Siddiqui Shahla, Ling Ng Ee, Chuan Voo Teck
Department of Anaesthesiology and Intensive Care, Khoo Teck Puat Hospital, Singapore, Singapore.
National Healthgroup, Singapore, Singapore.
Asian Bioeth Rev. 2018 Oct 28;10(3):189-198. doi: 10.1007/s41649-018-0065-9. eCollection 2018 Oct.
Brain death certification can be a clinically and ethically challenging affair. Healthcare workers are expected to refer patients for brain death certification to identify potential organ donors, but family members may be ill-prepared for this turn of events. Already distraught families may not appreciate delays in brain death certification, but such delays are common because of the need to manage the patient's altered physiological state to allow testing. Opportunities for donation are sometimes lost because of the unnecessary delay. With focus on an opt-out organ donation law, we discuss causes of delays in brain death certification, and the ethical issues faced by clinicians in using tests to certify patients. To resolve the issues, we argue for the use of supplementary confirmatory tests as part of a more protocol-driven approach to brain death certification to avoid delays. Such tests should be regarded as part of the donation process funded by the state.
脑死亡认证在临床和伦理方面可能是一件具有挑战性的事情。医护人员需要将患者转介进行脑死亡认证以确定潜在的器官捐献者，但家庭成员可能对此变故毫无准备。已然心烦意乱的家属可能不理解脑死亡认证的延迟，但由于需要处理患者改变的生理状态以便进行检测，这种延迟很常见。有时会因为不必要的延迟而错失捐赠机会。围绕一项默认同意的器官捐赠法，我们讨论脑死亡认证延迟的原因，以及临床医生在使用检测来认证患者时所面临的伦理问题。为解决这些问题，我们主张使用补充性确证检测，作为更具规程驱动性的脑死亡认证方法的一部分，以避免延迟。此类检测应被视为由国家资助的捐赠过程的一部分。
