뇌사와 식물인간(상태)은 구분 되어야 합니다.

뇌사와 식물인간(상태)은 구분 되어야 합니다.

뇌사 vs 식물인간

<손상범위>

식물인간: 대뇌

뇌      사: 대뇌 + 간뇌 + 뇌의 전반적인 부분

* 식물인간: 대뇌(의식적 활동 담당: 생각, 말하기 등) 손상 => 대개 인공호흡기 없이도 숨쉴수 있음. 인위적으로 영양분을 공급해주면 장기간 연명가능. (욕창, 폐렴, 요로감염 등을 방지하기 위해 지속적인 관리가 필요.)

* 뇌사: 대뇌(의식적 활동 담당: 생각, 말하기 등) + 소뇌 + 뇌간(생명유지담당: 간뇌, 중뇌, 연수 등이 체온, 혈당, 심장박동 등을 유지) 손상 => 인공호흡기를 통해 숨쉼. 생명연장 물질을 투여하여도 2~4주 내에 사망.

이미지출처: 네이버 지식백과 과학 돋보기

이미지출처: 서울대학교 병원 장기이식 센터

그러므로

장기기증을 위한 장기의 적출은 뇌사 상태인 사람으로부터 이루어지게 되며,

식물인간 상태인 사람으로부터의 장기 적출은 금지된다.

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뇌사

뇌사(腦死, 영어: brain death)는 외상과 같은 심각한 사고를 당해 뇌간을 포함한 전반적인 뇌 기능이 완전히 정지된 상태를 말한다. 회복은 불가능한 것으로 알려져 있다. 호흡을 유지시켜 주기만 한다면 완전히 사망하지는 않는다. 그러나 아무런 인지도 할 수 없어 사실상 죽은 것이나 다름이 없다. 뇌간을 포함한 뇌 기능이 완전히 정지했다는 점에서 식물인간과는 다르다.

아직 뇌사 상태에서 깨어난 사람은 아무도 없는 것으로 알려져 있으나, 교통사고로 뇌사 판정을 받은 남성이 장기 기증 수술 준비 중 팔을 움직여 신호를 보내거나[1]깨어난 보고도 있다.[2]

만에 하나 깨어난다 해도 기억이나 언어 기능, 사고 기능 등이 뇌사 이전 상태로 온전히 돌아올 수는 없을 것으로 보고 있다.

more info)

*ref: https://ko.wikipedia.org/wiki/%EB%87%8C%EC%82%AC

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Brain death is the complete and irreversible loss of brain function (including involuntary activity necessary to sustain life).[1][2][3][4] Brain death is one of the two ways of determination of death, according to the Uniform Determination of Death Act of the United States (the other way of determining death being "irreversible cessation of circulatory and respiratory functions").[5] It differs from persistent vegetative state, in which some autonomic functions remain.[6]

The Australia and New Zealand Intensive Care Society (ANZICS) states that the "determination of brain death requires that there is unresponsive coma, the absence of brain-stem reflexes and the absence of respiratory centre function, in the clinical setting in which these findings are irreversible. In particular, there must be definite clinical or neuro-imaging evidence of acute brain pathology (e.g.traumatic brain injury, intracranial haemorrhage, hypoxic encephalopathy) consistent with the irreversible loss of neurological function."[7]

Brain death is used as an indicator of legal death in many jurisdictions, but it is defined inconsistently. Various parts of the brain may keep living when others die, and the term "brain death" has been used to refer to various combinations. For example, although a major medical dictionary[8] says that "brain death" is synonymous with "cerebral death" (death of the cerebrum), the US National Library of Medicine Medical Subject Headings (MeSH) system defines brain death as including the brainstem. The distinctions can be important because, for example, in someone with a dead cerebrum but a living brainstem, the heartbeat and ventilation can continue unaided, whereas in whole-brain death (which includes brain stem death), only life support equipment would keep those functions going. Patients classified as brain-dead can have their organs surgically removed for organ donation; though not everyone agrees with this practice, preferring to limit organ donation to those individuals who have suffered the death of all of their brain and the death of their cardiac and respiratory systems (biological, or full, death). However, if one limits the criteria to those individuals, procuring viable organs can become much more difficult.

more info)

*ref: https://en.wikipedia.org/wiki/Brain_death

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식물인간

식물인간 (植物人間, 영어: Persistent Vegetative State)은 사고나 질병에 의해 대뇌피질에 손상을 입어 마치 식물처럼 아무런 움직임도 할 수 없고 의식도 없는 상태로 뇌간에 의해 호흡이나 소화 기능 등 생명 유지에 필수적인 기능만을 하는 사람을 말한다.

그러나 누군가의 지속적인 도움과 간병이 없으면 보통 수일 내로 길어야 2주 이내에 사망한다. 증상이 심하지 않은 경우 식물인간 상태에서 깨어나 정상적인 생활로 돌아가는 일이 종종 있으며 많지는 않으나 심각한 손상을 입은 식물인간이 기적적으로 완전히 또는 일시적으로 일부 기능이 회복되는 일도 가끔 일어난다. 식물인간의 재활을 위해 여러 방법이 시도되고 있으며 효과가 보이는 방법도 있으나 근본적인 치료법은 현재까지는 개발된 것이 없다.

사람들은 흔히 식물인간과 뇌사를 혼동하는 경우가 많은데, 적어도 뇌의 일부분은 살아있다는 점에서 뇌사와는 구별된다. 식물인간의 원인은 다양한데 보통 뇌경색, 뇌출혈 같은 뇌졸중과 같은 뇌혈관질환 일 수 있고 또 저 산소성 뇌손상도 식물인간의 원인이다. 식물인간의 치료법은 아직 확실하진 않지만 그 사람이 좋아하는 것을 계속 반복하며 말하면 식물인간의 세계에서 빠져나올 수 있다는 말도 있다. 하지만 아직 확실하진 않다.

more info)

*ref: https://ko.wikipedia.org/wiki/%EC%8B%9D%EB%AC%BC_%EC%9D%B8%EA%B0%84

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A persistent vegetative state (PVS) is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. After four weeks in a vegetative state (VS), the patient is classified as in a persistent (or 'continuing') vegetative state. This diagnosis is classified as a permanent vegetative state some months (3 in the US and 6 in the UK) after a non-traumatic brain injury or one year after a traumatic injury. Nowadays, more doctors and (neuro)scientists prefer to call the state of consciousness an unresponsive wakefulness syndrome, primarily because of ethical questions about whether a patient can be called "vegetative" or not.[1]

Definition

There are several definitions that vary by technical versus laymen's usage. There are different legal implications in different countries.

Medical definition

A wakeful unconscious state that lasts longer than a few weeks is referred to as a persistent (or 'continuing') vegetative state.[2][3]

Lack of legal clarity

Unlike brain death, permanent vegetative state (PVS) is recognized by statute law as death in very few legal systems. In the US, courts have required petitions before termination of life support that demonstrate that any recovery of cognitive functions above a vegetative state is assessed as impossible by authoritative medical opinion.[4] In England and Wales the legal precedent for withdrawal of clinically assisted nutrition and hydration in cases of patients in a PVS was set in 1993 in the case of Tony Bland, who sustained catastrophic anoxic brain injury in the 1989 Hillsborough disaster.[2] Application to the Court of Protection is still now required before nutrition and hydration can be withdrawn or withheld from PVS (or 'minimally conscious' - MCS) patients.[5]

This legal grey area has led to vocal advocates that those in PVS should be allowed to die. Others are equally determined that, if recovery is at all possible, care should continue. The existence of a small number of diagnosed PVS cases that have eventually resulted in improvement makes defining recovery as "impossible" particularly difficult in a legal sense.[6] This legal and ethical issue raises questions about autonomy, quality of life, appropriate use of resources, the wishes of family members, and professional responsibilities.

Vegetative state

The vegetative state is a chronic or long-term condition. This condition differs from a coma: a coma is a state that lacks both awareness and wakefulness. Patients in a vegetative state may have awoken from a coma, but still have not regained awareness. In the vegetative state patients can open their eyelids occasionally and demonstrate sleep-wake cycles, but completely lack cognitive function. The vegetative state is also called a "coma vigil". The chances of regaining awareness diminish considerably as the time spent in the vegetative state increases.[7]

Persistent vegetative state

Persistent vegetative state is the standard usage (except in the UK) for a medical diagnosis, made after numerous neurological and other tests, that due to extensive and irreversible brain damage a patient is highly unlikely ever to achieve higher functions above a vegetative state. This diagnosis does not mean that a doctor has diagnosed improvement as impossible, but does open the possibility, in the US, for a judicial request to end life support.[6] Informal guidelines hold that this diagnosis can be made after four weeks in a vegetative state. US caselaw has shown that successful petitions for termination have been made after a diagnosis of a persistent vegetative state, although in some cases, such as that of Terri Schiavo, such rulings have generated widespread controversy.

In the UK, the term 'persistent vegetative state' is discouraged in favor of two more precisely defined terms that have been strongly recommended by the Royal College of Physicians (RCP). These guidelines recommend using a continuous vegetative state for patients in a vegetative state for more than four weeks. A medical definition of a permanent vegetative state can be made if, after exhaustive testing and a customary 12 months of observation,[8] a medical diagnosis that it is impossible by any informed medical expectations that the mental condition will ever improve.[9] Hence, a "continuous vegetative state" in the UK may remain the diagnosis in cases that would be called "persistent" in the US or elsewhere.

While the actual testing criteria for a diagnosis of "permanent" in the UK are quite similar to the criteria for a diagnosis of "persistent" in the US, the semantic difference imparts in the UK a legal presumption that is commonly used in court applications for ending life support.[8] The UK diagnosis is generally only made after 12 months of observing a static vegetative state. A diagnosis of a persistent vegetative state in the US usually still requires a petitioner to prove in court that recovery is impossible by informed medical opinion, while in the UK the "permanent" diagnosis already gives the petitioner this presumption and may make the legal process less time-consuming.[6]

In common usage, the "permanent" and "persistent" definitions are sometimes conflated and used interchangeably. However, the acronym "PVS" is intended to define a "persistent vegetative state", without necessarily the connotations of permanence, and is used as such throughout this article.

Bryan Jennett, who originally coined the term "persistent vegetative state", has now recommended using the UK division between continuous and permanent in his most recent book The Vegetative State. This is one for purposes of precision, on the grounds that "the 'persistent' component of this term ... may seem to suggest irreversibility".[10]

The Australian National Health and Medical Research Council has suggested "post coma unresponsiveness" as an alternative term for "vegetative state" in general.[11]

more info)

*ref: https://en.wikipedia.org/wiki/Persistent_vegetative_state

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