Geven en nemen - dr Erwin JO Kompanje

ain as a whole (as in brainstem death) when essential criteria for clinical brain
death have been met, instead of complete loss of aU fllnctions. In the sitllation of
clinical brain death the person is considered dead, but not the hllman organism.
Thus, brain death is a moral value and not a scientific neutral concept. (Person' is
an ontological and sodal concept, the human organism a biological. From a moral
perspective, the death of a person is relevant, not the death of a hllman organism.
In the situation of persistent vegetative state in many cases the person may be
considered dead, but not always and the situation is not always irreversible. Thus,
a vegetative state can not, also from a moral perspective, be compared to death.
Complete loss of all functions is not required for the dedaration of dead as a
person. Patients fulfilling the criteria of the Dutdl Health Council for dedaration
ofbrain death have maybe not always lost a!llower ftmctions (completely), but
certainlyall higher cognitive and the most important integrative functions, essential
for life. In may therefore be conduded that procedures for organ preservation
and organ donation do not harm clinically brain dead patients as a person.
In c1/apter 4 medical and moral aspects of the rare sitllation of clinical brain
death in pregnant women is discussed. Eleven cases are described in the internationalHterature
in whom treatment was continued in order to permit ftuther
development of the fetus. When possible organ donation is considered, a conflict
of interests may arise. It is proposed that a pregnancy duration of22 to 24 weeks
or more continued treatment for the benefit of the fetus is justified, bath from a
moral and practical perspective, but that a more relllctant attitude is appropriate
in continuing treatment in pregnancies of shorter duration. In pregnandes
continued into the third trimester a cesarean delivery may be perfofmed and
if permission for organ donation obtained the organs of the woman can he
subsequently removed for transplantation.
In chapter 5 the turnÎ11g point from therapelltic to non therapeutic management
is discussed in patients fo!lowing the development ofbrain death. In the
recently passed organ donation act possibilities are provided for procedures to
maÎ11tain organ function and for preparations for organ donation. The act does
not specifically state whieh procedures are meant, but in practiee many measures
to maintain organ blood flow in preparation for possible organ donation procedure
are already taken duriIlg the phase in whieh the brain is still dying. According
to the organ donation act such procedures, perfonned before the definite
diagnosis ofbrain death, are only permitted if explicit consent of the patient
for organ donation has been dOCllmented in the donor register. IE intensive care
physicians strictly adhere to the restrictions imposed by this organ donation act,
a great risk exists of decreasing the potentialavailability oforgans and moreover
also of the quality of organs donated. This aspect is deserving of attention in the
evaluation of the Dutch organ donation act.
It is not reasonabIe to require ftllfilhnent of all criteria for brain death in an
individual patient when dedding to stop treatment. The criteria do however need
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