无脑畸形、脑死亡与器官捐献之间有争议的关系分析

J. Stiekema
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引用次数: 0

摘要

无脑畸形是胚胎发育第四周时神经管未能完全闭合的先天性缺陷(Obeidi, Russell, Higgins, & O'Donoghue, 2010)。无脑畸形医学工作队(1990年)将其定义为具有以下四个特征的病症:(a)大部分颅骨缺失,(b)颅骨缺损上方没有头皮,(c)暴露的组织出血和纤维化,以及(d)大脑半球无法区分。大约每4,647个新生儿中就有一个患有无脑畸形,估计每年有847名无脑婴儿出生(疾病控制和预防中心,2020年)。据估计,约65%的无脑胎儿将在子宫内死亡,而那些存活到出生的胎儿通常在出生后几小时或几天内死亡(无脑畸形医疗工作队,1990年)。在出生后存活下来的无脑婴儿通常表现出不规则的呼吸,需要使用机械通气来维持生命。几十年来,关于无脑婴儿作为器官捐赠者的地位和潜力,一直是一个备受争议和激烈辩论的话题。目前,无脑婴儿不被用作器官捐献者,因为他们不符合脑死亡的标准。对一些人来说,这似乎是消除了一个重要的器官捐献者库,而另一些人则认为这是对人类生命的神圣和尊严的保护。这个高度争议的无脑畸形问题以及它与脑死亡和器官捐赠的关系是本次讨论的主题。
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An Analysis of the Controversial Relationship Between Anencephaly, Brain Death, and Organ Donation
Abstract Anencephaly is a congenital defect in which the neural tube fails to fully close during the fourth week of embryonic development (Obeidi, Russell, Higgins, & O'Donoghue, 2010). The Medical Task Force on Anencephaly (1990) defined it as a condition with the following four characteristics: (a) A large portion of the skull is absent, (b) the scalp is absent over the skull defect, (c) the exposed tissue is hemorrhagic and fibrotic, and (d) the cerebral hemispheres are indistinguishable. Approximately one in every 4,647 births is affected by anencephaly, with an estimated 847 anencephalic infants born each year (Centers for Disease Control and Prevention, 2020). It is estimated that around 65% of anencephalic fetuses will die in utero, whereas those that survive to birth typically die within a few hours or days of life (Medical Task Force on Anencephaly, 1990). Anencephalic infants who do survive beyond birth often exhibit irregular breathing, requiring the use of mechanical ventilation to be kept alive. For decades, anencephalic infants have been the topic of a highly controversial and heated debate with regard to their status and potential as organ donors. Currently, anencephalic infants are not used as organ donors because they do not meet the criteria for brain death. To some, this seems like the elimination of a vital pool of organ donors, whereas others view this as preservation of the sanctity and dignity of human life. This highly disputed issue of anencephaly and how it relates to both brain death and organ donation is the topic of this discussion.
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