Brain Death Criteria

Mostafa Aboubakr, G. Alameda
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Abstract

Death is defined in the United States by the Uniform Determination of Death Act, proposed in 1981, as 1. Irreversible cessation of circulatory and pulmonary functions. 2. Irreversible cessation of all functions of the whole brain, which means brain death. The definition of brain death or irreversible coma as "loss of brain functions" was released by the Ad Hoc Committee of the Harvard Medical School in 1968. The American Academy of Neurology (AAN) guidelines of brain death determination ascertained this definition and released its first version in 1995. According to the AAN guidelines, brain death is clinically equivalent to the irreversible loss of all brain stem functions. Irreversibility in the definition refers to the impossibility of recovery, regardless of any medical intervention, which required clear elaboration. As with the advancement of mechanical ventilation and life support technologies during the 20th century, patients who suffered severe brain damage could be maintained physiologically for prolonged periods in the ICUs.[1][2][3] It is crucial to differentiate brain death from other forms of severe brain damage, which can cause vegetative states when some of the brain functions are maintained, and recovery can occur even after prolonged periods, especially in patients with traumatic brain injuries. Also, it is important to distinguish the term "brain death" from "coma" to the public, as coma may imply a limited form of life. Understanding that brain death is equivalent to death helps both the physicians and patients' families to decide about the withdrawal of care and prevents the unnecessary expenditure of resources. Another essential topic that evolved in parallel of brain death is the need of obtaining organs for transplantation. According to the "dead donor rule," organ procurement can occur only after death. So for patients who are brain dead, the procurement of viable organs is allowed, even if they still have some circulatory and pulmonary functions. This concept is still causing an ongoing debate and controversy.[4][5][6]
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脑死亡标准
在美国,1981年提出的《统一确定死亡法案》将死亡定义为1。不可逆的循环和肺功能停止。2. 整个大脑的所有功能不可逆转地停止,这意味着脑死亡。1968年,哈佛医学院特设委员会将脑死亡或不可逆昏迷定义为“脑功能丧失”。美国神经病学学会(AAN)的脑死亡判定指南确定了这一定义,并于1995年发布了第一版指南。根据AAN指南,脑死亡在临床上等同于所有脑干功能的不可逆转的丧失。定义中的不可逆性是指无论进行任何医疗干预都不可能恢复,这需要明确阐述。随着20世纪机械通气和生命支持技术的进步,严重脑损伤的患者可以在icu中进行长时间的生理维持。[1][2][3]将脑死亡与其他形式的严重脑损伤区分开来是至关重要的,严重脑损伤在维持部分脑功能的情况下会导致植物人状态,甚至在长时间后也能恢复,尤其是创伤性脑损伤患者。此外,对公众区分"脑死亡"和"昏迷"也很重要,因为昏迷可能意味着一种有限的生命形式。了解脑死亡等同于死亡,有助于医生和患者家属决定是否退出护理,防止不必要的资源消耗。与脑死亡并行发展的另一个重要问题是对移植器官的需求。根据“死亡捐赠者规则”,器官的获取只能在死亡后进行。因此,对于脑死亡的病人来说,即使他们还有一些循环和肺功能,也可以获得有活力的器官。这一概念仍在引起持续的争论和争议[4][5][6]。
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