人体捐献器官获取与分配管理规定(试行)

正第一章总则第一条为保障人体器官捐献工作顺利开展,不断完善科学、高效、公平、公正、公开的人体捐献器官获取与分配工作体系,维护人体器官捐献人(以下简称捐献人)及人体器官接受人(以下简称接受人)权益,依据《人体器官移植条例》和《中国人体器官分配与共享基本原则和肝脏与肾脏移植核心政策》(以下简称《基本原则和核心政策》)等法规政策,结合工作实际,制定本规定。第二条本规定适用于公民捐献的身故后尸体器官(以下简称捐献器官)的获取与分配。     

人体捐献器官获取与分配管理规定（试行）

第一章总则 第一条为保障人体器官捐献工作顺利开展,不断完善科学、高效、公平、公正、公开的人体捐献器官获取与分配工作体系,维护人体器官捐献人（以下简称捐献人）及人体器官接受人（以下简称接受人）权益,依据《人体器官移植条例》和《中国人体器官分配与共享基本原则和肝脏与。肾脏移植核心政策》（以下简称《基本原则和核心政策》）等法规政策,结合工作实际,制定本规定。     

等级医院评审人体器官捐献与移植技术评价标准专家共识

公民逝世后器官捐献是器官移植器官来源的根本途径, 但捐献数量不足所导致的器官短缺是目前最突出的问题。在等级医院评审标准中纳入人体器官捐献与移植相关指标, 有利于国家政策的落实, 实现人体器官捐献数量的大幅增长, 满足移植就医需求, 促进移植事业发展和移植质量的提升, 提高整体医疗水平。中华医学会器官移植学分会和中国医师协会器官移植医师分会基于国家卫生健康委员会《三级医院评审标准(2022年版)》及《肝脏移植技术医疗质量控制指标(2020年版)》《肾脏移植技术医疗质量控制指标(2020年版)》《心脏移植技术医疗质量控制指标(2020年版》《肺脏移植技术医疗质量控制指标(2020年版》等国家文件精神和要求, 在国家卫生健康委员会医政司的指导下, 组织全国专家制定了等级医院评审人体器官捐献与移植技术评价标准专家共识, 供各省、自治区、直辖市卫生健康委员会在制定评审标准和评审过程中参考。     

人体捐献器官获取与分配管理规定(试行)

<正>国卫医发〔2013〕11号各省、自治区、直辖市卫生厅局(卫生计生委),新疆生产建设兵团卫生局:自2007年国务院公布《人体器官移植条例》以来,我国人体器官移植工作逐步走上法制化、规范化轨道,人体器官捐献工作有序推进,取得积极进展。为保障人体器官捐献工作顺利开展,不断完善科学、高效、公平、公正、公开的人体捐献器官获取与分配工作体系,我委依据《人体器官移植条例》和《中国人体器官分配与共享基本原则和肝脏与肾脏移植核心政策》等相     

美国器官捐献和移植管理体系简介

美国是世界上器官移植开展最早和数量最多的国家,1968年就出台了《联邦遗体捐献法》,1984年又出台了《国家器官移植法》,有较为完善的法律体系,成立了国家层面的器官捐献移植协调管理机构和分布在各州和地区的58个器官获取组织,建立了覆盖全国的网络,形成了有效的经济运行机制,能有效地开展工作,较好地解决了移植器官短缺的问题。这些实践对中国目前开展的器官捐献工作有重要的借鉴和参考意义。     

中国心脏死亡捐献器官评估与应用专家共识(2014版)

自2010年原卫生部启动人体器官捐献工作以来,经过各界努力,目前人体器官捐献尤其是心脏死亡器官捐献(donation after cardiac death,DCD),在全国范围内已得到广泛开展.亟待制订相关专家共识来指导全国DCD器官的质量评估,推动其在临床上更规范、有效、安全地应用.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及中国医师协会器官移植医师分会组织专家制订了《中国心脏死亡捐献器官评估与应用专家共识(2014版)》,重点阐述了中国DCD与心脏死亡诊断标准、器官获取、DCD器官在肝移植和肾移植中的评估和应用以及移植受者围术期的特殊干预.     

卫生部办公厅关于启动心脏死亡捐献器官移植试点工作的通知

卫生部于2011年4月26日发布《卫生部办公厅关于启动心脏死亡捐献器官移植试点工作的通知》,启动心脏死亡捐献器官移植试点工作。试点医院参照《卫生部办公厅关于印发卫生部人体器官移植技术临床应用委员会第八次会议纪要的通知》(卫办医管函〔2011〕234号)确定的中国心脏死亡器官捐献分类标准(见附件1),开展心脏死亡捐献器官移植试点工作。试点结束后两年内,未开展心脏死亡捐献器官移植工作的省级指定和OTC核定移植医院将被取消相应移植资质。     

中国人体器官捐献与移植委员会成立

为贯彻落实国务院《人体器官移植条例》,依法推进人体器官捐献与移植工作,国家卫生和计划生育委员会（以下简称卫生计生委）计生委与中国红十字会总会决定将人体器官移植技术临床应用委员会（OTC）与中国人体器官捐献工作委员会（CODC）合并,成立中国人体器官捐献与移植委员会。     

浅谈人体器官捐献协调员队伍的建设

<正>启动公民心脏死亡器官捐献(donation after cardiac death,DCD)移植试点工作是2010年国家卫生和计划生育委员会(卫计委,原国家卫生部)推行的缓解器官供需矛盾、促进移植医学健康发展的重要举措[1]。试点工作内容要求各试点省、市红十字会和卫生行政部门根据试点方案所明确的相关职责,建立健全组织机构并配备相应的工作人员,招募并组建人体器官捐献志愿者队伍,逐步建立人体器官捐献协调员(协调员)队伍。协调员的工作贯穿器官捐献的每一个环节,尤其在与潜在     

卫生部办公厅关于启动心脏死亡捐献器官移植试点工作的通知

各省、自治区、直辖市卫生厅局,新疆生产建设兵团卫生局： 人体器官捐献试点工作启动一年来,取得了初步成效。为深入贯彻落实《人体器官移植条例》,全面推进人体器官捐献体系建设,进一步调动各地工作积极性,我部在卫生部人体器官移植技术临床应用委员会（以下简称OTC）第8次会议讨论的基础上,决定启动心脏死亡捐献器官移植试点工作。现就有关事项通知如下：     

Current techniques of organ procurement and organ conservation

Since organ transplantation became a standard procedure in medicine, some interdisciplinary discussion has evolved around the availability of organs for transplantation. The shortage of available donors leads to numerous deaths on waiting lists where heart, lung and liver disease is concerned. Patients on dialysis spend years waiting for a suitable cadaveric graft. The shortage of organs has widened not only the selection criteria for cadaveric donors and the optimization of procurement but also has led to the increased acceptance of relatives and friends as living donors for kidneys, parts of the liver and maybe in the future of the lung. It has to be decided in which direction one wants to influence the discussion about the retrieval of an adequate number of organs for our waiting patients.     

Extended criteria for organ acceptance. Strategies for achieving organ safety and for increasing organ pool

The terms extended donor or expanded donor mean changes in donor acceptability criteria. In almost all cases, the negative connotations of these terms cannot be justified. Factors considered to affect donor or organ acceptability have changed with time, after showing that they did not negatively affect graft or patient survival per se or when the adequate measures had been adopted. There is no age limit to be an organ donor. Kidney and liver transplantation from donors older than 65 years can have excellent graft and patient actuarial survival and graft function. Using these donors can be from an epidemiological point of view the most important factor to esablish the final number of cadaveric liver and kidney transplantations. Organs with broad structural parenchyma lesion with preserved functional reserve and organs with reversible functional impairment can be safely transplanted. Bacterial and fungal donor infection with the adequate antibiotic treatment of donor and/or recipient prevents infection in the latter. The organs, including the liver, from donors with infection by the hepatitis B and C viruses can be safely transplanted to recipients with infection by the same viruses, respectively. Poisoned donors and non-heart-beating donors, grafts from transplant recipients, reuse of grafts, domino transplant and splitting of one liver for two recipients can be an important and safe source of organs for transplantation.     

Thoracic organ transplantation

This article presents an overview of factors associated with thoracic transplantation outcomes over the past decade and provides valuable information regarding the heart, lung, and heart-lung waiting lists and thoracic organ transplant recipients. Waiting list and post-transplant information is used to assess the importance of patient demographics, risk factors, and primary cardiopulmonary disease on outcomes.
The time that the typical listed patient has been waiting for a heart, lung, or heart-lung transplant has markedly increased over the past decade, while the number of transplants performed has declined slightly and survival after transplant has plateaued. Waiting list mortality, however, appears to be declining for each organ and for most diseases and high-severity subgroups, perhaps in response to recent changes in organ allocation algorithms. Based on perceived inequity in organ access and in response to a mandate from Health Resources and Services Administration, the lung transplant community is developing a lung allocation system designed to minimize deaths on the waiting list while maximizing the benefit of transplant by incorporating post-transplant survival and quality of life into the algorithm. Areas where improved data collection could inform evolving organ allocation and candidate selection policies are emphasized.     

Intrathoracic organ transplantation

Thoracic organ transplantation improves survival and quality of life in patients with severe and refractory end-stage heart or respiratory failure. Since the first human-to-human heart transplant in 1967 there have been huge developments in organ preservation, perioperative management and immunosuppression regimes; and outcomes have improved accordingly. As the population ages and medical therapies improve, the number of patients who survive long enough to be considered for transplantation is increasing. At the same time, the number of donor organs available is static, even decreasing in some countries (including the UK), and the average age of donors is increasing. The lack of organs suitable for transplantation is a significant cause for concern and makes it imperative that all available donor organs are optimized. In this article we will summarize the principles of heart and lung transplantation, with emphasis on patient selection and donor and recipient management, as outlined in the Intercollegiate Surgical Curriculum Programme (ISCP) cardiothoracic surgery syllabus.     

Pediatric organ transplantation

Since we started our pediatric kidney transplant program in 1970, we advocate children's transplantation to be performed in pediatric surgery units. Recent progress in immuno-suppression with ciclosporine and in operative procedures lead us to extend the program to liver transplantations in 1986, then to heart and lung transplantations in 1988. The Pediatric Transplant Unit was designed to assume the pre-operative evaluation of the recipients and the post-operative course of transplanted patients, closely connected to all specialists dealing with medical and surgical diseases of children. 29 patients were transplanted (kidney: 8, liver: 14, heart: 1, lungs: 6) with a 83% overall survival rate. The goal of this paper is not to discuss and compare indications or results with others series. Through our experience of pediatric organ transplantation, we shall try to point out the main advantages of a Pediatric Transplantation Unit: it optimizes the management of the rare pediatric donnors, and allows better skill and efficiency of the numerous specialities concerned by organ transplantation, such as intensive care, infectiology, immunology, radiology... The common medical and para-medical staff, common operative theater, and common use of equipment in the same department for transplantation of different organs is also an important matter to be considered now in term of cost-effectiveness.     

Pancreas organ transplantation

Diabetes mellitus is a very common and dreadful disease which cannot be cured by exogenous insulin substitution. Many of the patients suffer from recurrent, and sometimes rather dangerous, hypo- or hyperglycemias and, in the long term, from the well-known secondary diabetic complications. At the moment, pancreas transplantation is the only known therapy to reliably reestablish endogenous insulin secretion responsive to normal feed back controls. Within the last decade, pancreas transplantation has evolved as a clinically well-established procedure. Nevertheless, the perioperative risk after pancreas/kidney transplantation is still higher than after isolated kidney transplantation. However, the benefits of a functioning pancreas graft for the patients are enormous. Ten-year survival of type-I diabetic patients with combined pancreas/ kidney grafts is dramatically better than of those with an isolated kidney graft. Long-term function of the pancreas grafts is excellent, reaching more than 60% after 10 years. Contrary to kidney transplantation, chronic rejection does not seem to be a major problem. Blood glucose levels in the fasting state, after glucose challenge, and in the postprandial state are completely normalized. A significant peripheral hyperinsulinemia, however, is found when the pancreas graft is connected to the systemic venous circulation. Thus, portal venous drainage of the pancreas graft, which is already being performed by a few transplant centers routinely, might be the procedure of choice for the future. Beneficial effects on secondary diabetic lesions can only be expected after a rather long observation period. In addition, for all secondary diabetic complications, there is a point of no return. Nevertheless, significant improvement of diabetic polyneuropathy, diabetic nephropathy, and the disturbed microcirculation has been convincingly demonstrated. The effect on diabetic retinopathy, however, is still controversial. One of the most impressive effects for the pancreas graft recipients seems to be the enormous improvement in quality of life, which is reported unanimously by almost all patients. Thus, simultaneous pancreas/kidney transplantation can be regarded as the optimal and only causal therapy for type-I diabetic patients with end-stage renal disease.