Bernat James L
Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
J Med Philos. 2010 Jun;35(3):242-55. doi: 10.1093/jmp/jhq018. Epub 2010 May 3.
The distinction between the "permanent" (will not reverse) and "irreversible" (cannot reverse) cessation of functions is critical to understand the meaning of a determination of death using circulatory-respiratory tests. Physicians determining death test only for the permanent cessation of circulation and respiration because they know that irreversible cessation follows rapidly and inevitably once circulation no longer will restore itself spontaneously and will not be restored medically. Although most statutes of death stipulate irreversible cessation of circulatory and respiratory functions, the accepted medical standard is their permanent cessation because permanence is a perfect surrogate indicator for irreversibility, and using it permits a more timely declaration. Therefore, patients properly declared dead in donation after circulatory death (DCD) protocols satisfy the requirements of death statutes and do not violate the dead donor rule. The acronym DCD should represent organ "donation after circulatory death" to clarify that the death standard is the permanent cessation of circulation, not heartbeat. Heart donation in DCD does not retroactively negate the donor's death determination because circulation has ceased permanently.
“永久性”（不会逆转）和“不可逆转”（无法逆转）的功能停止之间的区别，对于理解使用循环-呼吸测试判定死亡的含义至关重要。判定死亡的医生仅测试循环和呼吸的永久性停止，因为他们知道一旦循环不再能自发恢复且无法通过医学手段恢复，不可逆转的停止会迅速且不可避免地随之而来。尽管大多数死亡法规规定循环和呼吸功能不可逆转地停止，但公认的医学标准是其永久性停止，因为永久性是不可逆转性的完美替代指标，使用它可以更及时地宣告死亡。因此，在循环死亡后器官捐献（DCD）方案中被正确宣告死亡的患者符合死亡法规的要求，且不违反死亡捐献者规则。首字母缩写词DCD应代表“循环死亡后器官捐献”，以明确死亡标准是循环的永久性停止，而非心跳。DCD中的心脏捐献不会追溯否定捐献者的死亡判定，因为循环已经永久性停止。
