Truog Robert D
Department of Medical Ethics, Anesthesia, and Pediatrics at Harvard Medical School, Boston, MA, USA.
J Law Med Ethics. 2007 Summer;35(2):273-81. doi: 10.1111/j.1748-720X.2007.00136.x.
The concept of brain death has become deeply ingrained in our health care system. It serves as the justification for the removal of vital organs like the heart and liver from patients who still have circulation and respiration while these organs maintain viability. On close examination, however, the concept is seen as incoherent and counterintuitive to our understandings of death. In order to abandon the concept of brain death and yet retain our practices in organ transplantation, we need to either change the definition of death or no longer maintain a commitment to the dead donor rule, which is an implicit prohibition against removing vital organs from individuals before they are declared dead. After exploring these two options, the author argues that while new definitions of death are problematic, alternatives to the dead donor rule are both ethically justifiable and potentially palatable to the public. Even so, the author concludes that neither of these approaches is likely to be adopted and that resolution will most probably come when technological advances in immunology simply make the concept of brain death obsolete.
脑死亡的概念已在我们的医疗体系中根深蒂固。它成为了从仍有循环和呼吸但这些器官仍具活力的患者身上摘取心脏和肝脏等重要器官的正当理由。然而，仔细审视后会发现，这一概念在我们对死亡的理解中显得前后矛盾且违背直觉。为了摒弃脑死亡概念同时又保留我们在器官移植方面的做法，我们要么改变死亡的定义，要么不再坚持死体器官捐赠规则，该规则隐含着禁止在个体被宣布死亡之前摘取其重要器官。在探讨了这两种选择后，作者认为，虽然新的死亡定义存在问题，但死体器官捐赠规则的替代方案在伦理上是合理的，并且可能为公众所接受。即便如此，作者总结道，这两种方法都不太可能被采纳，而最有可能的解决办法是当免疫学的技术进步使脑死亡概念过时的时候。
