苏州市遗体捐献工作实践及存在问题探讨

摘要捐献器官、捐献遗体是拯救生命、造福人类的壮举,也是解决医学院校教学标本相对不足的重要途径。本文梳理了苏州市遗体捐献工作的进展,对取得成绩的经验及阻碍工作的原因进行剖析,认为影响我国遗体捐献的因素主要有封建迷信思想和传统孝道观念、遗体捐献相关机构不完善、法律法规不完善等。提出我国在遗体捐献工作方面应健全相关法律制度、建立高效服务体系以及加大教育宣传力度等措施。     

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。     

关于规范器官获取组织流程的思考

近年来,中国的器官移植事业发展较快,但由于缺乏系统规范的管理体系,衍生出了一系列社会、伦理、法律等方面的问题。通过分析我国器官捐献与获取现状以及所存在的问题,提示应采取及时发现潜在案例、判定生命状态、规范报批捐献手续、维护脏器功能、获取捐献器官、安抚供者家属、分配捐献器官等一系列措施来完善器官获取组织流程,以推进我国器官移植事业的健康长久发展。     

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。     

关于居民对器官捐献态度的调查分析——以江苏省徐州市区居民为例

目的:了解我市居民对器官捐献的态度看法并对其进行多方分析,为相关部门采取措施提供一定的依据。方法:采用随机整群抽样方法,对徐州市300位居民进行了关于器官捐献的调查问卷。结果:有55.7%的居民表示愿意捐献自己的器官,但仍存在43.9%的人明确表示不愿意,0.4%的人还未做决定;其中只有8.1%的人表示非常了解,绝大多数居民对器官捐献的相关内容、管理、流程、法律法规等了解甚少。结论:通过了解居民对器官捐献的真实态度及想法,可为相关部门促进我国器官捐献事业提供参考,有关部门可加大提高关于器官捐献的宣传力度,完善管理制度,透明捐献流程等。     

我国重症监护病房器官捐献的现状及对策

重症监护病房(ICU)作为医院危重病人抢救中心,是潜在捐献器官人群的聚集地。本文通过阐述ICU器官捐献现状与存在的问题,提出ICU器官捐献与获取过程中应遵循不伤害、死后捐献、知情同意、唯一性、保密性的基本伦理原则,并提出加快法律建设以规范ICU器官捐献与获取、加强ICU与器官获取组织(Organ Procurement Organization,OPO)合作以及时发现潜在捐献者、统一ICU潜在器官捐献者的入选标准、完善ICU器官捐献与获取伦理审查、加强经费监管与审查、建立人道主义救助体系等措施。     

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。     

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。     

温州市首例儿童心脏死亡器官捐献报告

2013年1月,我院暨温州市首例儿童心脏死亡器官捐献（DCD）成功。通过对该儿童DCD移植病例的回顾分析和总结,在借鉴国际上成功经验的同时,与我国实际情况相结合,完善器官捐献及移植法规,规范捐献流程,加大宣传力度,培养专业人员,从而促进器官捐献事业健康有序发展。     

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。     

The health care professional's attitudes towards brain death and cadaveric organ transplantation: the influence of cadaveric donor and transplantation programs--a Malaysian survey

One of the main reasons for poor response in organ donation is the lack of positive attitudes and knowledge present in health care professionals. Definite legislation, policies and programmes dealing with brain death and cadaveric organ transplantation have shown some favourable results in terms of increasing donor rates. These programmes are mainly Western based; therefore adopting such programmes to be used locally may not be adequate or proper. To address this issue, we decided to carry out a questionnaire in two tertiary hospitals in Malaysia, one with a well establish brain death and cadaveric organ transplantation programme and one with none.     

医务人员器官捐献知识和态度的研究进展

本文对器官捐献的定义、影响因素、医务人员对器官捐献知识和态度进行了综述,我们认为医务人员普遍对器官捐献的知识了解匮乏,但大多数对器官捐献持赞成态度,并结合我国医务人员对器官捐献知识和态度的现状提出建议。     

Awareness about organ donation among school girls

Prevalence of organ failure is high through out the world. Organ transplantation, the definitive treatment option of organ failure keeps very low due to scarcity of organ. Most of the people are not aware about organ donation. Adolescent girls will be the mother of future nation and they can motivate family members for organ donation. This study was carried out to see attitudes towards organ donation and determine the negative factors of organ donation prevailing among school girls. One hundred sixty eight girls from class VIII to class X of a higher secondary school were participated. A structured questionnaire was filled up by the girls. The data were processed from questionnaire and analyzed. Among study population, most of them (64%) had no idea about on going organ donation and transplantation. The positive attitude of the girls towards organ donation was low when they are live (16%) and their attitudes also kept low even after their death (14%). The girls who did not agree to donate organ were further asked to mention the reasons. The reasons of negative attitude were religious belief, fear of illness and social and familial reservation. The result of this study suggests that among girls, awareness and attitudes about organ donation is poor. There were several reasons identified for low consent rates. Multidisciplinary actions should be taken to improve the awareness of the people about organ donation and motivate them for donation.     

禁止器官移植旅游的对策探析

随着器官移植技术的发展,器官移植的应用前景越来越广阔,而器官资源短缺已成为当今世界性难题。一些有钱的境外患者为了尽早进行器官移植,通过移植旅游的方式到我国进行移植手术,严重破坏了我国器官移植环境,损害了我国患者的切身利益。本文阐述了我国器官移植旅游的现况,认为器官移植旅游在我国长期存在的主要原因是器官供体对相关法律和知识不了解、中介的引诱、器官供需比例失衡、器官捐献制度不健全。因此,应增强公民的器官损献意识,普及相关法律知识;加强行业监管,加大惩治力度;建立器官捐献激励机制;健全有关法律、法规,提高其可操作性。     

Attitudes, knowledge, and actions with regard to organ donation among Hong Kong medical students

OBJECTIVE. To study attitudes, knowledge, and actions of local medical students with regard to organ donation and self-perceived confidence and competence in approaching potential organ donors. DESIGN. Cross-sectional questionnaire survey. SETTING. Faculty of Medicine, The University of Hong Kong, Hong Kong. PARTICIPANTS. Medical students, years 1-5. MAIN OUTCOME MEASURES. Knowledge on various aspects of organ donation was assessed, and students' self-evaluated competence and confidence about counselling for organ donation was evaluated. Factors influencing attitudes and actions were determined. RESULTS. The response rate was 94% (655/694). A majority (85%) had a 'positive' attitude, but only a small proportion (23%) had signed the organ donation card. Inconvenience and lack of knowledge about organ donor registration, and concerns about premature termination of medical treatment accounted for such discrepancies. Socio-cultural factors such as the traditional Chinese belief in preservation of an intact body after death, unease discussing death-related issues, and family objections to organ donation were significantly associated with a 'negative' attitude. Knowledge and action increased with medical education yet only a small proportion of medical students felt competent and confident in counselling patients on organ donation. CONCLUSIONS. The medical curriculum should increase medical students' awareness of the organ shortage problem. The donor registration system should be made more convenient and public education is recommended to correct misconceptions.     

Presumed consent for transplantation: a dead issue after Alder Hey?

In the wake of scandals about the unauthorised retention of organs following postmortem examination, the issue of valid consent (or the lack of it) has returned to the forefront. Emphasis is put on obtaining explicit authorisation from the patient or family prior to any medical intervention, including those involving the dead. Although the controversies in the UK arose from the retention of human material for education or research rather than therapy, concern has been expressed that public mistrust could also adversely affect organ donation for transplantation. At the same time, however, the British Medical Association (BMA) continues to call for a shift to a system of presumed consent for organ transplantation. This apparent inconsistency can be justified because valid distinctions exist between the reasons requiring explicit consent for retention and the acceptability of presumed consent for transplantation. This paper argues for introducing a system of presumed consent for organ donation, given the overwhelming expressions of public support for transplantation. Ongoing legislative review in the UK provides an ideal chance to alter the default position to one where potential donors can simply acquiesce or opt out of donation. Combined with consultation with their relatives, this could be a much better method of realising individuals' wishes. It would also achieve a better balance between the duties owed to the deceased and those owed to people awaiting a transplant.     

Psychosocial variables associated with willingness to donate organs.

Questionnaires were administered to 108 university psychology students to investigate attitudes and behaviour related to organ donation. Three groups (committed, uncommitted and opposed) were identified. A multivariate analysis of variance showed that, compared with uncommitted donors, committed donors felt better informed about organ donation, had discussed donation more often with family members and knew more people who had signed donor cards. The subjects in the opposed group and those in the uncommitted group cited different reasons for not signing a donor card. Empathy, religious beliefs and attitudes about death did not affect willingness to donate. Analyses of the interaction between willingness to donate one's own organs and willingness to donate those of a family member revealed a monotonic increase in willingness to donate the organs of a family member as the type of recipient became more personally relevant. Our findings indicate that when health care professionals request donor organs the potential recipients must be presented to the potential donors in a personally relevant manner. Educational programs must be developed to train medical personnel in how to effectively ask for organs without coercing the potential donor or invading the privacy of the potential recipient.     

完善现代生命关怀体系，促进和谐医患关系

要重塑和谐的医患关系，就必须在全社会建构起完善的现代生命关怀体系，实现人与人之间的充分尊重和理解。要达此目的，就必须在全社会引起对因生命关怀缺失引发的医患冲突进行伦理分析的重现；就必须在全社会切实建构起完善的法律、法规、卫生管理体制和良好的人文关怀的社会环境等，作为医患双方实施生命关怀行为的前提保障；就必须在全社会切实加强生命伦理教育等。     

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.     

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.