Avtor/Urednik		Trontelj, Jože
Naslov		Možganska smrt in presajanje organov: biološka, etična in filozofska vprašanja
Prevedeni naslov		Brain death and organ transplantation: biological, ethical and philosophical issues
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 65, št. 4-5
Leto izdaje		1996
Obseg		str. 165-70
Jezik		slo
Abstrakt		The diagnosis of brain death is safe and reliable, provided that the preconditions are met and the diagnostic criteria are carefully applied. On the other hand, we still have no universally accepted concept of brain death. In some countries, a person is considered dead when the functions of his or her brainstem are permanently lost. In other countries, brain death is diagnosed when it can be demonstrated that function of the brain as a whole is irreparably destroyed. Arguments are presented agaist the concept of "brainstem death" as being equivalent to brain death, and in favour of the "whole brain death" concept. Occasional survival of the hemispheres above the dead brainstem, although usually short, has been well documented. This condition is suggested to represent an extreme form of the de-efferented states (locked-in syndromes); EEG or some other supportive method must be used to diagnose such cases. A third concept is increasingly often advocated in the literature: that an irreversible loss of neocortical function means death of the human being as a person, and that this condition, has to be considered as brain death with all its medical, ethical and legal consequences. Even among the medical professionals responsible for diagnosing brain-dead patients and working in the areas to intensive care and transplantation there seems to persist disturbing confusion regarding the concepts of dying and death. This is at least partly due to incoherence and logical contradictions between the different concepts of death. Anencephaly and persistent vegetative state do not meet the currently accepted criteria of brain death; they are considered a justifiable cause to discontinue life-supporting measures (including feeding and hydration) but these patients may not be used as a source of organs for transplantation. It is postulated that the same rules should apply to patients with "brainstem death", as long as they fail to satisfy the criteria of whole-brain death.
Izvleček		Diagnoza možganske smrti je varna in zanesljiva, če skrbno upoštevamo izhodiščne pogoje in vestno uporabimo diagnostične kriterije. Nasprotno pa v literaturi še vedno ni soglasja o konceptu možganske smrti. V nekaterih deželah velja, da je mogoče človeka spoznati za mrtvega, ko mu dokončno preneha delovanje možganskega debla. Drugod velja, da človek umre šele tedaj, ko dokončno odpovedo funkcije celotnih možganov. Navedeni so argumenti zoper enačenje odpovedi možganskega debla s smrtjo. Dokumentirani so primeri, ko sta hemisferi preživeli nad mrtvim možganski deblom, čeprav navadno le za kratek čas. Avtor predlaga, da se ti primeri obravnavajo kot skrajna oblika stanj deeferentacije, ki so dobro ugotovljiva z EEG-jem in nekaterimi drugimi preiskavnimi metodami. Vse pogosteje se pojavlja še tretje mnenje: da dokončna odpoved neokorteksa pomeni smrt človeka kot osebnosti in da je tudi to stanje treba obravnavati kot možgansko smrt z vsemi medicinskimi, etičnimi in pravnimi posledicami. To mnenje pa še nikjer ni uveljavljeno. Celo med specialisti in strokovnim medicinskim osebjem, ki je odgovorno za obravnavo bolnikov s hudo možgansko okvaro in za diagnosticiranje možganske smrti na oddelkih za intenzivno nego, je še vedno precej zmede v pojmovanju umiranja in smrti. To je vsaj deloma posledica nedoslednosti in logičnih protislovij med navedenimi tremi koncepti možganske smrti. Anencefalija in trajno vegetativno stanje ne izpolnjujeta sedanjih kriterijev možganske smrti. Danes je ponekod že dovoljeno prekiniti medicinske ukrepe, ki vzdržujejo telesne funkcije teh bolnikov (vključno s hranjenjem tekočin). Ni pa jih možno uporabiti kot dajalce organov. Avtor meni, da bi isti pravili morali veljati pri bolnikih z mrtvim možganskim deblom, dokler ne izpolnjujejo kriterijev smrti celotnih možganov.
Deskriptorji		BRAIN DEATH ORGAN TRANSPLANTATION