Citerio Giuseppe, Murphy Paul G
Department of Health Science, University of Milan Bicocca, Monza, Italy.
Department of Neuroanaesthesia and Critical Care, The General Infirmary at Leeds, Leeds, United Kingdom.
Semin Neurol. 2015 Apr;35(2):139-44. doi: 10.1055/s-0035-1547533. Epub 2015 Apr 3.
Some of the seminal steps toward the recognition and definition of brain death were European. There is a general consensus on both the medical concept of brain death in Europe as well as the minimum fundamental clinical standards that are required for its diagnosis-the absence of consciousness, brainstem reflexes, and the ability to breathe in the absence of reversible or confounding conditions. Two aspects of brain death determination are addressed in this article. The authors analyze how brain death is diagnosed across Europe, identifying both the similarities and differences that exist between countries (the latter mainly concerning ancillary tests, timing, and the number of physicians involved in the brain death determination). In addition, they describe the very considerable variations in when brain death determinations are made between and within individual European countries, and propose that they are due to differences in the end-of-life care practices in patients with irreversible brain injuries, medical attitudes, and organ donation practices. Although legislation is available to standardize the brain death diagnosis process in most individual European countries, there are still disparities across Europe as a whole. The current variation in practice makes a continental consensus for the definition of brain death imperative.
在对脑死亡的认识和定义方面，一些具有开创性的步骤来自欧洲。欧洲在脑死亡的医学概念以及诊断所需的最低基本临床标准方面已达成普遍共识，即无意识、脑干反射消失，且在不存在可逆或混淆情况时无法呼吸。本文探讨了脑死亡判定的两个方面。作者分析了欧洲各国如何诊断脑死亡，找出各国之间存在的异同（后者主要涉及辅助检查、时间安排以及参与脑死亡判定的医生数量）。此外，他们描述了欧洲各国之间以及各国国内在进行脑死亡判定时间上存在的巨大差异，并提出这些差异是由于不可逆脑损伤患者的临终护理实践、医学态度以及器官捐赠实践不同所致。尽管大多数欧洲国家都有立法来规范脑死亡诊断过程，但整个欧洲仍存在差异。目前实践中的差异使得在欧洲大陆就脑死亡定义达成共识势在必行。
