Kryterium śmierci mózgowej w perspektywie historycznej

Abstract

Beginning from the second part of the XX century, the traditional cardiopulmonary criteria for defining death was not able to meet the new challenges presented by the development of new medical technology. The use of the iron lung and, later on, the respirator and new methods applied in the intensive care units were able to help in the recovery of patient and, also, to maintain artificially and indefinitely those whose heart continued to beat, but who suffered irreversible brain damage. In the latter case, the patient was dead, but the traditional criteria did not allow the possibility of declaring death. New brain related criteria was needed to solve these difficulties. In 1968, a report of the Ad Hoc Committee of the Harvard Medical School appeared titled A Definition of Irreversible Coma, which gave the new criteria for defining death. It said that a permanently non-functioning brain could be considered dead. Its death was leading necessarily and consequently to the death of the whole organism. Based on this fact and using suitable medical tests it was possible to establish a new way of declaring a person’s death. The next step in the development of brain death criteria was the report of the President’s Commission on the Medical, Legal and Ethical Issues in the Determination of Death, edited in 1981. This document contained a Uniform Determination of Death Act. It stated that an individual, who has sustained either irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem, is dead. The report of the President’s Commission introduced the notion of total brain death (TBD) and analyzed and described three essential elements of the brain death issue: definition of death, criteria of death and clinical test for death. Currently, the brain death criteria is widely accepted, but there is no global consensus in diagnostic confirmatory procedures.