潜在的器官供体来源:“次优”遗体器官研究现状

器官移植是很多终末期患者(如晚期癌症、肾衰竭等)的主要治疗方法,但是捐献器官在全球范围内都是供不应求。为了解决这个问题,各国政府长期致力于提高活体器官以及遗体器官的捐献率,但却忽视了一个很重要的潜在器官来源,即那些因为捐献者年龄太大、病毒感染(如丙型肝炎)、心死亡等各种原因被放弃的"次优(suboptimal)"遗体器官。受益于医疗技术的迅速发展,以前被认为不适合进行移植的次优遗体器官现在变成了潜在的供体。因此,本文通过文献分析,对国外关于"次优"遗体器官的研究进展进行详细的介绍,以期为致力于器官移植事业的中国临床工作者提供一些研究方向。     

ICU医务人员在心脏死亡器官捐献中面临的伦理问题及对策

心脏死亡器官捐献是目前解决器官移植工作器官短缺的关键性举措,参与器官捐献过程的ICU的医务人员需要直接面临对潜在捐献者的治疗照护、临终护理、死亡判定等诸多伦理问题.应加强ICU医务人员器官捐献伦理知识的普及教育并完善相关法律制度,以保证器官捐献工作的健康、可持续发展.     

公众对活体大器官移植的认知态度与对策

对河南地区公众关于活体大器官移植态度进行的抽样调查结果显示：（1）公众赞成开展活体大器官移植;（2）多数公众反对器官买卖,但赞成器官买卖的也有相当大的比例;（3）亲情是亲属活体器官捐献者愿意捐献的主要原因。针对调查结果,我们在比较分析的基础上,提出了相关对策,促使活体大器官移植技术更好地造福于人类。     

法哲学视域下的活体器官悔捐问题研究

器官移植是医学技术的重大进步,挽救了很多患者的生命,只是面临着器官短缺的问题。目前,我国《人体器官移植条例》赋予了捐献者任意悔捐的权利,但任意悔捐带来了诸多弊端。所以,有必要不拘泥于"实定法",而从法哲学的视域分析悔捐问题。研究发现是否捐献器官应由个体自由决定;但做出捐献承诺后应诚实守信;对悔捐行为,应区分情况,适当追责。如此,活体器官捐献方能实现三大法律原则:意思自治、诚实守信、信赖保护,器官移植才能走得更远。     

论器官捐献中家属意愿的影响因素与对策

医疗技术的成熟使得脏器来源成为器官移植的主要矛盾。我国长期依赖死囚尸体供给脏器,随着近年死囚器官的停用,器官供给矛盾显得更加尖锐。大量研究表明捐献者家属的意愿和作用是影响捐献能否实现的重要因素。通过对相关文献的总结,影响家属捐献意愿的因素主要集中在家属的认知水平、情感因素和器官分配三个方面,这些因素可以通过建立公众信息平台、强化逝者家属照护系统、改善器官分配政策等对策进行调整,从而提高我国家属器官捐献的意愿。     

以小拨大:默认选项和反应模式效应助推中国器官捐献登记

器官短缺是全世界共同面临的难题,中国器官短缺形势尤为严重。为填补中国器官供需不平衡导致的严重缺口,本研究试图借鉴行为经济学手段中的默认选项、选项架构等心理学效应,兼顾总体器官捐献率和捐献器官的数量,探索提高中国器官捐献水平的可能方法。本研究以中国在校大学生为样本,通过3个调查研究考察了器官捐献制度和器官捐献登记表设计对我国民众器官捐献登记的影响。研究1在器官捐献制度层面上,发现在中国文化背景中,"决定退出"制度比"决定参加"制度下的器官捐献登记率更高。研究2在器官捐献登记表设计层面上,比较采用不同捐献制度的国家/地区的捐献登记表形式对器官捐献登记率的影响,发现在决定退出制度中的器官捐献率高于决定参加制度,且前者内各种形式间无明显优劣之分;但在决定参加制度中,采用拒绝反应模式登记表形式的器官捐献率最高,甚至与决定退出制度下的各登记表形式相比不相上下。研究3在具有潜在器官捐献意愿人群中,探索提高捐献者愿意捐献器官数量的可能途径,发现使用拒绝反应模式的捐献登记表能够增加捐献登记的器官数量;且低影响外观器官的捐献率在拒绝反应模式下以升序排列时最高。这些结果说明,决定退出制度和反应模式等行为经济学手段可以有效助推中国器官捐献行为。鉴此,政府和相关机构可考虑采取如下措施提高中国的志愿器官捐献水平:或改现行的"决定参加"为"决定退出"的器官捐献制度;或在现行的"决定参加"器官捐献制度下,在器官捐献登记表中采用拒绝反应模式,并按对外观影响大小升序排列捐献器官种类。     

移植协调员在DCD工作中的角色和作用

器官捐献是器官移植事业发展的基石,而协调员在器官捐献工作中则有着举足轻重的地位和作用。自2010年3月我国推行人体器官捐献试点工作以来,适合中国国情的DCD工作成为器官捐献工作的重中之重。如何充分发挥协调员在DCD工作中的作用,提高DCD捐献率和供体转化率,以有效地促进和推动DCD工作,是急待探讨和解决的问题。本文结合...     

论当前人体器官捐献的激励措施与问题——德国《器官移植法》修订的启示

中德两国的人体器官捐献制度都以自愿与无偿为基本原则,因此也面临同样的难题,即公众的捐献意愿决定性地影响器官捐献的数量。德国立法机关为了促进器官捐献,在德国《器官移植法》的修订中引进了"选择模式",法定机构将向年满16周岁的民众提供有关人体器官捐献的详细解说资料,并定期书面询问其是否愿意捐献。我国现行器官捐献制度尽管规定了多种激励措施,但是无法从根本上解决当前捐献意愿低迷的现状。德国器官移植制度的新变革对于解决我国当前面临的问题具有积极的参考意义。     

中国器官捐献立法完善的若干意见

《人体器官移植条例》颁布已有十余载,虽解决了器官捐献无法可依的问题,但因其内容不完备及严格的条件限制,已成为我国器官捐献发展的障碍。从人体器官捐献存在的主要问题及立法现状入手,借鉴国外器官捐献立法现状,论述该条例中器官捐献内容存在的问题,提出完善我国器官捐献的三条建议:(1)出台专门的《人体器官捐献法》;(2)从扩大活体器官捐献供体范围、适当放宽遗体器官捐献条件、建立器官捐献的有效激励机制、规范器官分配原则6个方面完善《人体器官移植条例》;(3)明确脑死亡标准,确立脑死亡立法。     

我国人体器官志愿捐献的伦理学思考

器官移植、骨髓移植是２０世纪生物医学工程领域中具有划时代意义的技术,是近代医学最伟大的成就之一,至今全球接受过各种移植的人数已累计超过５０万人次。但是供体的严重缺乏是制约我国器官移植工作开展和技术发展的主要原因之一。这其中传统观念的桎梏是摆在志愿捐献者面前的主要障碍,因此志愿捐献者的严重缺乏是我国医学伦理学研究的一道难题。这与我国这样一个有丰富人口资源的大国是不相适应的。本文将对我国志愿捐献伦理难题做一剖析。１　我国人体器官志愿捐献的现状第１６届世界器官移植大会上公布的一组数据显示,目前西班牙的…     

Attitudes and Behaviors Regarding Organ Donation: a Study on Officials of Religion in Turkey

The aim of this study is to determine the attitudes and behaviors of religious scholars regarding organ donation and transplantation. In this study, 540 officials working in the Department of Religious Affairs in Kayseri, Turkey, were included. Overall, 86.6% response rate (n = 468) was achieved. Although a majority of the officials of religion in this study stated that they believed in the importance of organ donation (90.8%), the rate of considering donation (57.9%) and the donation rate (1.1%) were found to be substantially low. There is a difference between the employment status and willingness to donate organs. The rate of willingness to donate was significantly high in men than women. And also was high in imams and preachers. Regarding the sources of information, the majority of the respondents (70.0%) cited mass media. Overall, 15.3% cited school education and 42.0% religious publications. The most common question (83.1%) that was asked was “whether or not organ donation was suitable for Muslim religious”. Our study revealed that although the research groups have positive ideas about organ donation and transplantation, their role was low in informing and motivating people about organ donation and transplantation.     

Transplantation: Biomedical and Ethical Concerns Raised by the Cloning and Stem-Cell Debate

Transplantation is becoming an increasingly more common approach to treatment of diseases of organ failure, making organ donation an important means of saving lives. Most world religions find organ donation for the purpose of transplantation to be acceptable, and some even encourage members to donate their organs as a gift of love to others. Recent developments, including artificial organs, transplants from nonhuman species, use of stem cells, and cloning, are impacting the field of transplantation. These new approaches should be discussed with bioethical considerations in mind, particularly the notion of human beings as a unity of body and spirit.     

Religion and Organ Donation: The Views of UK Faith Leaders

This article reports the findings from the one-to-one interviews with the main UK faith and belief leaders which were commissioned by the Organ Donation Taskforce as part of its evidence gathering. Interviews were arranged with the main faith and belief organisations within the UK. Interviews covered a range of issues related to organ donation. Although some faith groups had some reservations regarding organ donation, interviews with these leaders demonstrated that none of these faith groups have reached a consensus against organ donation. The interviewees stated that the majority opinion in their faith or belief group is to permit organ donation, with some actively supporting it. Interviewees were keen to stress that there is a broad spectrum of opinion on organ transplantation within each faith and belief group and that consequently it is difficult to speak on behalf of an entire group. One complication mentioned by interviewees is that as organ transplantation is a relatively new medical procedure, there is no explicit reference to it in many original religious texts. Consequently, positions on the receipt and donation of organs are based on interpretation. It was felt that a much greater level of engagement is needed, as organ donation is currently not a priority for many faith and belief groups.     

Knowledge and attitudes of Polish university students toward organ donation and transplantation

Although the number of patients needing organ transplantation systematically increases, recent years have seen a considerable shortage of donors. The level of knowledge and attitudes toward donation are critical factors in achieving the required balance between supply and demand. This pilot study assessed the knowledge, opinions, and behaviors related to organ donation and transplantation among 625 students representing eight different fields of study from the University of Rzeszow in south-eastern Poland. Although the participants provided evidence of knowledge about human organ donation and transplantation, they were aware of the main organs of the human body for potential transplants, and generally showed positive attitudes; only 24% of the subjects indicated their willingness to register as a donor; only 3% stated that they had already registered and had a donor card. The findings suggest that good intentions do not translate into action and that Poland needs to develop a nation-wide, up-to-date, and youth-oriented health education program that builds on favorable attitudes toward organ donation and transplantation.     

Islamic Legal and Ethical Views on Organ Transplantation and Donation

In Islam, one of the core beliefs is in the life of the hereafter. At the end of time and all that exists, all human beings will be resurrected (in their bodies and souls) and will face the Day of Judgment. Even their body parts or organs will stand witness against them. Furthermore, in Islamic law, every action or thing is categorized either as legitimate or prohibited. This article explores ethico‐legal opinions on the issues of organ donation and transplantation in the light of these essential Islamic beliefs.     

Non-heart-beating organ donation: personal and institutional conflicts of interest

While procurement of organs from donors who are not "brain dead" does not appear to pose insurmountable moral obstacles, the social practice may raise questions of conflict of interest. Non-heart-beating organ donation opens the door for pressure on patients or families to forgo possibly beneficial treatment to provide organs to save others. The combined effects of non-heart-beating donation and organ shortages at major transplant centers brought about by the 1991 United Network for Organ Sharing (UNOS) local-use organ allocation policy created potential conflicts, including the fact that candidates for organs become potential donors far more frequently than previously. Hospitals with a major emphasis on transplantation have economic and academic interests that may have been hurt by the relative organ shortage. Some may view non-heart-beating organ donation as a way to restore weakened programs and thus unconsciously compromise recognition of problems associated with non-heart-beating donation.     

我国大陆、台湾地区《人体器官移植条例》的比较研究

采用条文比较与法理分析方法,对我国大陆和台湾地区的《人体器官移植条例》进行比较,主要就立法目的、立法调整范围、人体器官自愿捐献、禁止人体器官商业交易、医疗机构与人员的准入和退出、违反人体器官移植之规定的法律责任等问题作了探讨与分析。本研究将为我国大陆地区的具体立法探索一些有价值的意见与建议。