Dalle Ave Anne L, Bernat James L
Ethics Unit, University hospital of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
Neurology Department, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA.
BMC Med Ethics. 2017 Feb 23;18(1):15. doi: 10.1186/s12910-017-0173-1.
The fundamental determinant of death in donation after circulatory determination of death is the cessation of brain circulation and function. We therefore propose the term donation after brain circulation determination of death [DBCDD].
In DBCDD, death is determined when the cessation of circulatory function is permanent but before it is irreversible, consistent with medical standards of death determination outside the context of organ donation. Safeguards to prevent error include that: 1] the possibility of auto-resuscitation has elapsed; 2] no brain circulation may resume after the determination of death; 3] complete circulatory cessation is verified; and 4] the cessation of brain function is permanent and complete. Death should be determined by the confirmation of the cessation of systemic circulation; the use of brain death tests is invalid and unnecessary. Because this concept differs from current standards, consensus should be sought among stakeholders. The patient or surrogate should provide informed consent for organ donation by understanding the basis of the declaration of death.
In cases of circulatory cessation, such as occurs in DBCDD, death can be defined as the permanent cessation of brain functions, determined by the permanent cessation of brain circulation.
在循环判定死亡后器官捐献中，死亡的根本决定因素是脑循环和功能的停止。因此，我们提出脑循环判定死亡后器官捐献（DBCDD）这一术语。
在DBCDD中，当循环功能的停止是永久性的但尚未不可逆时判定死亡，这与器官捐献背景之外的死亡判定医学标准一致。防止错误的保障措施包括：1] 自动复苏的可能性已经过去；2] 死亡判定后脑循环不能恢复；3] 循环完全停止得到确认；4] 脑功能的停止是永久性和完全性的。死亡应由全身循环停止的确认来判定；使用脑死亡测试无效且不必要。由于这一概念与现行标准不同，应在利益相关者之间寻求共识。患者或代理人应通过了解死亡宣告的依据来提供器官捐献的知情同意。
在循环停止的情况下，如在DBCDD中发生的情况，死亡可定义为脑功能的永久性停止，由脑循环的永久性停止来判定。
