中国器官捐献与移植现状

自2015年1月1日起,中国公民逝世后器官捐献(CDCD)全面取代司法途径供体来源,成为器官移植使用的唯一来源,自此,中国器官移植事业开始为国际社会所瞩目。本文对近年来中国器官捐献与移植事业的发展进行介绍,以期鼓励同道开创事业、发展新局面。     

人体器官捐献协调员的现状与素质要求

近年来,我国器官移植事业迅速发展,但是供体短缺问题依然严峻。在器官捐献过程中,人体器官捐献协调员发挥的作用更为直接,是器官捐献协调团队的骨干力量。充分认识协调员的职责与内涵,科学严谨地培养优秀的人体器官捐献协调员,有助于全面推动我国器官捐献事业的健康发展。     

我国首例儿童脑死亡判定暨无偿器官捐献与移植

2003年11月6～9日，华中科技大学同济医学院附属同济医院脑死亡协作组及器官移植研究所在武汉市江夏医院、武汉大学人民医院多名专家协助下，完成我国首次儿童标准脑死亡判定及判定后自愿、无偿器官捐献儿童肾移植2例。2例手术同时进行，均获成功。现报道如下。     

中国器官捐献与移植新动向

动员全社会参与捐献,建设OPO联盟,顶层设计呈现新动向。据国家卫生计生委统计,中国每年约有30万人需要器官移植,但只有约l万人能够完成移植,其主要原因是器官捐献的严重不足。2014年3月19-20日,国家卫生计生委港澳台办公室、国际扶轮社3450地区和中国医院协会共同举办了“器官捐献志愿者登记网启动仪式暨2014器官捐献国际合作论坛”和“中国医院协会OPO联盟成立大会”,旨在联手推动中国内地的器官捐献移植工作,逐步探索出适合中国的人体器官捐献宣传动员模式。     

公民逝世后器官捐献及移植伦理审查经验与思考

对144例公民逝世后器官捐献及移植伦理审查工作进行总结后发现,器官捐献案例和外院分配器官供体来源的器官移植均需要进行伦理审查。审查内容上,在目前没有统一的细化标准的情况下,对不同情形下的伦理审查所需的材料列出标准化清单有利于审查的高效开展;审查形式上,网络审查方式方便快捷,可操作性强,是公民逝世后器官捐献及移植伦理审查较为实用的手段。对审查中遇到的特殊情况,建议从加强培训学习等方面进一步提高伦理委员会的审查水平。     

捐献器官捐献爱

器官移植是20世纪一项重大的医学进展。1936年,前苏联首先开展人体肾移植,1954年,美国一位年仅21岁的妇女移植了自己同卯双生姐姐的肾,1964年美国心脏移植获得成功,现在全球“换心人”在400个以上。     

本科通识教育对提升大学生器官捐献与移植认知的调查

器官捐献与器官移植是一项大爱工程,在挽救患者生命的同时也传递了社会的真善美。浙江大学本科通识课“器官捐献与器官移植——生命的接力与延续”,深度融合医学教育和思政教育,注重科学性和人文性的融合平衡。本研究通过对参与本课程学生问卷调查,显示通过本课程的学习,学生对器官捐献及器官移植的认知有了大幅提升,能更深切体会医学、社会与伦理之间的密切联系,有助于培养学生大爱情怀、公益心和国民意识,塑造正确的价值观。     

我国公民逝世后器官捐献移植运作流程分析

随着器官移植技术的飞速发展,我国人体器官的需求量日益增加,为了扭转目前国内器官供需比例严重失调的局面,提高大众时器官捐献的知晓率和认同感,国家先后出台了一系列关于公民逝世后器官捐献移植的法律法规,各省市也根据实际情况先后对器官捐献移植运作流程进行了探索性研究。但是,目前在国家层面,器官捐献移植仍无统一的运作流程,缺乏统一的衡量标准,严重制约了我国器官移植事业的发展、本文从器官捐献的基本概念出发,总结分析了我国公民逝世后器官捐献移植的基本组成结构。以运作流程为视角,将我国公民逝世后器官捐献移植过程划分为器官捐献流程、器官获取流程、器官分配移植流程和器官移植后的总结分析流程,并对每个流程的具体运作过程进行了详细阐述。,     

中国心脏死亡捐献器官评估与应用专家共识

1 中国心脏死亡器官捐献与心脏死亡诊断标准 1.1 中国心脏死亡器官捐献 中国心脏死亡器官捐献,属于中国公民逝世后器官捐献(China donation after citizen's death,CDCD)三大类中的“中国二类(C-Ⅱ)”,即国际标准化心脏死亡器官捐献(donation after cardiac death,DCD注)或称无心跳器官捐献(non-heart beating donation,NHBD)[1]. 近年来,DCD在我国已发展成为移植器官来源的重要组成部分.中华医学会器官移植学分会、中华医学会外科学分会移植学组和中国医师协会器官移植医师分会,联合制定本专家共识,以规范DCD器官的评估与应用,保障移植疗效.     

关于我国器官移植与器官捐献的思考

本文着重分析我国器官移植技术的发展水平和社会需求与器官移植的供体缺乏之间的矛盾和原因,就如何解决器官移植中的器官捐献问题进行探讨.     

Attitudes toward organ donation in China

Background  Organ transplantation represents an important advance in modern medical science, and it has benefited many patients with organ failure; however, the severe deficiency of organ sources has been a bottleneck that has limited the benefits this technology can bring. The aim of this study was to show the results of a survey on Chinese people’s awareness and attitudes toward organ donation.

Methods  We designed a questionnaire regarding organ donation consisting of 20 short questions, which were distributed to 10 groups. Most of the questions were multiple-choice; the core question related to people’s attitudes to organ donation and the development of organ donation. The survey was held in the outpatient hall of Beijing Chao-Yang Hospital, a commercial district, and four professional colleges. Participants were randomly selected, and answered questions about gender, age, educational background, profession, and study major.

Results  In all, 2930 valid responses were received. Male:female ratio was nearly 1:1.2 (mean age 38 years). Over 90.0% of participants knew about organ transplantation and which organs could be transplanted; more than 95.0% knew about organ donation, but the time they had been aware of it varied. Nearly 90.0% of the participants approved of deceased organ donation; 73.0% indicated they would like to donate their organs post mortem. Participants who knew more about organ failure and organ transplantation were more likely to support organ donation. College students were very positive about organ donation, though as they gain professional knowledge their attitudes may change. Altogether, 65.3% of participants approved of living organ donation, which was obviously lower than the figure for deceased organ donation (P <0.05). In all, 85.7% of participants approved of compensation to the deceased donor’s family. To promote organ donation in China, 62.9% of participants indicated that the public’s knowledge about organ donation should be increased via the media and various kinds of education. Only 20.0% of the participants believed that legislation was required.

Conclusions  We conclude that at present the Chinese public has a basic understanding about organ transplantation and donation. The majority respondents were in favor of deceased organ donation and were willing to donate their own organs after death.

     

活体器官捐献医学伦理学审查探讨

器官移植的活体器官捐献是目前医学伦理学关注的焦点，要杜绝一切形式的器官买卖及其它非法交易，必需做好活体器官捐献的医学伦理学审查。现就我院器官移植的活体器官捐献医学伦理学审查工作总结如下。     

器官有偿捐赠的伦理学思考

器官短缺严重阻碍了器官移植发展。器官有偿捐赠可以增加器官的数量和减少移植等待时间,但是也会带来众多的社会问题和伦理问题,包括对人类传统道德观念的冲击,导致器官交易和器官商品化,并且相关的法律法规尚不健全。为了规范器官有偿捐赠行为使其能够充分发挥积极作用,要加快针对有偿捐赠的法律的制定,还要坚持生命价值、知情同意、公平公正和循序渐进的原则。     

肝移植术后心脏死亡捐献肾行肾移植手术2例并文献复习

目的:加深针对扩大标准供肾的心脏死亡器官捐献(donation after cardiac death, DCD) 肾移植手术供肾质量术前评估以及术中术后管理的认识。方法:2 例供肾均来自于中南大学湘雅二医院器官移植中心同一例行肝移植手术术后5 年的供者。供者因移植肝功能恶化, 依次出现肝昏迷、脑死亡、肝肾综合征和心脏死亡。供肾评分系统(deceaseddonor score, DDS) 以及“零点”双肾肾穿刺活检被用以评估供肾功能, 综合评估后2 例受者接受了肾移植手术。结果:术后随访6 个月, 2 例受者移植肾功能基本正常。2 例受者出现肺部感染, 在给予相应治疗后出院, 未出现急性排斥反应。结论:采用肝移植术后供者DCD 肾移植手术, 术前需对供肾做出详细评估;手术后短期效果满意, 有助于扩大供体池, 远期效果有待进一步观察。     

Current status of pediatric kidney transplantation in China: data analysis of Chinese Scientific Registry of Kidney Transplantation

Background Kidney transplantation （KTx） is the primary therapy for children with renal failure.Unlike KTx in adult patients,it is commonly agreed that pediatric KTx in China is far behind that of America.There has been no systematic analysis of Chinese pediatric KTx reported.This study aimed to demonstrate the current status of pediatric KTx in China.Methods Registry data of pediatric KTx （1983-2012） from Chinese Scientific Registry of Kidney Transplantation （CSRKT） were retrospectively analyzed.Results There were 851 pediatric KTx from 102 transplant units.The recipients were （15.4±2.5） years of age,93.9％ of who were over 10 years old.Chronic glomerulonephritis and pyelonephritis accounted for 75.6％ of recognized primary diseases.Allografts were from deceased donors （72.2％） or living donation （27.7％）.The patient survival for 1,3,5,and 10 years was 96.9％,94.2％,92.3％,and 92.3％ and the graft survival was 94.6％,91.4％,86.3％,and 79.2％,respectively.The majority of post-transplant complications were acute rejection and infections.Annual transplant reached the peak in 2008 （n=114）,and decreased sharply in 2006 （n=41） and 2010 （n=57）.The percentage of pediatric KTx in total KTx was highest in 2007 （1.95％） and decreased to trough level in 2010 （1.0％）.Living donation increased by 32.5-folds from 2004 to 2008 and then decreased by 86.6％ till 2010.The percentage of living donation in pediatric or total KTx dynamically changed in a similar manner,while living donation ratio in pediatric KTx was much higher.Conclusions Kidney transplant can provide long-term benefits to pediatric recipients.Rejection and infections are worthy of concern during follow-up.Pediatric kidney transplant in China is very much lagging behind that in developed countries.Living donation played an important role in its development in the past decades.New strategies for implementation are encouraged to increase the priority of uremic children in organ allocation so as to promote its progress in China.     

Current attitudes toward organ donation after cardiac death in northwest China

Background People＇s attitude toward organ donation after cardiac death （DCD） has not come to an agreement in different countries and regions.Influenced by the local culture in China for thousands of years,the general public has different ideas about this issue.The purpose of this study was to investigate the current attitudes trend and characteristics of transplantation with organs donated after cardiac death in northwest China.Methods This largest single-center cohort study was performed by an interview or by telephone using a questionnaire.The family members of potential DCD donors were recruited from the First Affiliated Hospital,medical college of Xi＇an Jiaotong University located in a metropolitan area of northwest China.The 12-item attitude questionnaire was specifically developed from the literature review with coordinator,physician,and donor＇s family feedback.The participants were asked to rate the queries on a 5-point Likert intensity scale.Results The 174 participants included 56 （32.2％） women and 118 （67.8％） men.Most people were aged between 41 and 50 years （n=63,36.2％）,31 and 40 years （n=59,33.9％）,and less than 30 years （n=36,20.7％）.The top five attitudes of participants were the best person to suggest organ donation to a family was ranked as the DCD coordinator of Red Cross Organization （RCO,n=160,92％）,donor is a hero （n=143,82.2％）,honor to be a donor＇s family member （n=136,78.2％）,improved relationship with colleagues （n=124,71.3％）,and with recipient after donation （n=123,70.7％）.The best person to suggest organ donation to a family was ranked as the coordinator of RCO （n=160,92％）,doctor unrelated to transplantation （n=104,59.8％）,social worker （n=36,20.7％）,and doctor related to transplantation （n=25,14.4％）.The top two reasons for non-consent to donation were that the family insisted on intact body after patient death and did not want to have surgery again （n=51,41.5％）,and feared that they would be misunderstood by neighbors,relatives,and friends about donation （n=28,22.8％）.Conclusions This study revealed initial attitudes toward DCD in China.Some data afford insight into the decision-making procedure.The concerns of potential DCD donors and their families may help professionals provide better interventions in the future.     

反对活体器官移植的伦理论证

针对活体器官移植在我国有日渐增加的趋势，旨在通过活体器官移植的伦理依据的分析，以及考查反对活体器官移植的论证，提出以鼓励活体器官捐赠来增加器官的来源。是一种本束倒置的做法。弥补器官供应的缺口。关键在于合理地利用尸体器官。这就需要对现有的器官移植伦理框架进行调整，构建新的框架。     

基于信息平台的门诊流程优化

随着人们生活水平的不断提高,对医疗服务的要求也越来越高。传统医院门诊流程已不能满足患者需求。由于传统的诊疗流程从患者角度考虑少,看病难现象普遍存在,诊疗流程的改进已成为近年来医院管理者普遍关注的问题。医院信息系统为流程改进提供了一个良好的运行平台,使人性化服务流程得以实现。就传统门诊流程的现状,提出了在信息技术支持下的门诊流程优化措施。