Haupt W F, Höfling W
Klinik und Poliklinik für Neurologie der Universität zu Köln, Germany.
Fortschr Neurol Psychiatr. 2002 Nov;70(11):583-90. doi: 10.1055/s-2002-35178.
The diagnosis of brain death following total and irreversible cessation of all cerebral functions is based on anthropological assumptions and conventions as well as on the exact medical diagnosis of total loss of brain function. The question whether individual life ends after cerebral function is irreversibly lost cannot be answered by medical definition alone. Clear and unrefutable legal definitions of death and the cessation of the rights of the individual must be provided before organs may be harvested from brain dead individuals. Acceptance of these definitions by the general population is of paramount importance for the practice of organ donation. In the first part of this article, the legal definition of death and the provisions of the German transplantation law are critically reviewed. The legal statements deal with the question of the definition of death and how death can be detected. The provisions of the German transplantation law are referenced with special attention to the provision of prior consent to the removal of organs following after the diagnosis of brain death. The provisions of the German constitution with respect to the preservation of the personal rights of the individual are discussed in the light of organ harvesting. The second part deals with the medical procedure of determining brain death in adults. The medical statements pertain to the diagnostic steps to be taken in the diagnosis and determination of brain death. The prerequisites for entering the diagnostic procedure to determine brain death are described. The clinical signs of total and irreversible cessation of brain function are listed, and the technical examinations to corroborate the clinical signs of brain death as accepted in Germany are delineated. In the perspective of the authors, individuals having suffered brain death still possess the protection of their personal human rights according to the German constitution since it cannot be conclusively demonstrated that total loss of brain function alone constitutes the cessation of life in the sense of the German constitution.
脑死亡的诊断是基于所有脑功能完全且不可逆停止，这既基于人类学假设和惯例，也基于脑功能完全丧失的确切医学诊断。脑功能不可逆丧失后个体生命是否终结的问题，仅靠医学定义无法回答。在从脑死亡个体身上摘取器官之前，必须提供明确且无可辩驳的死亡法律定义以及个体权利的终止定义。公众对这些定义的接受对于器官捐赠实践至关重要。在本文的第一部分，对死亡的法律定义和德国移植法的规定进行了批判性审视。法律声明涉及死亡定义问题以及如何检测死亡。特别关注德国移植法中关于在诊断脑死亡后事先同意摘取器官的规定，并结合器官摘取讨论了德国宪法中关于保护个人权利的规定。第二部分论述了确定成人脑死亡的医学程序。医学声明涉及诊断和确定脑死亡时应采取的诊断步骤。描述了进入确定脑死亡诊断程序的先决条件。列出了脑功能完全且不可逆停止的临床体征，并阐述了德国认可的用于证实脑死亡临床体征的技术检查。在作者看来，根据德国宪法，脑死亡个体的个人人权仍受保护，因为无法确凿证明仅脑功能完全丧失就构成德国宪法意义上的生命终止。
