Nair-Collins Michael, Joffe Ari R
Florida State University College of Medicine.
University of Alberta and Stollery Children's Hospital.
AJOB Neurosci. 2023 Jul-Sep;14(3):255-268. doi: 10.1080/21507740.2021.1973148. Epub 2021 Sep 29.
Some patients who have been diagnosed as "dead by neurologic criteria" continue to exhibit certain brain functions, most commonly, neuroendocrine functions. This preservation of neurologic function after the diagnosis of "brain death" or "brainstem death" is an ongoing source of controversy and concern in the medical, bioethics, and legal literatures. Most obviously, if some brain function persists, then it is not the case that all functions of the entire brain have ceased and hence, declaring such a patient to be "dead" would be a false positive, in any nation with so-called "whole brain death" laws. Furthermore, and perhaps more concerning, the preservation of any brain function necessarily entails the preservation of some amount of brain perfusion, thereby raising the concern as to whether additional areas of neural tissue may remain viable, including areas in the brainstem. These and other considerations cast significant doubt on the reliability of diagnosing either "brain death" or "brainstem death."
一些被诊断为“神经学标准判定死亡”的患者仍会表现出某些脑功能，最常见的是神经内分泌功能。在诊断为“脑死亡”或“脑干死亡”后仍保留神经功能，这在医学、生物伦理学和法律文献中一直是争议和关注的焦点。最明显的是，如果某些脑功能持续存在，那么整个大脑的所有功能并未停止，因此，在任何有所谓“全脑死亡”法律的国家，宣布这样的患者“死亡”将是一个误判。此外，或许更令人担忧的是，任何脑功能的保留必然意味着一定量的脑灌注得以保留，从而引发人们对神经组织的其他区域（包括脑干区域）是否可能仍具有活力的担忧。这些以及其他因素对诊断“脑死亡”或“脑干死亡”的可靠性提出了重大质疑。
