器官移植及其伦理学问题的思考

器官移植是人类关于自身科学的伟大成果之一。经历了幻想阶段、动物实验阶段、临床应用阶段后进入现代器官移植时期。目前，我国的器官移植水平还和国外有较大的差距。脑死亡标准的确立将会有数以万计的病人能得到有效的器官移植治疗而获得新生。知情同意是器官移植的首要伦理问题。活体供体、尸体供体、胎儿供体、异种器官供体、克隆器官供体、人工器官、干细胞移植是供体的主要来源。受体选择在伦理学方面应遵循：效用、公平、对患者忠诚的原则。伦理学等社会科学的进步将促进器官移植事业的发展。     

中国器官移植伦理学问题现状及研究进展

器官移植是目前治疗终末期器官衰竭患者的唯一有效手段,随着器官移植技术的发展,器官移植伦理学问题日渐复杂起来。活体器官移植、脑死亡及心脏死亡供体器官移植、器官获取及合理分配等方面均面临着相关的伦理学问题。对器官移植相关伦理学问题进行深入探讨及研究,并制定相关的伦理学准则及解决方案,是确保我国器官移植事业健康发展、并最大限度地保护移植供者及受者相关权益的关键性举措之一。     

器官移植面临的伦理问题及对策

器官移植引发的伦理道理问题,直接影响了该技术的应用和发展,供体严重匮乏是制约我国器官移植工作的重要因素.本文从伦理学角度,探讨了器官移植面临的伦理道德问题,提出应尽快为脑死亡立法,树立新的伦理观念,明确禁止器官商业化.另外强调,知情同意是供体器官摘取的首要伦理原则,医学原则和社会标准是受体选择的依据.     

我国人体器官移植的补偿机制研究

随着器官移植技术的发展,器官供体来源不足已成为制约其发展的瓶颈问题。由于人体器官移植的补偿机制不完善,导致黑市交易中买卖器官的现象难以遏制。本文对比分析国外人体器官移植补偿机制,提出构建器官捐献保障和补偿机制,在法律上确立器官捐献者的权利和补偿方式,从而有效解决器官移植供体来源短缺的问题。     

论人体器官有偿捐赠的可行性及伦理学问题

继公开讨论脑死亡法和器官移植法之后,移植学家、社会学家、伦理学家和法律界人士又对是否给予器官捐献者个人或家属经济补偿展开了讨论[1,2]。本文以美国和伊朗为例介绍目前移植器官短缺的现状及对捐赠模式的影响,论述实施有偿器官捐赠面临的伦理学问题,以及在我国施行器官有偿捐赠的可能性与设想,为中国器官移植事业的发展提供参考,并促进其与国际接轨。一、器官供求矛盾及解决方式随着医学科学技术的发展,器官移植已成为拯救终末期器官功能衰竭患者的惟一治疗手段。目前移植器官捐赠按供体来源分为尸体捐赠和活体捐赠。尸体捐献包括…     

脑死亡的临床方面

脑死亡意味着人的死亡,这个合理逻辑的概念,已被医护人员和大多数社会人士所接受。脑死亡这个概念的主要原动力是出于器官移植的需要。从心脏还在搏动的供体中取出的器官比血循环已停止者的器官对接受移植者来说,存活的机会要好得多。在急救室缺乏床位、医生和护士的情况下,应该收容可能救活的病人,如果将脑死亡的病人收入急救室,可能要付出另一个病人的生命作代价。什么是脑死亡?脑死亡的定义可以按以下二者之     

我国拟订出脑死亡诊断标准

10月 2 6日 ,在武汉举行的 2 0 0 2年全国器官移植学术会议上 ,中华医学会器官移植分会和诺华基金会呼吁加快制定我国《脑死亡法》、《器官移植法》、《器官捐献法》和《亲属活体器官移植伦理学指南》等器官移植和器官捐赠相关法律规章 ,促进我国器官移植与国际接轨 ,实现正规化、合法化、公开化和国际化发展的目标。这次会议上披露了拟订的中国脑死亡诊断标准(成人 )。这是继国家卫生部副部长黄杰夫公开表示支持脑死亡立法之后 ,医学界再次为解决我国器官移植合法化、公开化这一紧迫和热点问题的呼吁。拟订的脑死亡标准是由卫生部脑死亡法…     

我国人体器官移植立法研究

我国的人体器官移植手术在技术上已经达到国际领先水平,但是在相关立法上却与国际严重脱轨,至今没有一部专门的法律来进行规范,实践中很多人体器官移植行为都游离在法律的灰色地带,器官提供者及接受者的合法权益没有法律的保障,发生纠纷无法可依。我国应借鉴世界上人体器官移植立法的先进经验,对人体器官的范围、器官捐献人及接受人的关系、脑死亡立法等方面进行完善,尽快出台符合我国国情的人体器官移植法律。     

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。     

转基因器官移植的伦理学分析

器官供体缺乏一直是困扰器官移植界的世界性难题。动物器官移植人体后往往发生排斥反应,若将人体基因转移到动物体内培育出转基因器官然后再移植到人体,则可能大大减轻这种排斥。转基因器官移植是当今世界医学走向高科技的重要标志,但其在临床试验及应用中仍面临许多困扰。分析转基因器官移植的伦理问题,进而探讨转基因器官移植的伦理原则,对于这项技术的临床应用具有重要的现实意义。     

脑死亡无偿器官捐献肝脏移植2例报道

目的总结并探讨脑死亡无偿器官捐献肝脏移植在我国临床实施的可行性.方法昆明市第一人民医院于2011年12月至2012年1月期间共完成2例脑死亡无偿器官捐献工作.2例供体确诊为脑死亡,应用机械通气、血管活性药物等治疗维持供体器官灌注.受体1男性,术前诊断乙肝后性肝硬化,肝功能失代偿,child-pugh C级,MELD评分29分;受体2男性,术前诊断乙肝后性肝硬化,原发性肝癌,child-pugh C级,MELD评分26分.结果 2例脑死亡供体均顺利无偿捐献肝脏,2例受体均顺利接受肝脏移植手术并康复出院,目前随访移植肝功能良好.结论脑死亡无偿器官捐献肝脏移植的临床实施顺利,可以在我国逐渐推广实行,对缓解我国目前器官短缺状况起到相当重要的作用.     

Does it matter that organ donors are not dead? Ethical and policy implications

The "standard position" on organ donation is that the donor must be dead in order for vital organs to be removed, a position with which we agree. Recently, Robert Truog and Walter Robinson have argued that (1) brain death is not death, and (2) even though "brain dead" patients are not dead, it is morally acceptable to remove vital organs from those patients. We accept and defend their claim that brain death is not death, and we argue against both the US "whole brain" criterion and the UK "brain stem" criterion. Then we answer their arguments in favour of removing vital organs from "brain dead" and other classes of comatose patients. We dispute their claim that the removal of vital organs is morally equivalent to "letting nature take its course", arguing that, unlike "allowing to die", it is the removal of vital organs that kills the patient, not his or her disease or injury. Then, we argue that removing vital organs from living patients is immoral and contrary to the nature of medical practice. Finally, we offer practical suggestions for changing public policy on organ transplantation.     

Optimal management of brain-dead organ donor

Maintaining a brain stem–dead (BSD) donor is specialized science. It is a daunting task as they are fragile patients who need to be handled with utmost care owing to extreme haemodynamically instability and need the best of monitoring for maintenance of organs. To ensure a successful transplant, a BSD donor first needs to be identified on time. This requires scrupulous monitoring of neurologically compromised patients who tend to be the most frequent organ donors. Once the donor is identified, an all-out effort should be made to legally obtain consent for the donation. This may require numerous sessions of counselling of the relatives. It needs to be performed tactfully, displaying the best of intentions. It is important to understand the physiology of a brain-dead individual. A cascade of changes occurs in BSD donor which result in a catastrophic plummeting of the clinical condition of the donor. All organ systems are involved in this clinical chaos, and best possible clinical support of all organ systems should be available and extended to the donor. Organ support includes cardiovascular, pulmonary, temperature, glycaemic, metabolic and hormonal. This article has been written as a follow-up article of previously published article on identifying an organ donor. It intends to give the reader a concept of what the BSD donor undergoes after brain death and as to how to maintain and preserve various organs for donation for successful transplantation of maximum organs.     

公民死亡器官捐献潜在供体转运通道建立及供体重症监护室器官维护

目的 探讨适合临床的公民死亡器官捐献(DCD)潜在供体转运通道及供体重症监护室供体维护机制.方法 首都医科大学附属北京佑安医院自2012年1月开通转运通道,至2016年6月,器官获取组织(Organ Procurement Organization,OPO)共接到DCD相关信息152例,评估152例.临床判定为潜在捐献者合格84例,访谈84例,41例潜在供体家属同意捐献.建立DCD潜在供体转运通道,一般流程下直接转运潜在供体入供体重症监护室(DI-CU),并立即进行各重要器官的评估及维护.当潜在供体在转运过程中出现生命体征的恶化,紧急情况下启动应急流程.评价潜在供者进入DICU时和捐献前各项实验室检查指标的变化.结果 自2012年首都医科大学附属北京佑安医院共接收潜在供体41例,其中男29例,女12例;年龄(35.17±19.51)岁.1例(2.4％)转运过程中出现呼吸心跳停止,3例(7.3％)因家属意愿改变而中止捐献,37例(90.2％)顺利完成器官捐献.按中国心脏死亡器官捐献分类标准进行分类,此37例中国际标准化脑死亡供体28例(75.7％),国际标准化心脏死亡供体3例(8.1％),国际标准化心脑死亡供体6例(16.2％).其中31例供体捐献器官用于移植,6例供体的器官捐献后因损伤超出标准被弃用.潜在供体入DICU时和捐献前各项化验指标变化,AST、T-BIL、D-BIL、BUN的差异有统计学意义(P＜0.05).结论 建立适合临床工作的公民死亡器官捐献潜在供体转运通道及供体重症监护室以维护器官功能、提高捐献成功率非常重要,保证了供体器官的数量及质量.     

The organ procurement problem: many causes, no easy solutions

Participants at the Second International Symposium on Organ Procurement, held in 1985 in Detroit, addressed one of the principal problems of organ transplantation: the shortage of suitable donor organs. Several factors were identified as contributing to the shortage--failure to make provision before death for donation, refusal of requests for donation by families of suitable donors, failure of hospital personnel to request donation, inability to match available organs with recipients, and improper organ allocation. The participants rejected adopting a presumed consent policy and advocated laws now being enacted in several states requiring hospital personnel routinely to request donation from family members of suitable brain dead patients.     

婴幼儿心死亡后捐献肾行肾移植术：2 例病例报告并文献复习

目的：加深针对扩大标准供肾的心脏死亡器官捐献(donation aer cardiac death，DCD) 肾移植手术术中、
术后管理的认识。方法：2 例供肾来自于诊断为脑死亡的2 例低龄儿童供者，年龄分别为11 个月和1 岁7 个月，脑
死亡的原因分别是重症婴儿肝综合征和重症颅脑外伤。2 例供者出现心死亡后，切取双肾整块，并分别整块移植给了
2 位受者。2 例受者的年龄分别是37 岁和41 岁。结果：术后随访6 个月，2 例受者移植肾功能基本正常。2 例受者术
后都出现大量血性引流液，在给予相应治疗后停止，未出现急性排斥反应和其他手术并发症。结论：采用改进的技
术可以安全采用年龄<3 岁的婴幼儿DCD 供肾；手术后短期效果满意，有助于扩大供体池，但血管并发症值得重视。     

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.     

Non-heart beating organ donation: old procurement strategy--new ethical problems

The imbalance between supply of organs for transplantation and demand for them is widening. Although the current international drive to re-establish procurement via non-heart beating organ donation/donor (NHBOD) is founded therefore on necessity, the process may constitute a desirable outcome for patient and family when progression to brain stem death (BSD) does not occur and conventional organ retrieval from the beating heart donor is thereby prevented. The literature accounts of this practice, however, raise concerns that risk jeopardising professional and public confidence in the broader transplant programme. This article focuses on these clinical, ethical, and legal issues in the context of other approaches aimed at increasing donor numbers. The feasibility of introducing such an initiative will hinge on the ability to reassure patients, families, attendant staff, professional bodies, the wider public, law enforcement agencies, and the media that practitioners are working within explicit guidelines which are both ethically and legally defensible.     

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。