活体肝移植供体伦理学思考

器官移植,特别是活体供体器官移植,面临着许多伦理、道德和社会方面的难题.一方面要鼓励人们为挽救他人生命贡献自己的器官,另一方面社会又要求医学技术保证"健康人"的绝对安全.作为活体供体,既冒着生命危险和承受健康损害,又特别关注自身器官是否能有效挽救指定患者的生命.根据我们开展临床活体肝移植的体会,从供体的知情同意权、自愿原则、风险和利益对等、优先考虑供体利益、供体的健康和经济风险、保护精神病人和青少年利益以及捐献者的骄傲感和光荣感等方面探讨伦理学的基本原则.     

乙肝歧视:热过后的冷思考

乙肝歧视作为一个术语存在明显的语义学缺陷,在伦理学的视域中,乙肝歧视既非程序不公正,也非分配不公正,而是主体对客体缺少必要的仁慈.虽然通过医学手段彻底治愈乙型肝炎的时间无法准确地估测,但只要我们能够充分利用现有的医学和社会手段,就有望在30年左右的时间内将中国社会人群的乙肝病原携带率控制在1%以内,这大体上可看作是乙肝歧视的终结.     

乙肝治疗现状和反思

从我国目前情况看 ,只要是乙肝表面抗原阳性者 ,一律划归乙肝患者行列。据不完全统计 ,我国乙肝患者已逾一亿三千万 ,该病无可争议地成为我国的第一病 ,该病几乎是清一色的慢性病 ,缠绵不愈 ,治来治去 ,时好时坏 ,彻底治愈者极少。广大患者和有良知的医生都在翘首以待特效药物问世 ,盼来盼去 ,特效药没见着 ,倒是数不尽的疗效似是而非的药物出个不断。乙肝治疗市场空前繁荣 ,治疗效果却屡屡不佳 ,乙肝治疗存在不少问题已是不争的事实。但是到底存在些什么问题 ,有待深究。笔者随机调查了 14 6名慢性乙肝患者 ,采用问卷方式 ,就乙肝患者治疗…     

从"被自愿体检"反思乙肝歧视的成因

乙肝歧视在我国呈普遍现象,已引起社会的广泛关注.为维护乙肝表面抗原携带者的合法权益,国家相继出台了一系列规章,但收效甚微.从医学和社会学视角分析我国乙肝歧视难以消除的原因,指出职能部门、用人单位、医疗机构、公众、乙肝表面抗原携带者存在的问题和原因,并提出了消除乙肝歧视的措施.     

亲体肝移植的伦理学问题探讨

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多年来其发展迅速,并取得了良好的疗效.由于活体肝移植需从活的供体身上切取部分肝脏,且供体多为患者家属,故存在着供体的选择、供体的贡献与代价,患者的家庭、心理、社会等伦理学问题.因此在提高活体肝移植技术水平的同时,必须充分考虑活体肝移植的伦理学问题,遵守伦理原则,使活体肝移植不但能从技术上达到,在伦理学方面也是可行的.     

器官移植供体公平分配问题的初步研究

随着器官移植技术的飞速发展,供体器官严重缺乏的问题日益突出,在供需矛盾严重失衡的情况下,如何保障供体器官的公平分配成为社会焦点.通过分析研究了目前国内外器官分配的基本情况,建议进一步完善器官移植立法和医保模式,借签国外经验建立全国性器官移植协调中心,进而实现我国供体器官的公平分配.     

中、西医治疗慢性乙型肝炎现状的分析与思考

分析了中、西医肝病临床治疗慢性乙型肝炎的现状,着重探讨了中医药在防治乙肝中的优势和不足.指出多数医生存在对乙肝发病机制认识模糊、不能提供合理的治疗方案和研究方法欠科学等三个误区.倡导用循征医学方法对中医药防治乙肝的疗效进行评价.     

器官移植道德反思--兼评器官商品化

自从器官移植技术出现以来,器官移植供体的缺乏就成为了制约其发展的瓶颈问题,而脑死亡临床诊断标准的出台为解决这个问题指明了方向.如何为脑死亡立法和器官移植立法寻求合理的道德支持是立足点,也是现代生命伦理学的热点与难点之一.以器官移植的供体来源短缺为切入点,提出了解决有关立法和寻求新的道德资源支持的一些思路与方向,坚决反对通过器官商品化来解决移植供体短缺的问题.     

我国器官移植中供体不足的原因分析及对策

器官移植对于挽救晚期脏器功能衰竭病人的生命具有极其重要的意义,我国器官移植起步较晚,多种因素限制器官移植的发展,其中供体不足是关键因素之一.分析器官移植中供体不足的原因,认为冲破传统观念的束缚,加大宣传力度,加快立法步伐是我国器官移植中供体不足亟待解决的问题.     

扩展人体器官来源的思考

扩展人体器官来源的思考中国医科大学社科部（沈阳１１０００１）黄焱一我国器官的供体来源除了一部分来自亲属的活供体外,其余的要靠死刑犯的尸体,作为移植器官的主要供体来源,甚至是唯一的来源。所以供体器官的来源十分有限。但在我国这样一个人口众多,每年有７００...     

“Is It Me,or Isn't It?”—Transplanted Organs and Their Donors as Transitional Objects

There are indications in psychosomatic transplant literature that the "transitional space" (in the D.W. Winnicott's sense) plays an important part in the psychic integration of an transplanted organ or its donor. The present case study is based on a semi-standard textbook interview carried out in the course of a qualitative research program with 20 male and female patients following a lung transplant. Two transcribed passages in the text, which relate to the transplanted organ and its donor, were interpreted from the point of view of Winnicott's "transitional phenomenon" model. The case study made it clear that, even years after a lung transplant, the patient experiences the organ and donor as transitional objects. The donor, as perceived by the patient, is a living, omnipotent person who is really present and to whom the recipient attributes ideal (personality) qualities. The transplanted lung, however, insofar as a psychosomatic integration of the organ has only partially succeeded, remains in the possession of both the donor and the recipient. The donor, as a typical transitional object, performs a creative function in helping the patient to cope with everyday life. The employment of the donor or the transplanted organ as "transitional object" may be seen, above all, as a positive assimilation strategy. On the other hand, transitional phenomena may also draw attention to desintegrative processes in surmounting an organ transplant. These clinical questions are discussed at the end of the paper.     

Death and organ procurement: public beliefs and attitudes

Although "brain death" and the dead donor rule--i.e., patients must not be killed by organ retrieval--have been clinically and legally accepted in the U.S. as prerequisites to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents >18 years were randomly selected and surveyed using random digit dialing (RDD) sample frames. The RDD telephone survey was conducted using computer-assisted telephone interviews. The survey instrument was developed from information provided by 12 focus groups and a pilot study of the questionnaire. Three scenarios based on hypothetical patients were presented: "brain dead," in a coma, or in a persistent vegetative state (PVS). Respondents provided personal assessments of whether the patient in each scenario was dead and their willingness to donate that patient's organs in these circumstances. More than 98 percent of respondents had heard of the term "brain death," but only one-third (33.7%) believed that someone who was "brain dead" was legally dead. The majority of respondents (86.2%) identified the "brain dead" patient in the first scenario as dead, 57.2 percent identified the patient in a coma as dead (Scenario 2), and 34.1 percent identified the patient in a PVS as dead (Scenario 3). Nearly one-third (33.5%) were willing to donate the organs of patients they classified as alive for at least one scenario, in seeming violation of the dead donor rule. Most respondents were not willing to violate the dead donor rule, although a substantial minority was. However, the majority of respondents were unaware, misinformed, or held beliefs there were not congruent with current definitions of "brain death." This study highlights the need for more public dialogue and education about "brain death" and organ donation.     

Doctor can I buy a new kidney? I've heard it isn't forbidden: what is the role of the nephrologist when dealing with a patient who wants to buy a kidney?

Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments.In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient (and, with several caveats, of the donor) may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of “reverse” informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles (beneficence, non-maleficence, justice and autonomy) to the donor and recipient parties.     

谈中医认知方式及中医理论体系的构建

提出开箱式思维和闭箱式思维的概念,并以此为基础对中医认知方式和中医理论体系的构建进行初步的探讨.整体上,中医认知方式是一种宏观性闭箱式思维,中医学是一种闭箱式理论体系.     

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。     

论器官资源的开拓与公平分配

器官移植在我国正处于快速发展阶段,目前除技术层面的问题外,供体数量严重不足和分配不公的问题也十分突出。本文对我国器官资源短缺原因、器官移植立法的迫切性、器官移植市场的规范化引导等问题做了全面论述,尤其对如何建立可靠的供体库和器官分配公平性的实现等问题做了较为深入细致的探讨。     

Real Donors, Real Consent: Testing the Theory of Reasoned Action on Organ Donor Consent

In an attempt to apply the theory of reasoned action (TRA) to the process underlying organ donor consent, participants completed questionnaires concerning their affective responses to organ donation, as well as their intentions to donate. Participants were given the opportunity to sign an organ donor card. Those who chose to sign the card had more positive attitudes about donation, perceived donation as something that their reference group would encourage, and had stronger intentions to consent to signing a card. The current investigation extends the organ donor literature by using a true behavioral outcome measure indicating consent. Moreover, the pattern of results between attitudes, norms, intention, and behavior illustrates the usefulness of applying the TRA to yet another health-related behavior.     

Living donation and cosmetic surgery: a double standard in medical ethics?

The commitment of transplant physicians to protect the physical and psychological health of potential donors is fundamental to the process of living donor organ transplantation. It is appropriate that strict regulations to govern an individual's decision to donate have been developed. Some may argue that adherence to such regulations creates a doctor-patient relationship that is rooted in paternalism, which is in drastic contrast with a doctor-patient relationship that is rooted in patients' autonomy, characteristic of most other operative interventions. In this article we analyze the similarities between cosmetic plastic surgery and living donor surgery as examples of surgeries governed by different ethical principles. It is interesting that, while the prevailing ethical approach in living donor surgery is based on paternalism, the ethical principle guiding cosmetic surgery is respect for patients' autonomy. The purpose of this article is not to criticize either practice, but to suggest that, given the similarities between the two procedures, both operative interventions should be guided by the same ethical principle: a respect for patients' autonomy. We further suggest that if living organ donation valued donors' autonomy as much as cosmetic plastic surgery does, we might witness a wider acceptance of and increase in living organ donation.     

关于阴茎移植的伦理问题

随着医学科学的发展,器官移植日趋成熟,不仅使患者延长了生命,更大大提高了生活质量。阴茎移植是器官移植和免疫学发展的结晶,是异体器官移植领域内新的突破,为阴茎缺失的患者带来了新生,对患者心理、家庭和社会有着重大影响。但目前异体阴茎移植刚刚起步,技术尚不成熟,且阴茎是一特殊器官,涉及到的伦理道德问题很多,我们试图从受者、供者、医生和法律等方面讨论阴茎移植所面临的伦理道德问题,希望阴茎移植能真正造福于人类。     

Death, organ transplantation and medical practice

A series of papers in Philosophy, Ethics and Humanities in Medicine (PEHM) have recently disputed whether non-heart beating organ donors are alive and whether non-heart beating organ donation (NHBD) contravenes the dead donor rule. Several authors who argue that NHBD involves harvesting organs from live patients appeal to "strong irreversibility" (death beyond the reach of resuscitative efforts to restore life) as a necessary criterion that patients must meet before physicians can declare them to be dead. Sam Shemie, who defends our current practice of NHBD, holds that in fact physicians consider patients to be dead or not according to physician intention to resuscitate or not. We suggest that criteria for a concept are not necessarily truth conditions for assertions involving the concept. Hence, non-heart beating donors may be declared dead without meeting the criterion of strong irreversibility even though strong irreversibility is implied by the concept of death. Our perception that a concept applies in a given case is determined not by the concept itself but by our necessary skill and judgment when using it. In the case of deciding that a patient is dead, such judgment is learned by physicians as they learn the practice of medicine and may vary according to circumstances. Current practice of NHBD can therefore be defended without abandoning death as an empirical concept, as Shemie appears to do. We conclude that the dead donor rule continues to be viable and ought to be retained so as to guarantee what the public most cares about as regards organ donation: that physicians can be trusted to make determinations of eligibility for organ donation in the interests of patients and not for other purposes such as increasing the availability of organs.