加强我国器官移植技术的法制建设

目前，世界上绝大多数成熟开展器官移植技术的国家，基本上完成了器官移植的立法工作，但我国对器官移植的法律研究和立法还处在起步阶段。人体器官捐献移植的合法性问题，已经成为这项新技术发展中无法回避、必须正视的一个关键点。在法律的框架里，更新、规范人体器官捐献移植双方的观念和行为，已迫在眉睫。     

器官移植新规实施之后——器官移植伦理优先

今年5月1日．卫生部颁布实施《人体器官移植条例》．并成立人体器官移植技术临床应用委员会，组织专家对开展器官移植医疗机构进行评审．通过87家．同时根据需要指定77家省级医院开展器官移植，[编者按]     

器官移植的医学伦理学问题浅析

近几十年医学科学得到了极大的发展，为患者带来了福音，以往许多的不治之症已成功的被人们攻克，人们的寿命以及生活的质量有了极大的提高。器官移植这项高新医学技术，已经成为挽救生命垂危病人最有效的手段之一。器官移植的设想源于公元前300年，中国和古代希腊都有器官移植。但是直到20世纪随着血管吻合术、低温生物学的发展以及免疫制剂的产生，这一设想才真正得以实现。至今，全球累计超过50万人接受过各类的人体器官移植，并且随着人体器官移植技术的日臻成熟，器官移植的成活率也大大提高。自1954年美国Murtay在同卵双胞胎个体间，不使用抗排斥药物下首次进行肾移植手术获得成功以来，截止至2000年10月，     

国家卫生计生委、中国红十字会总会关于成立中国人体器官捐献与移植委员会的通知

各省、自治区、直辖市卫生计生委（卫生厅局）、红十字会，新疆生产建设兵团卫生局、红十字会：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，经研究，国家卫生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...     

器官移植技术法规建设

1　器官移植技术的兴起与器官移植技术立法随着世界范围内蓬勃兴起的新技术革命以雷霆万钧之势推动着生命科学的发展 ,人类传统的生老病死的自然生命过程得到了极大的改善。而人体器官移植技术正是 2 0世纪现代生物医学发展的一个代表性领域。器官移植是指通过手术等方法 ,替换     

什么样的医院能做器官移植手术？

<正>自改革开放后,我国的器官移植技术得到了蓬勃发展,同时也暴露了一些问题:大家蜂拥而上,遍地开花,使得开展器官移植业务的医疗机构过多过滥,审核管理和技术规范滞后,加之我国很长一段时间是使用死囚器官,由此派生出了很多非正常现象,因有的医院不具备相关资质,事故和争端时有发生。2007年2月,原卫生部发布《关于对人体器官移植技术临床应用规划及拟批准开展人体器官     

卫生部办公厅关于成立卫生部人体器官移植技术临床应用委员会的通知

卫办医发〔2006〕63号各省、自治区、直辖市卫生厅局,新疆生产建设兵团卫生局:为了规范和加强器官移植技术临床应用管理,保证医疗质量和医疗安全,保护患者健康,根据《人体器官移植技术临床应用管理暂行规定》的有关规定,经部领导同意,决定组建卫生部人体器官移植技术临床应用委     

以特色技术的发展带动医院整体技术水平的提高

在业务发展上，医院依托普外、心血管等全省重点学科的带动作用．坚持整体发展、重点突破的原则，大力开展技术创新，重点打造了器官移植、微创技术、介入治疗等技术亮点．取得了明显成效。器官移植是多年来医院重点打造的特色品牌。目前医院已完成多例心脏移植、肝脏移植和肾脏移植．完成数量和质量走在了省内前列．并先后开展了心肾联合移植、     

亲属肾移植的社会伦理学思考

随着我国《器官移植条例》和《人体器官移植技术临床应用管理暂行规定》的公布实施,亲属肾移植在全国迅速推广,伦理学问题也随之而来。     

亲属活体供肾移植的相关伦理学问题与实践

国家卫生部和国务院相继制定颁发了《人体器官移植技术临床应用管理暂行规定》和《人体器官移植条例》。作者介绍了所在单位学习和贯彻《暂行规定》和《条例》，成立“人体器官移植技术应用与伦理委员会”和召开“伦理委员会听证会”的情况。介绍了亲属活体供肾移植的伦理学操作程序以及对所发生的医学和伦理学问题的解决办法。介绍了供受者随访系统的建立与运行机制，并特别强调了亲属活体供肾移植的法律责任问题。     

自愿捐赠移植器官知情同意权问题的探讨

自从人体器官移植技术开展以来，器官捐赠已经成为器官来源的最重要的途径和方式。随着这项技术的广泛开展，规范了器官捐赠行为，使器官捐赠者的自主权得到有效合法保护，捐赠者的知情权和同意权得到全面履行，从而提高捐赠者参与社会捐赠的积极性，以便解决器官需求紧缺状况。     

Transplants. The heart of the matter

Thirty years after the world's first successful heart transplant, UK services are embroiled in a funding row. The country's eight units carried out more than 200 transplants last year, but after-care costs are rising as more people survive longer, and cardiologists fear the switch from central to regional funding will lead to cuts. Jenny Bryan looks at the past, present and future.     

Iniquities in the access to renal transplant for patients with end-stage chronic renal disease in Brazil

The objective of this present study is to analyze individual and contextual factors associated with access to renal transplant in Brazil. An observational, prospective and non-concurrent study was carried out, based on data from the National Database on renal replacement therapies in Brazil. Patients undergoing dialysis between 01/Jan/2000 and 31/Dec/2000 were included and monitored up to the point of transplant, death or until the end of the study period. Variables that were analyzed included: individual variables (age, sex, region of residence, primary renal disease, hospitalizations); and context variables concerning both the dialysis unit (level of complexity, juridical nature, hemodialysis machines and location) and the city (geographic region, location and HDI). Proportional hazard models were adjusted with hierarchical entry to identify factors associated with the risk of transplant. The results point to differentials in access according to socio-demographic, clinical, geographic and social factors, indicating that the organ allocation system has not eliminated avoidable disparities for those who compete for an organ in the nationwide waiting list.     

Organ and tissue transplants in Mexico

A report is submitted on the activities carried out by National Transplant Center of Mexico and special importance is given to the state transplant councils. Information is provided in a comparative form on the activities of the last ten years as well as those of the states.     

Characteristics of Rural and Urban Cadaveric Organ Transplant Donors and Recipients

CONTEXT: Health disparities have been found when comparing rural and urban populations. Purpose: To compare characteristics of rural and urban cadaveric transplant donors and recipients. METHODS: We used deidentified individual-level data on 55,929 cadaveric transplant donor-recipient exchanges between 2000 and 2003 and examined the relative rates of donating and receiving cadaveric transplants for rural compared to urban residents, as defined by ZIP Codes. FINDINGS: When compared to their urban counterparts, rural organ donors were more likely to have died from head trauma, drowning, motor vehicle accidents, or suicide and less likely to have died from cerebrovascular events, cardiac events, or homicide (P < .001 for all). Rural transplant recipients had lower levels of educational attainment and were less likely to have had the transplant financed by private insurance (P < .001 for all). While we found no statistical difference in days wait to organ transplantation, rural residents were more likely to donate than to receive cadaveric organs (P < .001). CONCLUSIONS: The differences in organ donation that we found warrant further exploration.     

Pretransplant obesity: a weighty issue affecting transplant candidacy and outcomes.

Because of the global increase in prevalence of obesity, many more overweight and obese individuals are undergoing evaluation for transplantation than in the past. Although obesity seems to provide a survival benefit in dialysis patients, obesity has traditionally been considered a contraindication for transplantation of most organs. It is theorized that obesity will contribute to worse transplant outcomes, including lower rates of graft and patient survival and higher rates of delayed graft function and infection. This review evaluates the available literature evaluating outcomes of obese patients with end-stage organ failure who undergo transplantation. Obesity seems to be associated with increased rates of wound infection after transplantation. However, other adverse transplant outcomes related to obesity seem to be dependent on the type of organ being transplanted and the degree of obesity. For example, a body mass index (BMI) of 30 kg/m(2) may reduce short-term survival in lung transplant recipients; however, obesity does not seem to confer an adverse effect on short- or long-term survival in liver transplant patients until a much higher BMI is reached (such as 35 or 40 kg/m(2)). Each transplant center must determine weight guidelines and criteria for identifying the level of obesity as a contraindication for transplantation. This must be based on organ type, each center's transplant and complication statistics, and available donor pools. Guidelines must also consider the morbidity and mortality risks of the obese patient with organ failure who does not receive a transplant.     

Cryptococcus neoformans infection in organ transplant recipients: variables influencing clinical characteristics and outcome

Unique clinical characteristics and other variables influencing the outcome of Cryptococcus neoformans infection in organ transplant recipients have not been well defined. From a review of published reports, we found that C. neoformans infection was documented in 2.8% of organ transplant recipients (overall death rate 42%). The type of primary immunosuppressive agent used in transplantation influenced the predominant clinical manifestation of cryptococcosis. Patients receiving tacrolimus were significantly less likely to have central nervous system involvement (78% versus 11%, p =0.001) and more likely to have skin, soft-tissue, and osteoarticular involvement (66% versus 21%, p = 0.006) than patients receiving nontacrolimus- based immunosuppression. Renal failure at admission was the only independently significant predictor of death in these patients (odds ratio 16.4, 95% CI 1.9-143, p = 0.004). Hypotheses based on these data may elucidate the pathogenesis and may ultimately guide the management of C. neoformans infection in organ transplant recipients.     

Transmission of multidrug-resistant Escherichia coli through kidney transplantation --- California and Texas, 2009

On July 6, 2009, the Organ Procurement and Transplantation Network received notification of possible disease transmission. A transplant center in California (TCA) reported a kidney transplant recipient with Escherichia coli urinary tract infection and sepsis suspected to have been contracted from the donated kidney. Upon further investigation, a transplant center in Texas (TCB) reported that the recipient of the other kidney from the same donor developed a perinephric abscess caused by E. coli. The kidney grafts failed in both recipients; however, both recipients survived. E. coli isolates from both recipients demonstrated similar antimicrobial susceptibility profiles. Molecular typing studies conducted at CDC showed that the E. coli isolates from both kidney recipients were identical to an isolate from the donor's urine. On October 30, 2009, the Texas Department of State Health Services requested assistance from CDC to investigate this transplant-associated E. coli transmission and make recommendations to prevent future transmissions. The investigation identified gaps in communicating important donor information that might have adversely affected transplant outcomes. Each organ procurement organization (OPO) should establish protocols that clearly assign responsibilities for receiving, reviewing, and conveying any relevant donor information that becomes available subsequent to organ procurement.     

A methodological framework for optimally reorganizing liver transplant regions.

BACKGROUND: The United States is divided currently into 11 transplant regions, which vary in area and number of organ procurement organizations (OPOs). Region size affects organ travel time and organ viability at transplant. PURPOSE: To develop a methodologic framework for determining optimal configurations of regions maximizing transplant allocation efficiency and geographic parity. METHODS: An integer program was designed to maximize a weighted combination of 2 objectives: 1) intraregional transplants, 2) geographic parity-maximizing the lowest intraregional transplant rate across all OPOs. Two classes of functions relating liver travel time to liver viability were also examined as part of the sensitivity analyses. RESULTS: Preliminary results indicate that reorganizing regions, while constraining their number to 11, resulted in up to 17 additional transplants/year depending on the travel-viability function; when not constrained, it resulted in up to 18/year of increase. CONCLUSION: Our analysis indicates that liver transplantation may benefit through region reorganization. The analytic method developed here should be applicable to other organs and sets of organs.     

Heart transplant

A heart transplant is at present considered the treatment of choice in cases of terminal cardiac insufficiency refractory to medical or surgical treatment. Due to factors such as the greater life expectancy of the population and the more efficient management of acute coronary syndromes, there is an increasing number of people who suffer from heart failure. It is estimated that the prevalence of the disease in developed countries is around 1%; of this figure, some 10% are in an advanced stage and are thus potential receptors of a heart transplant. The problem is that it is still not possible to offer this therapeutic form to all of the patients that require it. Consequently, it is necessary to optimise the results of the heart transplant through the selection of patients, selection and management of donors, perioperative management and control of the disease due to graft rejection. Since the first transplant carried out in 1967, numerous advances and changes have taken place, which has made it possible to increase survival and quality of life of those who have received a new heart. In this article we review the most relevant aspects of the heart transplant and the challenges that are currently faced.