Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Brain. 2012 Apr;135(Pt 4):1321-31. doi: 10.1093/brain/awr282. Epub 2011 Dec 24.
In 1976, the Royal College of Physicians published neurological criteria of death. The memorandum stated that-after preconditions and exclusion criteria were met-the absence of brainstem function, including apnoea testing, would suffice. In the USA, many experts felt that brain death could be only determined by demonstrating death of the entire brain. In the history of further refinement of UK and USA brain death criteria, one particular period stands out that would bring about an apparent transatlantic divide. On 13 October 1980, the British Broadcasting Corporation aired a programme entitled 'Transplants: Are the Donors Really Dead?' Several United States experts not only disagreed with the United Kingdom criteria, but claimed that patients diagnosed with brain death using United Kingdom criteria could recover. The fallout of this television programme was substantial, as indicated by a media frenzy and a 6-month period of heated correspondence within The Lancet and The British Medical Journal. Members of the Parliament questioned the potential long-term effect on the public's trust in organ transplantation. Given the concerns raised, the British Broadcasting Corporation commissioned a second programme, which was broadcast on 19 February 1981 entitled 'A Question of Life or Death: The Brain Death Debate.' Two panels debated the issues on the accuracy of the electroencephalogram and its place, the absolute need for assessing preconditions before an examination, the problems with recognition of toxins and the feasibility of doing a new prospective study in the United Kingdom, which would follow patients' examination assessed with United Kingdom criteria until cardiac standstill. The positions of the United States and United Kingdom remained diametrically opposed to each other. This article revisits this landmark moment and places it in a wider historical context. In the USA, the focus was not on the brainstem, and the definition of brain death became rapidly infused with terms such as whole brain death (all intracranial structures above the foramen magnum), cerebral death (all supratentorial structures) or higher brain death (cortical structures) virtually synonymous with persistent vegetative state. This review also identifies the fortitude of neurosurgeon Bryan Jennett and neurologist Christopher Pallis by introducing new corroborative data on the diagnosis of brain death and clarifying the United Kingdom position. Both understood that brainstem death was the infratentorial consequence of a supratentorial catastrophe. With the 1995 American Academy of Neurology practice parameters, the differences between the UK and USA brain death determination would become much less apparent.
1976 年，皇家内科医师学院发布了神经学死亡标准。备忘录指出，在满足前提条件和排除标准后，脑功能缺失，包括呼吸暂停测试，就足以确定。在美国，许多专家认为，只有通过证明整个大脑死亡才能确定脑死亡。在英国和美国脑死亡标准进一步完善的历史中，有一个特定的时期尤为突出，它导致了明显的跨大西洋分歧。1980 年 10 月 13 日，英国广播公司播出了一个名为《移植：供体真的死了吗？》的节目。几位美国专家不仅不同意英国的标准，还声称使用英国标准诊断为脑死亡的患者可能会康复。这个电视节目的影响很大，《柳叶刀》和《英国医学杂志》在 6 个月的时间里都对这个节目进行了激烈的讨论。国会议员质疑这对公众对器官移植信任的潜在长期影响。考虑到提出的担忧，英国广播公司委托制作了第二个节目，该节目于 1981 年 2 月 19 日播出，名为《生死攸关：脑死亡辩论》。两个小组就脑电图的准确性及其所处的位置、在检查前绝对需要评估前提条件、识别毒素的问题以及在英国进行新的前瞻性研究的可行性进行了辩论，该研究将跟随使用英国标准进行检查的患者，直到心脏停搏。美国和英国的立场仍然完全对立。本文回顾了这一具有里程碑意义的时刻，并将其置于更广泛的历史背景下。在美国，重点不是脑干，脑死亡的定义很快就融入了全脑死亡（所有颅腔结构高于枕骨大孔）、脑死亡（所有幕上结构）或更高脑死亡（皮质结构）等术语，几乎与持续性植物状态同义。这篇综述还通过介绍关于脑死亡诊断的新佐证数据，并澄清英国的立场，确认神经外科医生 Bryan Jennett 和神经学家 Christopher Pallis 的坚韧不拔。他们都明白，脑干死亡是幕上灾难的幕下后果。随着 1995 年美国神经病学学会实践参数的出现，英国和美国脑死亡判定之间的差异将变得不那么明显。
