
 
 There was no immediate word from the family about why relatives declined an autopsy, which may have shed more light on the cause of the neurological injuries that left him in a coma. 
 
 Warmbier’s death came just days after he was released by the North Korean government and returned to the United States suffering from what U.S. doctors described as extensive brain damage. 
 
 Warmbier, an Ohio native and student at the University of Virginia, was arrested in North Korea in January 2016 while visiting as a tourist. He was sentenced two months later to 15 years of hard labor for trying to steal an item bearing a propaganda slogan from his hotel in North Korea’s capital, Pyongyang, the nation’s state media said. 
 
 The circumstances of his detention and what medical treatment he received in North Korea remain unknown. The United States has demanded North Korea release three other U.S. citizens it holds in detention: missionary Kim Dong Chul and academics Tony Kim and Kim Hak Song. (Graphic of Americans held by North Korea: tmsnrt.rs/2pmE3ks) 
 
 Warmbier’s death has only heightened U.S.-North Korean tensions aggravated by dozens of North Korean missile launches and two nuclear bomb tests since last year in defiance of U.N. Security Council resolutions. The North Korean government has vowed to develop a nuclear-tipped intercontinental missile capable of hitting the U.S. mainland. 
 
 Warmbier’s family has not specified how he slipped from a comatose state to death, but said in a statement on Monday that the “awful torturous mistreatment” he endured while in captivity meant “no other outcome was possible.” 
 
 Relatives have said they were told by U.S. envoys that North Korean officials claimed Warmbier contracted botulism after his trial and lapsed into a coma after taking a sleeping pill. Fred Warmbier, the student’s father, has said he disbelieves this account. 
 
 North Korea’s government said it released Warmbier last week on “humanitarian grounds.” 
 
 U.S. President Donald Trump said on Tuesday he had spoken with Warmbier’s family and praised them as “incredible.” 
 
 “It’s a total disgrace what happened to Otto,” Trump told reporters in the White House, where he was meeting with Ukrainian President Petro Poroshenko. “And frankly, if he were brought home sooner, I think the results would have been a lot different.” 
 
 FILE PHOTO - Otto Frederick Warmbier, a University of Virginia student who has been detained in North Korea since early January, attends a news conference in Pyongyang, North Korea, in this photo released by Kyodo February 29, 2016. Mandatory credit REUTERS/Kyodo/File Photo 
 
 White House press secretary Sean Spicer said the administration would “continue to apply economic and political pressure” on North Korea, in conjunction with U.S. allies and China, “to change this behavior and this regime.” 
 
 Trump said on Twitter on Tuesday he appreciated efforts by Chinese President Xi Jinping “to help with North Korea,” adding “It has not worked out. At least I know China tried!” 
 
 The government of China, North Korea’s main ally, said Warmbier’s death was a tragedy. ||||| SEOUL, South Korea — When a senior United States official visits North Korea, it is usually taken as a sign that tensions between the adversaries are easing somewhat. That is particularly true when the official brings home a newly freed American captive. 
 
 But the trip made last week by Joseph Y. Yun, the top United States envoy on North Korea, was starkly different. The American prisoner he brought home, Otto Warmbier, had been in a coma for most of the 17 months he spent incarcerated in the North. On Monday, Mr. Warmbier, a 22-year-old college student, died at a hospital in Cincinnati, where his parents blamed Pyongyang’s “awful, torturous mistreatment” of their son. 
 
 Analysts said anger over Mr. Warmbier’s death would dim, if not scuttle, any prospect of a less antagonistic relationship in the near future between Washington and Pyongyang, which is still holding three other Americans. The White House has quietly pushed for the release of all the Americans as a first step toward better relations, and President Trump has sometimes publicly indicated a willingness to talk with the North’s leader, Kim Jong-un, about its pursuit of nuclear arms and missiles capable of striking the United States. 
 
 “I believe it’s going to set back any serious discussion about a diplomatic dialogue until this is cleared up,” former Gov. Bill Richardson of New Mexico, an expert on North Korea who has helped extricate Americans held there, said of Mr. Warmbier’s death. “I think the first objective has to be to get the three other Americans out, and get a full explanation of what happened to Otto Warmbier.”
– When Otto Warmbier was returned from North Korea last week after being held for more than a year, he was in a state of "unresponsive wakefulness" but otherwise stable—until he died suddenly Monday. Now NBC News reports doctors are trying to figure out what happened. One expert says Warmbier's family may have decided not to treat a medical issue—such as pneumonia, or sepsis, or a urinary tract infection—given that Warmbier was unlikely ever to recover from his vegetative state. Another says Warmbier may have suffered a pulmonary embolism, with his long flight from North Korea making a blood clot more likely. Here's what else you need to know about Warmbier and North Korea following the 22-year-old's death: We should have more details on Warmbier's death late Tuesday or Wednesday when the coroner releases initial autopsy findings, Reuters reports. The Cavalier Daily reports the University of Virginia Student Council will hold a vigil for Warmbier at 9pm Tuesday on campus. "The thoughts and prayers of the University of Virginia Student Body are with the Warmbier family and all those who loved Otto," the council said in a statement. Warmbier's funeral will be held Thursday morning at Wyoming High School in Ohio, ABC News tweets. Despite Trump's apparent willingness to sit down with Kim Jong Un, experts say Warmbier's death dramatically reduces—if not outright kills—chances for an improved relationship between the US and North Korea. "There is going to be a lot of anger," the director of the US-Korea Institute at Johns Hopkins School of Advanced International Studies tells the New York Times. Time reports South Korean President Moon Jae-in condemned North Korea's "unjust and cruel treatment" of Warmbier without outright accusing its government of murder. "We cannot know for sure that North Korea killed Mr. Warmbier," Moon said. "But I believe it is quite clear that they have a heavy responsibility in the process that led to Mr. Warmbier's death."