Neurology Department, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Prog Brain Res. 2009;177:21-31. doi: 10.1016/S0079-6123(09)17703-8.
Human death is a unitary phenomenon that physicians can determine in two ways: (1) showing the irreversible cessation of all brain clinical functions; or (2) showing the permanent cessation of circulatory and respiratory functions. Over the last 40 years the determination of human death using neurological tests ("brain death") has become an accepted practice throughout the world but has remained controversial within academic circles. Brain death has a rigorous biophilosophical basis by defining death as the irreversible loss of the critical functions of the organism as a whole. The criterion best fulfilling this definition is the irreversible cessation of all clinical functions of the brain. Competing definitions, such as those within the higher brain, brain stem, and circulation formulations, all have deficiencies in theory or practice. Among physicians, the area of greatest controversy in death determination now is the use of circulatory-respiratory tests, particularly as applied to organ donation after circulatory death. Circulatory-respiratory tests are valid only because they produce destruction of the whole brain, the criterion of death. Clarifying the distinction between the permanent and irreversible cessation of circulatory and respiratory functions is essential to understanding the use of these tests, and explains why death determination in organ donation after circulatory death does not violate the dead donor rule.
人类死亡是一种单一的现象，医生可以通过两种方式来确定：（1）显示所有大脑临床功能的不可逆转停止；或（2）显示循环和呼吸功能的永久停止。在过去的 40 年中，使用神经学测试（“脑死亡”）来确定人类死亡已成为全世界公认的做法，但在学术界仍存在争议。脑死亡有严格的生物哲学基础，将死亡定义为整个生物体不可逆转地丧失关键功能。最符合这一定义的标准是大脑所有临床功能的不可逆转停止。竞争定义，如大脑高级、脑干和循环公式中的定义，在理论或实践上都存在缺陷。在医生中，现在在死亡确定方面最具争议的领域是循环-呼吸测试的使用，特别是在循环死亡后的器官捐赠中。循环-呼吸测试是有效的，因为它们会导致整个大脑的破坏，这是死亡的标准。澄清循环和呼吸功能的永久和不可逆转停止之间的区别对于理解这些测试的用途至关重要，并且解释了为什么在循环死亡后的器官捐赠中确定死亡不会违反死亡供体规则。
