Dartmouth Geisel School of Medicine.
Am J Bioeth. 2024 Jun;24(6):4-15. doi: 10.1080/15265161.2024.2337392. Epub 2024 Jun 3.
Organ donation after the circulatory determination of death requires the permanent cessation of circulation while organ donation after the brain determination of death requires the irreversible cessation of brain functions. The unified brain-based determination of death connects the brain and circulatory death criteria for circulatory death determination in organ donation as follows: permanent cessation of systemic circulation causes permanent cessation of brain circulation which causes permanent cessation of brain perfusion which causes permanent cessation of brain function. The relevant circulation that must cease in circulatory death determination is that to the brain. Eliminating brain circulation from the donor ECMO organ perfusion circuit in thoracoabdominal NRP protocols satisfies the unified brain-based determination of death but only if the complete cessation of brain circulation can be proved. Despite its medical and physiologic rationale, the unified brain-based determination of death remains inconsistent with the Uniform Determination of Death Act.
器官捐献在循环死亡判定后需要永久性停止循环，而在脑死亡判定后需要不可逆地停止脑功能。基于大脑的统一死亡判定将脑和循环死亡标准连接起来，用于器官捐献的循环死亡判定，如下所示：全身循环的永久性停止导致脑循环的永久性停止，从而导致脑灌注的永久性停止，最终导致脑功能的永久性停止。在循环死亡判定中必须停止的相关循环是到大脑的循环。在胸腹部 NRP 方案的 ECMO 器官灌注回路中消除脑循环，满足基于大脑的统一死亡判定，但前提是可以证明脑循环完全停止。尽管有其医学和生理学依据，但基于大脑的统一死亡判定仍然与《统一死亡判定法》不一致。
