Varelas Panayiotis N, Abdelhak Tamer, Hacein-Bey Lotfi
Departments of Neurology and Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
Semin Neurol. 2008 Nov;28(5):726-35. doi: 10.1055/s-0028-1105969. Epub 2008 Dec 29.
The majority of patients who die in intensive care units (ICUs), do so as a result of the withdrawal of life-sustaining treatments or as a result of brain death. With the increasing shortage of transplantable organs, there is growing interest in both these patient populations and their potential for organ donation after cardiac death (DCD) or death by neurological criteria. Therefore, it is imperative for neurologists and neurosurgeons to be familiar with both processes when consulted to evaluate these very sick patients in the ICU. The medicolegal and ethical considerations, the factors that lead to the decision for withdrawal (with special attention to prognostication of the major neurological diseases encountered in an ICU), the process of withdrawal of life-sustaining treatment itself, and the DCD process will be examined. The medicolegal aspects of brain death will also be examined, with particular focus on the process and the various pitfalls and misconceptions.
在重症监护病房（ICU）死亡的大多数患者，是由于撤除维持生命的治疗或因脑死亡而死亡。随着可移植器官的日益短缺，人们对这两类患者群体以及他们在心脏死亡（DCD）或依据神经学标准判定死亡后进行器官捐献的潜力越来越感兴趣。因此，当被咨询对ICU中这些危重病患者进行评估时，神经科医生和神经外科医生必须熟悉这两个过程。本文将探讨法医学和伦理学考量、导致撤除决定的因素（特别关注ICU中常见的主要神经系统疾病的预后判断）、维持生命治疗的撤除过程本身以及DCD过程。还将探讨脑死亡的法医学方面，尤其关注其过程以及各种陷阱和误解。
