Pearson I Y
Sydney Adventist Hospital.
Med J Aust. 1993 Jan 4;158(1):45-7.
The source of most organs for transplantation is the brain-dead cadaveric donor. The realistic potential donor is one for whom mechanical ventilation and other support, to the point of brain death, is provided in the best interests of that patient, and not solely for the purpose of organ donation. Brain death secondary to spontaneous intracranial haemorrhage now exceeds traumatic head injury as a source of organ donors in Australia. There are now few medical exclusions to organ donation. Age limits rise constantly. No patient should be excluded without referral to the transplant coordinator. Adequate medical support of the potential donor is no more than should be provided to the severely brain-injured patient. Haemodynamic and other organ support are as logically appropriate as ventilation and must be continued until confirmation of brain death. Support should cease only if organ donation will not occur. Australian State laws define brain death as irreversible cessation of all function of the brain of the person, but do not dictate the methods of confirmation. The prospect of organ donation should not be raised until brain death is confirmed. The over-riding principle is that the family always has the right to be asked. There is no other way for the family's and patient's wishes about organ donation to be known and respected. It is vital that the person who will ask be experienced, competent and committed. A dedicated medical, nursing and allied health team providing care of the family throughout the period is essential.
大多数移植器官的来源是脑死亡的尸体捐赠者。现实中的潜在捐赠者是指那些为了患者的最大利益而接受机械通气和其他支持直至脑死亡的人，而不仅仅是为了器官捐赠的目的。在澳大利亚，自发性颅内出血继发的脑死亡现已超过创伤性颅脑损伤，成为器官捐赠者的来源。目前，器官捐赠几乎没有医学上的排除标准。年龄限制在不断提高。未经转诊至移植协调员，不应排除任何患者。对潜在捐赠者提供的充分医疗支持不应超过对重度脑损伤患者的支持。血流动力学和其他器官支持与通气一样，在逻辑上是合适的，并且必须持续到脑死亡得到确认。只有在不会进行器官捐赠时，支持才应停止。澳大利亚各州法律将脑死亡定义为该人脑部所有功能的不可逆停止，但并未规定确认方法。在脑死亡得到确认之前，不应提及器官捐赠的可能性。首要原则是始终有权询问家属。了解并尊重家属和患者关于器官捐赠的意愿没有其他办法。至关重要的是，询问者要有经验、有能力且尽职尽责。在整个期间，由专业的医疗、护理和相关健康团队为家属提供护理是必不可少的。
