关于我国公民逝世后器官捐献与获取的伦理思考

目前,我国公民逝世后器官捐献与获取存在器官捐献宣传工作不力,器官移植伦理审查不完善,器官捐献与获取缺乏统一的协调机制等问题。提出公民逝世后器官捐献与获取应坚持自主自愿、知情同意、尊重生命、无偿捐献的基本原则,并提出加大公民逝世后器官捐献的宣传力度、建立符合伦理的公民逝世后捐献与获取流程、切实加强伦理监管、建立健全器官获取组织(OPO)的组织架构及管理规范、创建供体补偿机制等措施。     

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。,     

医界快讯

卫生部:准备规范器官移植和捐献的管理卫生部新闻发言人毛群安近日在卫生部例行新闻发布会上表示,卫生部现正在会同有关部门起草关于器官移植的条例,既规范器官移植以及技术的应用,也要规范器官捐献的管理,保证公民在捐献活动中比较顺畅地实现愿望。随着条例的颁布,对器官的捐献规范化管理可望实现。卫生部鼓励公民积极参与到器官移植的捐献活动中来。     

公民逝世后器官捐献肝质量研究进展

国际规范性器官移植的供体主要来源于公民逝世后器官捐献(donation after citizen's death)。近年国际国内有关公民逝世后器官捐献肝脏质量的研究取得了长足的进展,大量降低术后早期原发性无功能、肝功能延迟性恢复等相关并发症的新疗法涌现。脑死亡捐献(donation after brain death,DBD)及心死亡器官捐献(donation after cardiac death,DCD)成为公民逝世后器官捐献肝脏的基础,DBD与DCD供体肝移植并发症及其预后成为新的关注点。     

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.     

陈忠华

中国教育部、卫生部器官移植重点实验室主任，深圳市红十字会器官捐献办公室主任陈忠华，多年来一直为建立中国公民去世后的器官捐献网络而奔波。     

医学生器官捐献意愿度研究进展的综述

通过调研国内外器官捐献的现状,客观分析了影响我国器官捐献的因素,主要包括了传统文化的束缚、相关法律不够完善、脑死亡立法的不足。文章通过提高医学生器官捐献的意愿度,以期以医学生为突破口,快速提高公民的认知,提升公民自愿器官捐献率,更好地推动我国器官移植事业的发展。     

医疗机构开展公民逝世后器官捐献移植伦理审查的经验与思考

为了探讨公民逝世后器官捐献与移植的伦理审查经验,为医疗机构开展相应伦理审查提供参考性价值。通过运用描述性研究,采用目的抽样法,根据数据饱和原则,最终选取10名器官移植技术临床应用伦理委员会委员及秘书作为受访者进行半结构式访谈,并采取Colaizzi 7步分析法进行资料分析、归纳和提炼主题。结果发现,公民逝世后器官捐献与移植的伦理审查经验包括伦理委员会职责、伦理审查要点、伦理审查会议形式及其优缺点、器官移植伦理委员会建设四个主题。因此,目前医疗机构开展器官捐献与移植伦理审查存在缺陷,可通过遵循医学伦理四大原则落实伦理审查要素、完善公民逝世后器官捐赠相关法律、构建合理高效的伦理审查会议模式、建立健全适宜的器官移植伦理委员会运行方式等予以完善。     

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。     

成都市某医院医务工作者对器官移植与捐献的意愿调查

目的了解医务工作者对器官移植与捐献的意愿和认知情况。方法通过自编调查问卷,以医务工作者为调查对象的问卷调查形式。问卷内容包含医务工作者的一般信息,器官移植与捐献的认知情况,器官移植与捐献的意愿,器官移植与捐献关注的问题及影响捐献的相关因素,捐献移植方式的选择等。问卷数据由SPSS 17.0分析描述和统计。结果发放问卷200份,回收200份,回收率100%,有效率100%。139例愿意在离世后进行遗体器官捐献,61例不愿意;但绝大多数医务人员没有进行器官捐献意愿登记;175例没有移植亲属;108例支持家人进行遗体器官捐献;我国当前尚处于捐献体系的初步建立中,应扩充器官捐献协调员队伍、建立健全器官捐献分配体系、加大器官移植与捐献知识的宣教力度、完善法律法规,从而推动器官移植事业的发展。结论作为医务工作者,应在器官移植与捐献上做出榜样,丰富自身的器官移植与捐献的知识,为器官移植与捐献的宣传做出贡献,促进器官移植与捐献事业的发展。     

我国公民逝世后器官捐献意愿调查及影响因素研究简

目的：了解国内公民逝世后器官捐献意愿状况及其影响因素。方法：采用随机整群抽样法,选取北京、上海、重庆和广州4座城市900名来自不同社会阶层的人群为研究对象,应用自制的公众对人体器官捐献的认知、态度和行为调查表进行问卷调查。结果：国内公民逝世后器官捐献意愿率为16.57%,在性别方面,男性较女性捐献率高（P＝0.032）;同时,捐献意愿与年龄和学历有相关关系（P＝0.047;P＝0.029）。影响国内公民进行遗体捐献的最主要因素为中国传统文化和观念,其次不了解国内遗体捐献程序和法规制度。结论：发现公民捐献意愿较以往调查明显升高,可能与当前国内器官捐献工作的全面开展,人们的捐献态度改变有关。影响捐献主要因素有中国传统文化和观念、不了解遗体捐献程序和法规制度,以及担心同意器官捐献后医院会因此而消极治疗等。     

公民逝世后器官捐献的推定同意及其在中国的可行性

通过叙述我国目前器官捐献的现状,进而研究了推定同意的概念,并论述了推定同意的意义：推定同意也是知情同意,其在相当程度上能提高器官捐献率,能让器官被充分利用、减少浪费,可以使器官捐献的利他与利己完善结合。认为通过国家倡导、进行长期广泛的宣传教育、借鉴国际经验等措施可促进其在我国的推行性。     

我国器官捐献的困境及对策

目前,我国器官捐献率低的主要原因有传统文化影响,政策法规不完善,缺乏完善的器官捐献组织机构,社会信任危机等原因.运用综摄法对器官捐献现状及其深层原因进行剖析,提出我国应完善相关医疗政策,建立系统完善的人体器官捐献渠道,加大宣传教育力度,设立专用账户,对器官捐献者应注重人文关怀以及推广脑死亡标准等对策.     

影响器官捐献的伦理因素及对策探讨

影响器官捐献的伦理原因在于传统道德观念的制约、职业道德因素的影响、年龄及受教育程度的影响、对器官捐献的伦理认知缺乏、死者家属及周围人文伦理环境的影响、医生的伦理劝说程度不够、移植的亲属及补偿机制的道德问题.为了提高器官捐献率,需要转变道德认知、应用克隆技术、提高全民道德意识、加强移植协调员的培训、深化器官捐献及移植的研究、加强医德医风建设、普及伦理教育.     

关于大学生器官捐献认知状况及影响因素的调查研究——以温州茶山高教园区为例

目的 了解温州市茶山高教园区在校大学生对器官捐献的认知现状,分析其影响因素,为相关部门采取措施提供依据.方法 采用偶遇抽样方法,对温州市茶山高教园区279名大学生进行了关于器官捐献认知现状的问卷调查.结果 绝大多数大学生对器官捐献有所了解,但对具体知识、流程、用途及相关法规等知晓程度较低;有22.9％的大学生表示从来没有捐献器官的意愿,且仍有66.9％的人还未做决定;大学生整体器官捐献态度呈正向态度,但不同年级、性别、科系类别、风俗习惯及献血习惯者的器官捐献认知水平存在差异.结论 政府、高校和社会应加强对器官捐献知识和价值的宣传,采取多种形式,通过提高大学生的器官捐献的知识水平,促进器官捐献态度的改善和器官捐献意愿的提升。     

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.

     

乌鲁木齐市无偿献血人群分布及献血动机调查分析

目的探讨乌鲁木齐市无偿献血者的人群分布及献血动机,为今后的无偿献血工作提供实践依据和宣传策略。方法采用问卷调查法,对乌鲁木齐市2 000名无偿献血者进行问卷调查,将调查结果进行统计学分析。结果学生、服务人员、私营业主、城镇户籍及常住本市的外来人口是乌鲁木齐市无偿献血的主力军;＂奉献爱心＂是公民献血的主要原因（87.2%）,不同文化程度、不同职业的无偿献血人群献血动机有明显差异（χ2文化程度=59.780,P〈0.05;χ2职业=102.339,P〈0.05）;＂街头宣传＂、＂周围环境影响＂、＂大众媒体宣传＂是献血人群了解献血知识的主要渠道。结论加强不同形式的宣传力度,挖掘不同人群的血源潜力,建立一支固定的无偿献血队伍。     

Communication strategies for organ donation

A country, state or hospital may have the latest medical technology and infrastructure as well as qualified professionals for organ transplantation, but unless there is an adequate donor population the waiting lists for transplants will continue to be long and for some patients, hopeless. Public and professional awareness programmes are key factor in the donation process. Social education that explains the life-saving benefits of organ transplantation, the enormous need for organ donation, the concept of brain death and religious teachings related to these issues is vital for creating a conducive environment for the organ transplant co-ordinator or physician soliciting the donation. The education of hospital medical, nursing and administrative personnel is also essential to both miximise opportunities for donation, as well as to prevent loss of potential organs after donor consent. Other target populations are medical examiners or coroners, and police personnel under whose jurisdiction the donations occur, as their co-operation and guidance is necessary for meeting statutory requirements. The involvement of government officials and politicians is also valuable, as their active intervention is essential for the introduction and amendment of rules and laws to promote the donation and transplantation of organs. The present paper describes communication strategies for the development of an efficient education plan that will provide information about organ transplantation, explain the desired outcome, address potential queries, misconceptions or obstacles, and identify potential sources of support.     

Medical students’ education on organ donation and its evaluation during six consecutive years: results of a voluntary,anonymous educational intervention study

Background

One of the main reasons for organ shortage is insufficient education on organ donation. Knowledgeable medical students could share the information with friends and families resulting in a positive attitude to organ donation of the general public.

Methods

During six consecutive years (2009 to 2014), we conducted a voluntary, anonymous educational intervention study on organ donation among fourth year medical students in the course of the main surgery lecture at the University of Essen, Germany.

Results

Questionnaires of 383 students were analyzed. Prior to the specific lecture on organ donation, 64% of the students carried a signed organ donor card with the intention to donate. Further information regarding organ donation was required by 37% of the students. The request for further information was statistically significantly higher among students without a donor card compared to organ donor card carriers (P < 0.0001). After the lecture, the number of students requiring further information decreased statistically significantly to 19% (P < 0.0001).

Conclusions

Already a 45-minute lecture for fourth year medical students significantly decreases their request for further information on organ donation and improves their attitude to organ donation. Continued training on organ donation will help medical students to become disseminators for this important topic in our society.