Institute for the History, Philosophy, and Ethics of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany.
Saint Scholastica College, Duluth, Minnesota, USA.
Camb Q Healthc Ethics. 2022 Jul;31(3):379-385. doi: 10.1017/S0963180121001067.
Organ donation after brain death has been practiced in China since 2003 in the absence of brain death legislation. Similar to international standards, China's brain death diagnostic criteria include coma, absence of brainstem reflexes, and the lack of spontaneous respiration. The Chinese criteria require that the lack of spontaneous respiration must be verified with an apnea test by disconnecting the ventilator for 8 min to provoke spontaneous respiration. However, we have found publications in Chinese medical journals, in which the donors were declared to be brain dead, yet without an apnea test. The organ procurement procedures started with initiating "intratracheal intubation for mechanical ventilation after brain death," indicating that a brain death diagnosis was not performed. The purpose of the intubation was not to resuscitate the patient but rather was directly related to facilitating the explantation of organs. Moreover, it was unmistakably stated in two of these publications that the cardiac arrest was induced in these patients without brain death determination by cold St. Thomas cardioplegic solution or other cold myocardial protection solutions. This means that the condition of these donors neither met the criteria of brain death nor that of cardiac death. In other words, the "donor organs" may well have been procured in these cases from living human beings. Thus, brain death definition is abused in China by some individuals for organ harvesting, and a systematic investigation is needed to clarify the situation of organ donation after brain death in China.
脑死亡后的器官捐献在中国自 2003 年以来一直在进行，当时没有脑死亡立法。与国际标准相似，中国的脑死亡诊断标准包括昏迷、脑反射消失和自主呼吸缺失。中国的标准要求必须通过断开呼吸机 8 分钟进行窒息试验来验证自主呼吸缺失，但我们发现中国医学期刊上的出版物中，供体被宣布为脑死亡，但没有进行窒息试验。器官获取程序从“脑死亡后进行气管内插管机械通气”开始，表明没有进行脑死亡诊断。插管的目的不是为了抢救患者，而是直接与器官的切除有关。此外，其中有两份出版物明确指出，在这些没有脑死亡确定的患者中，通过冷圣托马斯心脏停搏液或其他冷心肌保护液诱导心脏骤停。这意味着这些供者的情况既不符合脑死亡标准，也不符合心脏死亡标准。换句话说，这些“供体器官”很可能是从活体人类中获取的。因此，在中国，一些人滥用脑死亡定义进行器官摘取，需要进行系统调查以澄清中国脑死亡后器官捐献的情况。
