What does it mean for a human being to “die”? This question is more complex than one might think. In the domain of vital organ procurement, there is significant disagreement about the criteria that we should employ to assess when someone has died.
The standard criterion for several decades has been the “brain death” criterion, according to which a patient can be pronounced dead once “whole brain death” has occurred. Whole brain death refers to the comprehensive and irreversible cessation of brain function, typically caused by trauma, anoxia or tumor.
Yet transplant surgeons have in recent years employed a different, more ethically contentious definition of death, the so-called “circulatory criterion for death”. “Circulatory death” refers to the permanent cessation of cardiopulmonary function, after which point brain tissue quickly begins to deteriorate (if it hasn’t already).
According to proponents of the circulatory criterion, a patient’s heart will never spontaneously restart after 2 or so minutes of pulselessness. As such, it is seen as ethically permissible to begin organ procurement once this short time period has elapsed. There are in practice different time periods specified by healthcare regulators for when organ procurement can begin (typically between 75 seconds and 5 minutes).
Yet several scholars have criticised the cardiopulmonary definition of death, arguing that the impossibility of autoresuscitation does not necessarily indicate that death has occurred. Critics point out that CPR could still restart a person’s heart even when autoresuscitation has become an impossibility.
The most recent criticism came from Kennedy Institute for Ethics bioethicist Robert Veatch, who wrote an extended blog post on the topic this week. Veatch states:
If one opts for requiring physiological irreversibility, death should be pronounced whenever it is physiologically impossible to restore brain function. Autoresuscitation is completely irrelevant. If autoresuscitation can be ruled out before physiological irreversibility, one must still wait until that point is reached. On the other hand, if it becomes physiologically impossible to restore function before autoresuscitation can be ruled out, death can be pronounced at the earlier point. Either way autoresuscitation is irrelevant.
Fonte: https://www.bioedge.org/bioethics/are-organ-donors-really-dead/12677?utm_source=BioEdge&utm_campaign=ceae4f4597-EMAIL_CAMPAIGN_2018_05_06&utm_medium=email&utm_term=0_76ab23e62c-ceae4f4597-136431629
- MARCOS COLTRI
- Advogado. Especialista em Direito Médico e Odontológico. Especialista em Direito da Medicina (Coimbra). Mestre em Odontologia Legal. Coordenador da Pós-graduação em Direito Médico e Hospitalar - Escola Paulista de Direito (EPD). Coordenador ajunto do Mestrado em Direito Médico e Odontológico da São Leopoldo Mandic. Preceptor nos programas de Residência Jurídica em Direito Médico e Odontológico (Responsabilidade civil, Processo ético médico/odontológico e Perícia Cível) - ABRADIMED (Academia Brasileira de Direito Médico). Membro do Comitê de Bioética do HCor. Docente convidado da Especialização em Direito da Medicina do Centro de Direito Biomédico - Universidade de Coimbra. Ex-Presidente das Comissões de Direito Médico e de Direito Odontológico da OAB-Santana/SP. Docente convidado em cursos de Especialização em Odontologia Legal. Docente convidado no curso de Perícias e Assessorias Técnicas em Odontologia (FUNDECTO). Docente convidado de cursos de Gestão da Qualidade em Serviços de Saúde. Especialista em Seguro de Responsabilidade Civil Profissional. Diretor da ABRADIMED. Autor da obra: COMENTÁRIOS AO CÓDIGO DE ÉTICA MÉDICA.
