Balen-Bernat A, Grbavac Z, Ribarić B, Djaković V
Klinika za neurologiju, KBC Rebro.
Lijec Vjesn. 1995 Jun;117 Suppl 2:61-3.
Traditional definition of death-cessation of heart function-became obsolete, because it was indisputably ascertained that brain function may be totally an irreversibly destroyed, while other parts of the body continue to live including the heart. So the definition of death switched from the heart to brain function--a brain stem dead patient becomes'' a corps with a beating heart "(ghostly aspects of the medical progress). Early recognition of brain death before the unavoidable cessation of circulation is the basis of organ(s) transplantation. The tests necessary to show that the brain stem is not functioning take only a few minutes to carry out, but the moral and legal responsibility for such a diagnosis is tremendous. The best safeguards against suspicion of error are well-written guidelines. Doctors involved with diagnosis of brain death must acquire clear and unambiguous criteria. The purpose of this presentation is to contribute to wider distribution of knowledge of brain death symptoms in our local situation where organ transplants, including the heart, have been achieved. During the year 1994, 296 patients were admitted into the neurological intensive care unit, 32 of them in respiratory arrest. Ten were considered as potential organ donors but nine died during observation. However, one transplantation was performed: heart, kidneys, and corneae were donated and used.
传统的死亡定义——心脏功能停止——已过时,因为无可争议地确定,大脑功能可能已完全且不可逆转地被破坏,而身体的其他部分,包括心脏,仍在继续存活。于是,死亡的定义从心脏转向了大脑功能——脑干死亡的患者变成了“有心跳的尸体”(医学进步带来的诡异一面)。在不可避免的循环停止之前尽早识别脑死亡,是器官移植的基础。证明脑干不再发挥功能所需的检测只需几分钟就能完成,但做出这种诊断的道德和法律责任却极其重大。防止被怀疑出错的最佳保障是编写完善的指南。参与脑死亡诊断的医生必须掌握清晰明确的标准。本报告的目的是,在我们当地已实现包括心脏在内的器官移植的情况下,促进更广泛地传播脑死亡症状的知识。1994年,296名患者被收治入神经重症监护病房,其中32人呼吸骤停。有10人被视为潜在的器官捐献者,但9人在观察期间死亡。不过,进行了1例移植手术:捐献并使用了心脏、肾脏和角膜。