How the Distinction between "Irreversible" and "Permanent" Illuminates Circulatory-Respiratory Death Determination
How the Distinction between "Irreversible" and "Permanent" Illuminates Circulatory-Respiratory Death Determination
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DOI：
10.1093/jmp/jhq018
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发表时间：
2010-06-01
影响因子：
1.6
通讯作者：
Bernat, James L.
中科院分区：
文献类型：
--
作者：
Bernat, James L.
“永久性”（不会逆转）和“不可逆”（不能逆转）功能停止之间的区别对于理解使用循环呼吸试验确定死亡的含义至关重要。医生只对循环和呼吸的永久停止进行死亡试验，因为他们知道一旦循环不再自发恢复，不可逆的停止将迅速和不可避免地发生，并且不会通过医学方法恢复。虽然大多数死亡法规规定循环和呼吸功能的不可逆停止，但公认的医学标准是永久停止，因为永久性是不可逆性的完美替代指标，使用它可以更及时地宣布。因此，在循环死亡（DCD）后捐献时正确宣布死亡的患者符合死亡法规的要求，并且不违反死亡捐献者规则。首字母缩写DCD应该代表器官“循环死亡后捐献”，以明确死亡标准是循环永久停止，而不是心跳。DCD中的心脏捐献不会追溯性地否定捐献者的死亡判定，因为循环已经永久停止。
The distinction between the "permanent" (will not reverse) and "irreversible" (cannot reverse) cessation of functions is critical to understand the meaning of a determination of death using circulatory-respiratory tests. Physicians determining death test only for the permanent cessation of circulation and respiration because they know that irreversible cessation follows rapidly and inevitably once circulation no longer will restore itself spontaneously and will not be restored medically. Although most statutes of death stipulate irreversible cessation of circulatory and respiratory functions, the accepted medical standard is their permanent cessation because permanence is a perfect surrogate indicator for irreversibility, and using it permits a more timely declaration. Therefore, patients properly declared dead in donation after circulatory death (DCD) protocols satisfy the requirements of death statutes and do not violate the dead donor rule. The acronym DCD should represent organ "donation after circulatory death" to clarify that the death standard is the permanent cessation of circulation, not heartbeat. Heart donation in DCD does not retroactively negate the donor's death determination because circulation has ceased permanently.