Evans David Wainwright
Queens' College, Cambridge, CB3 9ET, UK.
Philos Ethics Humanit Med. 2007 Jun 29;2:11. doi: 10.1186/1747-5341-2-11.
Because complex organs taken from unequivocally dead people are not suitable for transplantation, human death has been redefined so that it can be certified at some earlier stage in the dying process and thereby make viable organs available without legal problems. Redefinitions based on concepts of "brain death" have underpinned transplant practice for many years although those concepts have never found universal philosophical acceptance. Neither is there consensus about the clinical tests which have been held sufficient to diagnose the irreversible cessation of all brain function--or as much of it as is deemed relevant--while the body remains alive. For these reasons, the certification of death for transplant purposes on "brain death" grounds is increasingly questioned and there has been pressure to return to its diagnosis on the basis of cardiac arrest and the consequent cessation of blood circulation throughout the body. While superficially a welcome return to the traditional and universally accepted understanding of human death, examination of the protocols using such criteria for the diagnosis of death prior to organ removal reveals a materially different scenario in which the circulatory arrest is not certainly final and purely nominal periods of arrest are required before surgery begins. Recognizing the probably unresolvable conflict between allowing enough time to pass after truly final circulatory arrest for a safe diagnosis of death and its minimization for the sake of the wanted organs, Verheijde and colleagues follow others in calling for the abandonment of the "dead donor rule" and the enactment of legislation to permit the removal of organs from the dying, without pretence that they are dead before that surgery. While it may be doubted whether such a "paradigm change" in the ethics of organ procurement would be accepted by society, their call for its consideration as a fully and fairly informed basis for organ donation is to be applauded.
由于从明确判定为死亡的人身上获取的复杂器官不适合用于移植，人类死亡的定义已被重新界定，以便能在死亡过程的更早阶段进行认证，从而使可用的活体器官不存在法律问题。基于“脑死亡”概念的重新定义多年来一直支撑着移植实践，尽管这些概念从未获得普遍的哲学认可。对于足以诊断所有脑功能不可逆停止（或与脑功能相关的部分）且身体仍存活的临床测试，也没有达成共识。出于这些原因，基于“脑死亡”进行移植目的的死亡认证越来越受到质疑，并且存在一种压力，要求回归到基于心脏骤停及随之而来的全身血液循环停止来进行死亡诊断。虽然表面上这是回归到对人类死亡的传统且普遍接受的理解，但审视在器官摘除前使用此类标准诊断死亡的方案会发现，实际情况大不相同，即循环停止不一定是最终的，并且在手术开始前需要有纯粹名义上的停止期。认识到在真正的最终循环停止后留出足够时间以安全诊断死亡与为了获取所需器官而尽量缩短这段时间之间可能无法解决的冲突，费尔海杰德及其同事与其他人一道呼吁摒弃“死亡供体规则”，并制定立法，允许在患者临终时摘除器官，而不假装他们在手术前已经死亡。虽然人们可能会怀疑器官获取伦理方面的这种“范式转变”是否会被社会接受，但他们呼吁将其作为器官捐赠的充分且知情的基础加以考虑，这一点值得称赞。
