أكذوبة موت المخ

اعتراف أطباء نقل الاعضاء بأن الهدف من اختلاق مفهوم ( موت المخ ) المزعوم هو انتزاع الاعضاء من المرضى وهى فى حالة سليمة قبل الوفاة الحقيقية بتوقف القلب والرئتين

يعترف اطباء نقل الاعضاء في العشرات من الابحاث والمقالات في المجلات الطبية العالمية بأن مفهوم موت المخ قد اختلق من اجل اطلاق ايدي الاطباء في انتزاع الاعضاء من مرضى الغيبوبة و هم احياء نابضي القلب حتى تكون الاعضاء في حاله سليمة قابلة للعمل بعد نقلها..وأن هذا السبب الحقيقي لاختلاق اكذوبة موت المخ ..... ومن امثلة هذه المقالات ما يلى :

Critical Care Med.2003 Sep,31(9):2391-6

Role of brain death and the dead-donor rule in the ethics of organ transplantation

Auteur (s) / Author (s)

TRUOG Robert D. ⁽¹²⁾ ; ROBINSON Walter M.  ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Departments of Anaesthesiology and Medical Ethics, Harvard Medical School, Cambridge, MA, ETATS-UNIS
(2) Medical Intensive Care Unit, Children's Hospital, Boston, MA, ETATS-UNIS

Résumé / Abstract

The dead-donor rule requires patients to be declared dead before the removal of life-sustaining organs for transplantation. The concept of brain death was developed, in part, to allow patients with devastating neurologic injury to be declared dead before the occurrence of cardiopulmonary arrest. Brain death is essential to current practices of organ retrieval because it legitimates organ removal from bodies that continue to have circulation and respiration, thereby avoiding ischemic injury to the organs. The concept of brain death has long been recognized, however, to be plagued with serious inconsistencies and contradictions. Indeed, the concept fails to correspond to any coherent biological or philosophical understanding of death. We review the evidence and arguments that expose these problems and present an alternative ethical framework to guide the procurement of transplantable organs. This alternative is based not on brain death and the dead-donor rule, but on the ethical principles of nonmaleficence (the duty not to harm, or primum non nocere) and respect for persons. We propose that individuals who desire to donate their organs and who are either neurologically devastated or imminently dying should be allowed to donate their organs, without first being declared dead. Advantages of this approach are that (unlike the dead-donor rule) it focuses on the most salient ethical issues at stake, and (unlike the concept of brain death) it avoids conceptual confusion and inconsistencies. Finally, we point out parallel developments, both domestically and abroad, that reflect both implicit and explicit support for our proposal

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Intensive Care Med.2004 Sep,30(9):1715-22.

Irreversible apnoeic coma 35 years later Towards a more rigorous definition of brain death?

Nereo Zamperetti1 , Rinaldo Bellomo2, Carlo Alberto Defanti3 and Nicola Latronico4

Abstract  The concept of brain death (BD) has been widely accepted by medical and lay communities in the Western world and is the basis of policies of organ retrieval for transplantation from brain-dead donors. Nevertheless, concerns still exist over various aspects of the clinical condition it refers to. They include the utilitarian origin of the concept, the substantial international variation in BD definitions and criteria, the equivalence between BD and the donors biological death, the practice of retrieving organs from donors who are not brain-dead (as in non-heart-beating organ donor protocols), the proposal to abandon the dead donor rule and attempts to overcome these problems by adapting rules and definitions. Suggesting that BD, as it was originally proposed by the Harvard Committee, is more a moral than a scientific concept, we argue that current criteria do not empirically justify the definition of BD; yet they consistently identify a clinical condition in which organ retrieval can be morally and socially justified. We propose to revert to the old term of irreversible coma or, better yet, of irreversible apnoeic coma, thus abandoning the presumption of diagnosing the death of all intracranial neurons and/or the patients biological death. On the other hand, we think that a (re)definition of the vital status of donors identified on neurological criteria can only occur through a prior (re)definition of death, a task which is not only medical but societal.

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Hastings Cent Rep.1997 Jan-Feb,27(1):29-37

Robert D. Truog

Is It Time to Abandon Brain Death?

The Hastings Center Report

Despite its familiarity and widespread acceptance, the concept of "brain death" remains incoherent in theory and confused in practice. Moreover, the only purpose served by the concept is to facilitate the procurement of transplantable organs. By abandoning the concept of brain death and adopting different criteria for organ procurement, we may be able to increase both the supply of transplantable organs and clarity in our understanding of death.

Over the past several decades, the concept of brain death has become well entrenched within the practice of medicine. At a practical level, this concept has been successful in delineating widely accepted ethical and legal boundaries for the procurement of vital organs for transplantation. Despite this success, however, there have been persistent concerns over whether the concept is theoretically coherent and internally consistent.[1] Indeed, some have concluded that the concept is fundamentally flawed, and that it represents only a "superficial and fragile consensus.

[2] In this analysis I will identify the sources of these inconsistencies, and suggest that the best resolution to these issues may be to abandon the concept of brain death altogether

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Seminars in Neurology

Semin Neurol. 1997,17(3):265-70

Reexamining the definition and criteria of death.
Taylor RM

Department of Neurology, Ohio State University, Columbus 43210, USA.

The whole-brain criterion of death was first formally proposed by the "Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death" in a "Special Communication" published in JAMA in 1968. Since then, all states in the United States and many western countries have endorsed this definition of death. The strongest defense of the concept of "brain death" was provided by Bernat, Culver, and Gert in a series of papers published in the early 1980s, emphasizing the important distinctions between the definition and the criteria of death and the tests for death. Careful analysis, however, demonstrates that brain-related criteria of death are inconsistent with traditional concepts of death. Thus, although death is properly understood as a biological phenomenon, "brain death" is a social construct created for utilitarian purposes, primarily to permit organ transplantation. The best definition of death is "the event that separates the process of dying from the process of disintegration" and the proper criterion of death in human beings is "the permanent cessation of the circulation of blood." Nevertheless, because brain-related criteria of death have been widely accepted, and because our society has demonstrated a strong commitment to organ transplantation, abandoning the concept of brain death would create serious political problems. Abandoning the "dead donor rule" would solve the problem of obtaining organs for transplantation, but would create different, equally serious, political problems. Preserving the concept of brain death as a social construct, as a "legal definition of death," but distinct from biological death, is also problematic, but may be our most acceptable alternative

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JOURNAL OF CRITICAL CARE
Crit Care.2005,9(6):538-42 

Pro/con ethics debate: When is dead really dead?

Leslie Whetstine1, Stephen Streat2, Mike Darwin3 and David Crippen4

1. Health Care Ethics Center, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282, USA

2. Department of Critical Care Medicine, Auckland Hospital, Private Bag 92-024, Auckland, New Zealand

3. Independent Critical Care Consultant, PO Box 1175, Ash Fork Arizona 86320, USA

4. Department of Critical Care Medicine, University of Pittsburgh Medical Center, 644a Scaife Hall, 3550 Terrace Ave, Pittsburgh, PA 15261

Abstract

Contemporary intensive care unit (ICU) medicine has complicated the issue of what constitutes death in a life support environment.

Not only is the distinction between sapient life and prolongation ofvital signs blurred but the concept of death itself has been mademore complex. The demand for organs to facilitate transplantation promotes a strong incentive to define clinical death in a manner that most effectively supplies that demand. We consider the problem of defining death in the ICU as a function of viable organ availability for transplantation

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