Neurology Department, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Crit Care Med. 2010 Mar;38(3):963-70. doi: 10.1097/CCM.0b013e3181c58916.
Death statutes permit physicians to declare death on the basis of irreversible cessation of circulatory-respiratory or brain functions. The growing practice of organ donation after circulatory determination of death now requires physicians to exercise greater specificity in circulatory-respiratory death determination. We studied circulatory-respiratory death determination to clarify its concept, practice, and application to innovative circulatory determination of death protocols.
It is ethically and legally appropriate to procure organs when permanent cessation (will not return) of circulation and respiration has occurred but before irreversible cessation (cannot return) has occurred because permanent cessation: 1) is an established medical practice standard for determining death; 2) is the meaning of "irreversible" in the Uniform Determination of Death Act; and 3) does not violate the "Dead Donor Rule."
The use of unmodified extracorporeal membrane oxygenation in the circulatory determination of death donor after death is declared should be abandoned because, by restoring brain circulation, it retroactively negates the previous death determination. Modifications of extracorporeal membrane oxygenation that avoid this problem by excluding brain circulation are contrived, invasive, and, if used, should require consent of surrogates. Heart donation in circulatory determination of death is acceptable if proper standards are followed to declare donor death after establishing the permanent cessation of circulation. Pending additional data on "auto-resuscitation," we recommend that all circulatory determination of death programs should utilize the prevailing standard of 2 to 5 mins of demonstrated mechanical asystole before declaring death.
死亡法规允许医生根据循环-呼吸或脑功能的不可逆转停止来宣布死亡。随着循环确定死亡后器官捐献的实践日益增多，医生现在需要在循环-呼吸死亡确定方面更加具体。我们研究了循环-呼吸死亡的确定，以阐明其概念、实践以及对创新的循环死亡确定协议的应用。
在循环和呼吸永久性停止（不会恢复）但不可逆转停止（不能恢复）发生之前获取器官在伦理和法律上是合适的，因为永久性停止：1）是确定死亡的既定医疗实践标准；2）是《统一死亡确定法》中“不可逆转”的含义；3）并不违反“死者捐献者规则”。
应放弃在宣布死亡后使用未经修改的体外膜氧合机进行循环死亡供体的确定，因为通过恢复脑循环，它会追溯否定先前的死亡确定。通过排除脑循环来避免这个问题的体外膜氧合机的修改是人为的、侵入性的，如果使用，应该需要代理人的同意。如果遵循适当的标准在建立循环永久性停止后宣布供体死亡，那么心脏捐赠在循环确定死亡中是可以接受的。在等待更多关于“自动复苏”的数据的同时，我们建议所有循环确定死亡计划都应该利用当前的 2 到 5 分钟机械停搏的标准，然后再宣布死亡。
