Institute of Neurology and Neurosurgery, Havana, Cuba.
Clin Neurol Neurosurg. 2021 Jul;206:106674. doi: 10.1016/j.clineuro.2021.106674. Epub 2021 May 5.
I read with interest the paper by Lewis et al. to identify the countries in the Latin America/Caribbean Group of the United Nations (GRULAC) that have protocols for brain death/death by neurologic criteria (BD/DNC). Curiously, the authors don't mention Cuba, which has been one of the most active countries in the area, since the early '90s. The first kidney transplant in Cuba was performed on 24 February 1970, using a cadaveric donor. In September 1992, the First Symposium on Brain Death was held in Havana, with the attendance of the main and world-known authors at that time, like Cristopher Pallis, Earl Walker, among others. These conferences uninterruptedly continued over the years, and the last Symposium was held in December 2018. In the First Symposium, the Cuban Commission for Death Determination presented for the first time the Guidelines for the Determination of BD/DNC in Cuba. Since that time, Machado proposed a concept of death, based on the basic pathophysiological mechanism of consciousness generation. This author also proposed as ancillary tests in BD/DNC diagnosis the use of a test battery composed of multimodality evoked potentials (MEP) and electroretinography (ERG). Later, a Cuban Law for the determination of death was issued. The Cuban Commission The Commission stated that there is only one kind of death, based on the irreversible loss of brain functions based on the whole brain criteria. Furthermore, the Cuban law did not even mention the term 'transplants'. It is clear the human beings die regardless bodies would be useful or not for transplantation.
我饶有兴趣地阅读了 Lewis 等人的论文,以确定联合国拉丁美洲和加勒比集团(GRULAC)中哪些国家制定了脑死亡/神经标准死亡(BD/DNC)的协议。奇怪的是,作者没有提到古巴,自 90 年代初以来,古巴一直是该领域最活跃的国家之一。古巴的首例肾移植于 1970 年 2 月 24 日进行,使用了一具尸体供体。1992 年 9 月,在哈瓦那举行了第一届脑死亡研讨会,当时的主要和世界知名作者如 Christopher Pallis、Earl Walker 等人出席了会议。这些会议多年来一直不间断地继续进行,最后一次研讨会于 2018 年 12 月举行。在第一届研讨会上,古巴死亡确定委员会首次提出了在古巴确定 BD/DNC 的指南。从那时起,Machado 提出了一种基于意识产生的基本病理生理机制的死亡概念。这位作者还提出在 BD/DNC 诊断中使用由多模态诱发电位(MEP)和视网膜电图(ERG)组成的测试电池作为辅助测试。后来,古巴颁布了一项确定死亡的法律。古巴委员会表示,只有一种死亡,基于整个大脑标准的不可逆的脑功能丧失。此外,古巴法律甚至没有提到“移植”一词。很明显,无论身体是否对移植有用,人类都会死亡。