La mort cérébrale : résoudre les contradictions de la déclaration éthique de la mort

Voici un article scientifique traitant des contradictions de la déclaration éthique de la mort :

Canadian Journal of Anesthesia 50:725-731 (2003)
© Canadian Anesthesiologists' Society, 2003
Neuroanesthesia and Intensive Care

[Brain death: resolving inconsistencies in the ethical declaration of death:]

La mort cérébrale : résoudre les contradictions de la déclaration éthique de la mort :

"Objectif : Les premiers critères de mort cérébrale ont été formulés en 1968 pour répondre, en partie, aux inquiétudes soulevées par la recherche d’organes pour les greffes. Malgré 30 ans d’application, un certain doute subsiste chez les professionnels et le public sur la validité de la notion théorique à l’origine de cette façon de déterminer la mort. Notre revue aborde les perspectives historiques de la formulation des critères de mort cérébrale et des contradictions des critères cliniques actuels.

Méthode : La revue descriptive provient de la consultation de références dans MEDLINE et d’autres sources publiées.

Constatations principales : Le principal concept de la détermination de la mort est l’arrêt irréversible de la fonction cardio-pulmonaire ou neurologique. Cependant, il y a des contradictions dans les critères neurologiques de la mort entre les pays, entre les populations de patients et dans l’usage des tests de confirmation. Ces contradictions peuvent inquiéter le public et la profession médicale sur la validité de la détermination de la mort par des critères neurologiques.

Conclusion : La greffe d’organes est fondée sur l’acceptation publique et professionnelle du fait que le donneur soit décédé. Étant donné que les critères de mort cérébrale, ou de leur application, demeurent variables, nous croyons qu’il est raisonnable d’envisager la formation d’un consensus visant à traiter de ces contradictions. Autrement, l’utilisation standard des tests radiographiques confirmatifs, qui précèdent le prélèvement d’organes de donneurs répondant aux critères cliniques de mort cérébrale, devrait être considérée pour fournir la preuve concluante de la perte permanente et irréversible de la fonction cérébrale."

English version :

Brain death: resolving inconsistencies in the ethical declaration of death:

Christopher James Doig, MD MSc* and Ellen Burgess, MD
* From the Department of Critical Care Medicine and the Office of Medical Bioethics;
and the Division of Nephrology, Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.

"Purpose: The first criteria for the determination of brain death were developed in 1968 in part to address concerns that had arisen with the retrieval of organs for transplantation. Despite over 30 years of application, some professional and public doubt persists over the validity of the theoretical construct underlying this method of determining death. Our review will address historical perspectives on the development of brain death criteria, and inconsistencies in current clinical criteria.

Method: Narrative review from selected MEDLINE references and other published sources.

Principal findings: The primary construct of the determination of death is that either cardiopulmonary or neurological function irreversibly ceases. However, there is inconsistency in the neurological criteria for death between jurisdictions, between patient populations, and in the use of confirmatory tests. These inconsistencies may cause concern in the public or profession about the validity of the determination of death by neurological criteria.

Conclusions: Organ transplantation is premised on professional and public acceptance that the donor is dead. Given that the criteria for brain death or their application remain variable, we suggest that it is reasonable to consider a national consensus to address these inconsistencies. Alternatively, the standard use of confirmatory radiographic testing prior to the retrieval of organs from donors who meet clinical brain death criteria should be considered to provide conclusive evidence of permanent and irreversible loss of brain function."

AS A CONCLUSION :

"Increasing organ donation is an important and laudable objective. To do so at the expense of exploiting society’s most vulnerable cannot be supported despite the best of intentions. We share the opinion of Dossetor who states: "ethics dictates the following: organs should not be procured from bodies where there is life... no measures should be carried out on the dying person even with family consent, that are not directed at serving the best interests of the dying person... Our faith in the supposedly objective diagnosis of brain death leads us to remove organs from the dead body where the heart is still beating. We now need to take seriously the question of whether the criteria to establish brain death are as reliable as we claim them to be.

If they are not as satisfactory as we once thought, the whole matter should be brought into debate."

Revision received April 30, 2003. Accepted for publication March 17, 2003.

Christopher James Doig, MD MSc* and Ellen Burgess, MD
* From the Department of Critical Care Medicine and the Office of Medical Bioethics;
and the Division of Nephrology, Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.

Address correspondence to: Dr. Christopher James Doig, Rm EG23G, Foothills Medical Centre, 1403, 29th Street NW, Calgary Alberta T2N 2T9, Canada. E-mail: cdoig@ucalgary.ca