Muerte encefálica bioética y trasplante de órganos / Brain death, bioethics and organ transplantation

The concept of death has evolved medically, legally and culturally since the introduction of life support technologies in the middle of the 20th century. The traditional cardiopulmonary and the new neurologically based brain death criterions of death are examined. We conclude that brain death, defined as total and irreversible loss of function of the whole brain, fulfills better "the permanent cessation of functioning of the organism as a whole² definition of death. Brain death diagnosis, based on standard neurologic clinical examination performed accurately, is unequivocal. Transplantation medicine, mostly based on organ donation of brain dead people, has become a routine and universally accepted therapeutic intervention nowadays, which benefits many people. Ethics foundations of organ transplantation are reviewed. Even though brain death and organ donation are widely accepted in medical, legal, religious and public opinion today, the whole society and medical community need to be further educated about these matters, so that unavoidable changes of traditional concepts might be better understood. Permanent education should be the best way to dissipate social fears and distrust towards organ donation and brain death (Rev Méd Chile 2004; 132: 109-18).

Tuberculosis en pacientes trasplantados renales / Tuberculosis in renal transplant patients

We estudied the incidence of tuberculosis in 37 renal transplant patients. Mean age was 37 years and immune supression therapy had been used for a mean of 37 mounths. Tuberculosis free cases had received presnisone at a mean dose of 10 ñ 4 mg/day and azathyoprine, 96 ñ 35 mg/day. 28% of patients had a postive tuberculin test, 24% a healed tuberculous lung lesion and 40% received chemoprofilaxis. Four patients developed tuberculosis, 10 times the incidence expected for the general population. Fever was present in all patients. Two patients had a disseminated form and one a laryngeal location. None of the patients had recived chemoprophylaxis and the dose of prednisone was higher (18 ñ 9 mg/day) than that received by non-infected patients. Thus, chemoprofilaxis for tuberculosis appears warranted in all renal transplant recipients, regardiess of tuberculin test results or chest X ray findings