Wig N, Wadhwa J, Aggarwal P, Handa R, Wali J P
Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
Natl Med J India. 1997 May-Jun;10(3):120-5.
Brain death is the irreversible cessation of all brain functions. Brainstem death is the 'physiological core' of brain death. The Indian Parliament has given legal recognition to brain death though it applies only in the context of performance of organ transplantation. Brain death is diagnosed if there is irreversible loss of consciousness, absence of brainstem reflexes and apnoea. Care and diligence in the application of the criteria for brain death provide important safeguards for Individual patients and the community in general. These criteria also allow death to be diagnosed with certainty prior to the occurrence of circulatory arrest. Solid organ transplantation has become possible through the diagnosis of brain death but is not the primary consideration; the management of a potential organ donor, who is brain dead, is also vital. If optimal preservation of organs for transplantation is to be achieved the clinician needs to understand the pathophysiology and consequences of changes occurring in various organs after brain death and active management is required to reverse or control these changes. Discussions about organ donation with relatives of brain deed patients are never easy. These should always be frank and sympathetic. It has been suggested that those whose interests lie in transplantation must bear the responsibility of educating the general public. This will help intensivists who expose themselves knowingly to the unpleasant aspects of organ donation.
脑死亡是所有脑功能的不可逆终止。脑干死亡是脑死亡的“生理核心”。印度议会已对脑死亡给予法律认可，不过这仅适用于器官移植的情形。如果存在意识的不可逆丧失、脑干反射消失及呼吸暂停，则可诊断为脑死亡。在应用脑死亡标准时保持谨慎和勤勉，为个体患者及整个社会提供了重要保障。这些标准还使得在循环停止之前就能确切诊断死亡。通过脑死亡诊断使得实体器官移植成为可能，但这并非首要考虑因素；对脑死亡潜在器官捐献者的管理也至关重要。若要实现对移植器官的最佳保存，临床医生需要了解脑死亡后各器官发生的病理生理变化及后果，并且需要积极采取措施来逆转或控制这些变化。与脑死亡患者的亲属讨论器官捐献绝非易事。这些讨论应该始终坦诚且充满同情。有人建议，那些关注移植的人必须承担起教育公众的责任。这将有助于那些明知会面临器官捐献不愉快方面的重症监护医生。
