脳死判定の指針と国内外の動向

Brain Death/Death by Neurologic Criteria: Guidelines and Recent Developments

わが国では脳死判定は「臓器の移植に関する法律」（臓器移植法）に基づいており，臓器移植を前提とするときに適用され「法的脳死判定」と呼ぶ。法的脳死判定の方法は，いわゆる竹内基準に基づいて作成された法的脳死判定マニュアルに従って行われる。一方，国際的には2020年8月，脳死判定の標準化の必要性が指摘され，2023年10月に米国神経学会，米国小児科学会，小児神経学会合同による米国の脳死（BD/DNC）判定ガイドライン改訂版が公表されている。本論では，わが国の脳死判定に関する指針，国内外の最新動向を紹介する。

Abstract

Brain death/death by neurologic criteria (BD/DNC) is a diagnostic guideline that defines the irreversible cessation of all functions of the brain, including both cerebral hemispheres and the brainstem, resulting from massive organic brain damage. In 2020, the World Brain Death Project, an international collaborative endorsed by 27 international societies, published comprehensive guidelines regarding the standardization of terminology and criteria for the accurate determination of BD/DNC in adults and children. In 2023, the updated and integrated 2010 American Academy of Neurology brain death guidelines for adults and the 2011 American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine guidelines for infants and children were published. In this article, the current concepts of BD/DNC and the practice of BD/DNC determination in Japan and worldwide are reviewed, along with the most recent developments.