Veatch Robert M
Georgetown University, Washington, DC 20057, USA.
J Med Philos. 2010 Jun;35(3):313-29. doi: 10.1093/jmp/jhq020. Epub 2010 May 3.
The current definition of death used for donation after cardiac death relies on a determination of the irreversible cessation of the cardiac function. Although this criterion can be compatible with transplantation of most organs, it is not compatible with heart transplantation since heart transplants by definition involve the resuscitation of the supposedly "irreversibly" stopped heart. Subsequently, the definition of "irreversible" has been altered so as to permit heart transplantation in some circumstances, but this is unsatisfactory. There are three available strategies for solving this "irreversibility problem": altering the definition of death so as to rely on circulatory irreversibility, rather than cardiac; defining death strictly on the basis of brain death (either whole-brain or more pragmatically some higher brain criteria); or redefining death in traditional terms and simultaneously legalizing some limited instances of medical killing to procure viable hearts. The first two strategies are the most ethically justifiable and practical.
目前用于心脏死亡后捐赠的死亡定义依赖于对心脏功能不可逆停止的判定。尽管这一标准与大多数器官移植兼容，但与心脏移植不兼容，因为从定义上讲，心脏移植涉及对假定“不可逆”停止跳动的心脏进行复苏。随后，“不可逆”的定义被修改，以便在某些情况下允许心脏移植，但这并不令人满意。解决这个“不可逆性问题”有三种可行策略：改变死亡定义，使其依赖于循环不可逆性而非心脏不可逆性；严格基于脑死亡（全脑死亡或更实际地基于某些高级脑标准）来定义死亡；或者用传统术语重新定义死亡，同时将一些有限的医疗杀戮实例合法化以获取可存活的心脏。前两种策略在伦理上最具正当性且最为实际。
