Grande A M, Rinaldi M, Goggi C, Politi P, Viganò M
Department of Cardiovascular Surgery, IRCCS Policlinico San Matteo, Pavia, Italy.
Intensive Care Med. 1998 Mar;24(3):251-4. doi: 10.1007/s001340050559.
To discuss informed consent to heart transplantation in the case of an intensive care unit (ICU) patient: relatives' informed consent was refused by the patient himself whose cognitive ability appeared to be reasonable for the purpose.
ICU of a university teaching hospital.
A 62-year-old man who underwent myocardial revascularization had in the immediate post-operative hemodynamic instability, continuous serious arrhythmias, ventilatory support, fentanyl infusion. Heart transplantation could be the only chance for his survival. INVENTION: Heart transplantation.
Despite patient's refusal, we decided to hold the relative's consent as valid, and transplantation was accordingly performed, to the subsequent satisfaction of the patient.
Our decision was based on two beliefs: (1) the severity of the patient's clinical condition may have impaired his cognitive abilities; (2) the very same conditions may mask impairment and certainly make reliable assessment of cognition and judgment impossible. This being so, the preservation of life assumes priority.
探讨重症监护病房（ICU）患者心脏移植的知情同意问题：患者本人拒绝亲属的知情同意，而其认知能力在此情况下看似合理。
某大学教学医院的ICU。
一名62岁男性，接受了心肌血运重建术，术后即刻出现血流动力学不稳定、持续性严重心律失常、通气支持、芬太尼输注。心脏移植可能是其存活的唯一机会。干预措施：心脏移植。
尽管患者拒绝，但我们判定亲属的同意有效，并据此进行了移植手术，患者随后表示满意。
我们的决定基于两点信念：（1）患者临床状况的严重性可能损害了其认知能力；（2）同样的状况可能掩盖了损害，并且肯定使得对认知和判断进行可靠评估变得不可能。既然如此，挽救生命应优先考虑。
