对我国儿童肾移植发展的思考与建议

肾移植是儿童终末期肾衰最重要的替代治疗手段。国内数家大的移植中心儿童肾移植长期存活率已接近国外先进水平,但我国肾移植患儿总数较少,主要原因是经费不足和供体缺乏。为推动儿童肾移植的发展,建议建立国家医疗救助制度,鼓励亲属活体肾脏捐献,严格掌握适应证,合理使用免疫抑制剂,加强多中心协作,建立移植随访网络。     

亲属肾移植的伦理学探讨

活体亲属肾移植是当前解决器官匮乏最重要的途径,近年来我国亲属肾移植例数也不断增多。但是亲属肾移植因其具有一定的特殊性,相比尸体供肾移植更为敏感,也更易于引发伦理问题。简要介绍国内外亲属肾移植的研究进展,重点对亲属肾移植的生命伦理学问题加以探讨。     

对我国儿童肾移植发展的思考与建议

肾移植是儿童终末期肾衰最重要的替代治疗手段.国内数家大的移植中心儿童肾移植长期存活率已接近国外先进水平,但我国肾移植患儿总数较少,主要原因是经费不足和供体缺乏.为推动儿童肾移植的发展,建议建立国家医疗救助制度,鼓励亲属活体肾脏捐献,严格掌握适应证,合理使用免疫抑制剂,加强多中心协作,建立移植随访网络.     

亲属肾移植的伦理学探讨

活体亲属肾移植是当前解决器官匮乏最重要的途径,近年来我国亲属肾移植例数也不断增多.但是亲属肾移植因其具有一定的特殊性,相比尸体供肾移植更为敏感,也更易于引发伦理问题.简要介绍国内外亲属肾移植的研究进展,重点对亲属肾移植的生命伦理学问题加以探讨.     

《人体器官移植条例》颁布后面临的问题与对策

《人体器官移植条例》规范引导着我国器官移植健康发展,然而,随着《条例》对器官移植供、受者条件的严格限制,尸体供器官数量迅速下降,亲属活体移植逐步占据主导地位,由此引发一系列问题。结合《条例》,就器官来源短缺、保障活体供者安全、亲属活体供者选择和器官移植伦理委员会作用等问题做出较详细的分析,提出解决方法和对策。     

清末民国时期刑法典建设中亲属伦理关系的传承与变革

清末民国时期刑法典建设中对于亲属伦理关系的传承与变革主要表现在亲属容隐从宽处理、亲属相奸从严治罪、亲属相害区别对待、亲属侵财宽免处罚等方面.这种传承与变革首先是由巨大的传统惯性和特定的历史境遇造成的,亲属伦理关系的固有特质也预示了这种传承与变革的某种必然性.另外,这种亲属伦理关系在近代刑法中的传承与变革也为当代刑法的完善提供了历史镜鉴.     

患者亲属——医疗决策的重要主体

在医患关系中,患者亲属起着重要作用,是医疗行为及后果生理和心理的承担者,患者的疾病本身和康复情况会直接对家庭生活产生影响。患者亲属也是患者医疗费用的主要承担者。由于医疗决策会涉及到患者的家庭利益,患者患病会对其决定能力产生不利的影响,在法律上确立患者亲属在医患关系中的主体地位,甚至在必要时赋予亲属医疗决定权是必要的和现实的。     

摩梭人亲属词的概念结构

采用自由分类法探讨了摩梭人亲属词的概念结构。结果表明：(1)摩梭人亲属词的概念结构有两个维度：“亲属的亲密程度”和“辈分大小”。这与汉族和纳西族亲属词的概念结构既相似, 又存在差异。摩梭人亲属词分类的特点反映了独特的母系家庭和婚姻制度。(2)舅权和父权在摩梭人的亲属关系中正在经历着变化。作者对“摩梭母系制是原始母系制的‘活化石’”的观点提出了质疑。     

摩梭人亲属词的概念结构——兼与汉族、纳西族亲属词的概念结构比较

采用自由分类法探讨了摩梭人亲属词的概念结构。结果表明:(1)摩梭人亲属词的概念结构有两个维度:"亲属的亲密程度"和"辈分大小"。这与汉族和纳西族亲属词的概念结构既相似,又存在差异。摩梭人亲属词分类的特点反映了独特的母系家庭和婚姻制度。(2)舅权和父权在摩梭人的亲属关系中正在经历着变化。作者对"摩梭母系制是原始母系制的‘活化石’"的观点提出了质疑。     

活体肝移植应用及其伦理学思考

目前,肝移植已成为治疗终末期肝病的有效手段。活体肝移植术部分解决了供肝短缺的问题,10多年来发展迅速,并取得了良好的疗效。但开展这一技术时务必需要遵循知知情自愿原则和利益和风险并存等原则,注意活供体肝移植在伦理学方面尚未解决的问题。     

我国人体器官移植的社会支持系统研究

供体来源不足严重制约了我国器官移植事业的发展。有鉴于此,建立一个非技术的人体器官移植的社会支持系统对促进我国器官移植事业的发展将具有重要意义。通过对该系统各组成部分如法律法规系统、组织管理系统、宣传教育系统、补偿系统的研究,旨在对我国器官移植事业的发展有所裨益。     

Changes in Family Structure After a Renal Transplant

Two girls (9 and 10 years old) and one male adolescent (19 years old) with chronic renal failure (CRF) were studied along with their families in order to evaluate their family structure before (4–5 weeks) and after (3–5 weeks) a renal transplant from a live donor. After the renal transplant there was a close association between the donor and the recipient that led to the creation of an alliance or the reinforcement of an alliance already present before the transplant. This may favor a family disruption or a better family equilibrium depending upon whether the donor ranked highest in the family hierarchy and was already in a rigid alliance with the patient before the transplant. It is suggested that the study and diagnosis of the family structure before the renal transplant may help to: (a) select the most suitable donor candidate from a biological as well as psychological point of view so as to allow a better possibility of success in the structural functioning of the family after the transplant; (b) predict changes that will appear within the family after the transplant, which in turn may alert the personnel to detect changes in the family structure as early as possible; and (c) offer more rapid therapeutic assistance to bring the family back to a functional level within its social framework.     

Effect of family environment and donor source on patient quality of life following renal transplantation.

The authors examined the degree to which the supportiveness of a patient's family environment predicts change in quality of life following renal transplantation. The sample consisted of 95 patients receiving renal grafts from either a living donor or a cadaveric donor. Patients were initially assessed prior to transplantation with follow-up assessment occurring an average of 5.5 months after transplantation. Among patients receiving a living-donor kidney, those reporting a more supportive family environment exhibited reduced depression, improved mobility, and improved social functioning. However, those living-donor recipients reporting less family support exhibited increased depression and diminished mobility and social functioning after transplantation. Patients receiving a kidney from a cadaveric donor showed modest improvements in quality of life regardless of the degree of family support.     

Reconsidering the dead donor rule: is it important that organ donors be dead?

The "dead donor rule" is increasingly under attack for several reasons. First, there has long been disagreement about whether there is a correct or coherent definition of "death." Second, it has long been clear that the concept and ascertainment of "brain death" is medically flawed. Third, the requirement stands in the way of improving organ supply by prohibiting organ removal from patients who have little to lose--e.g., infants with anencephaly--and from patients who ardently want to donate while still alive--e.g., patients in a permanent vegetative state. One argument against abandoning the dead donor rule has been that the rule is important to the general public. There is now data suggesting that this assumption also may be flawed. These findings add additional weight to proposals to abandon the dead donor rule so that organ supply can be expanded in a way that is consistent with traditional notions of ethics, law, public policy, and public opinion.     

肝移植的伦理学问题

肝脏移植和其它器官移植一起实现了人类长期以来渴望生命再生的梦想,并成为终末期肝病的有效治疗方法。器官移植也面对许多伦理道德方面的难题。供体,特别是活体器官的摘取,受体的选择等,都受到社会道德观的制约。从伦理道德角度来分析如何制定相关的法律法规,成为当前社会关注的热点。从受体的利益、人体科研的道德规范以及相关制度的伦理学要求等方面,较为详细的阐述肝移植伦理学的基本原则。     

Kidney Transplants From Young Children and the Mentally Retarded

Kidney donation by young children and the mentally retarded has been supported by court decisions, arguments based on obligations inherent in family relationships, an array of contextual factors, and the principle of beneficence. These justifications for taking organs from people who cannot protect themselves are problematic and must be weighed against our obligation to protect the vulnerable. A compromise solution is presented that strongly protects young children and the mentally retarded but does not abdicate all responsibility to relieve suffering. Guidelines are proposed that prohibit the retrieval of kidneys from young children and the mentally retarded but permit one exception. They would allow retrieval of a kidney when the consequence to a first order relative with whom the donor has a meaningful and valuable relationship is otherwise imminent death. This would be done in accordance with additional guidelines that minimize harm to the donor. Since most patients with end stage renal disease can be maintained on dialysis the need for a kidney to prevent death should be an uncommon occurrence. This compromise is proposed as a solution to a dilemma that exists because two ethical principles are in conflict and one cannot be honored without violating the other.     

Law and LGBQ-Parent Families

This paper addresses how the law affects LGBQ-parent families. We first outline the legal landscape that LGBQ parents face in the US, underscoring that it varies drastically by state and creates inequity for families. Reviewing existing social science research, we then address how the law affects three processes for LGBQ people: desiring parenthood, becoming a parent, and experiencing parenthood. Our review indicates that the law affects if and how LGBQ people become parents. LGBQ people consider the law as they make decisions about whether to pursue adoption, donor insemination, or surrogacy and often view the latter two pathways as the most legally secure. Further, the law continues to be salient for LGBQ parents throughout parenthood and affects family well-being. Specifically, legal inequity diminishes parent’s well-being, the relationship among couples who are parenting, and parents’ ability to effectively advocate for their children in institutional settings like healthcare contexts. Finally, we address directions for future research for scholars interested in the law, family processes and outcomes, and LGBQ families.     

Embolie gazeuse cérébrale lors d’une séance d’hémodialyse : aspects médico-légaux : à propos d’une affaire judiciaire

Air embolism is a serious iatrogenic event, concerning many invasive medical therapies. It is a rare but life-threatening adverse event. We report a case of a cerebral air embolism occurring during a renal replacement therapy. We report the case of a court case analyzed in the Department of Legal Medicine of Farhat Hached University Hospital in Sousse, Tunisia, related to a cerebral gas embolism occurring during a session of renal replacement therapy. Then we discuss the medical liability of the medical team involved in this act. Through a draft organic law (law No. 41/2019 on patients’ rights and medical liability), Tunisian jurisprudence aims at resolving legal claims in the field of medical liability by providing more opportunities for an amicable solution and by guaranteeing an adequate and quick compensation of the damage suffered.