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。     

CD4＋调节性T细胞与多脏器功能障碍综合征免疫功能紊乱

免疫功能紊乱是多脏器功能不全综合征发生的重要原因之一,其机制仍不明了。本文概述CD4＋调节性T细胞在免疫紊乱发生机制中的作用,及其潜在的治疗价值,拓宽MODS的免疫调节治疗的思路。     

认识脑死亡

脑死亡是指脑功能永久性不可逆的完全丧失,而不考虑呼吸心跳是否停止。目前脑死亡临床诊断标准已具有高度准确性。脑死亡的确立对树立新的道德观念、节约社会资源、促进器官移植发展意义重大,但要在中国立法可能还需要一个漫长的过程。     

死亡标准与器官移植时的伦理痛苦与法律的无奈

死亡是一个过程。基于纯功利主义考虑,为了增加可移植器官的供应量而人为规定的脑死亡标准,将这一过程提前了。由此,面对生命垂危、处于弥留之际的同胞,人类也永远摆脱不了良心的拷问,永远要生活在道德的焦虑和不安之中,感受着法律的无助与无奈。     

应紧急叫停活体捐献器官

“不伤害原则”是医学的基本要求。活体摘取器官,则意味着要对另一人造成重大伤害,不如顺其自然。死刑犯其人身自由受到严格限制,又是处在一个相对封闭的环境(监狱)之中,因此,虽有死刑犯生前关于“自愿捐献器官”的书面签字,也难以证明其是真正出于自愿。故器官移植应禁止以死刑犯作为供体来源。     

When is the gift given? Organ donation,social representations,and an opportunity to register

The gift of life doctrine underpins Australia's approach to organ donation: in legislation, clinical practice, community awareness campaigns, and educational activities. In this paper, we present an approach that situates an understanding of organ donation within a social representation framework as a system of values, ideas, and practices. In cadaveric donation, the final giving‐of‐the‐gift can never be by the donor, leading us to ask where the potential donor's decision to give the gift really lies. We present research from three studies that explored the relationship between what was socially understood about organ donation and the registration of donation intent. Drawing from three socially and culturally diverse populations, we asked people working in a corporate city institution and those attending two football matches in the outer city area to complete a word‐association task and Likert‐scale belief questions about organ donation—followed by an opportunity to register immediately on the Australian Organ Donor Register. Driven by the interdependent themata of life/death and self/other, the gift of life doctrine is inextricably linked with the loss of life emerging as both positive and negative beliefs allowing their relationship to actual registration behaviour to be observed. Our findings suggest that in many instances, the potential donor's genuine desire to give the gift lies in the tension between positive and negative beliefs, manifesting as a consent registration when the positive beliefs about donation prevail and an immediate opportunity to register is available.     

技术之后是法规和观念的更新--中国器官移植的重大进展

从我国器官移植的历史和现状出发,在器官移植的技术和基础研究有了理观念的更新.这种更新应建立在对器官移植的伦理思考和讨论的基础之上.2003年我国关于器官移植的法规和观念有了新的突破,有关的管理办法和条例也在草拟之中.中国政府和医学界对器官移植始终持积极和慎重的态度,所谓"中国移植和买卖死刑犯器官"完全是别有用心的捏造.     

Neurodevelopmental functioning in children being evaluated for heart transplant prior to 2 years of age

Cardiac defects represent the most common type of birth defect and children with these abnormalities are known to experience a variety of developmental and neuropsychological delays. Children receiving heart transplants may be at the highest risk for delays as they tend to represent the most severely ill patients with heart disease. This study investigates neurocognitive and adaptive functioning in 20 children under 2 years of age who were undergoing evaluation for heart transplant, comparing their performance to that of normative samples. The results indicate delays across various domains of neurocognition, including general cognitive, receptive language, expressive language, fine motor, and gross motor skills. In addition, adaptive and social-emotional functioning fell significantly below that of normative samples. No significant differences were found when comparing the test performance of patients with congenital heart defects (n = 12) to patients with cardiomyopathy (n = 8). Secondary analyses investigating the impact of genetic conditions, premature birth, and non-English language dominance showed minor changes in results across some domains, although this may have been due, at least in part, to decreased power to detect differences. Overall, this study’s results support the need for early evaluation, intensive intervention (e.g., speech, occupational, and physical therapy), and continued monitoring of these patients’ neurodevelopmental/neuropsychological functioning over time. Future research should examine longitudinal changes in development using both pre- and post-transplant data and should investigate the impact of early intervention.     

Attachment patterns moderate the relation between coping flexibility and illness acceptance among kidney transplant recipients

Background and Objectives: Post-transplant kidney recipients may experience psychological concerns which have been associated with negative health behaviors. Illness acceptance might have an important role in this process. In line with the Conservation of Resources Theory (COR), the current study aimed to examine the relationship between coping flexibility, attachment patterns and illness acceptance among post-transplant kidney recipients, and to evaluate whether attachment patterns moderate the link between coping flexibility and illness acceptance.

Design: The study employed a cross-sectional design.

Methods: Ninety-four post-transplant kidney recipients completed questionnaires assessing demographic and medical characteristics, illness acceptance, coping flexibility and attachment patterns.

Results: Our results indicated that coping flexibility was positively associated with illness acceptance. Moreover, attachment moderated this link, as high coping flexibility was associated with increased illness acceptance among individuals with low levels of attachment anxiety, a finding which was not significant when high levels of anxiety were reported.

Conclusions: This study highlights the potential importance of building greater flexibility in order to enhance illness acceptance among kidney transplants recipients. Moreover, the role of insecure attachment patterns in health-related outcomes among kidney transplants recipients is emphasized.