“人体器官移植工作体系”框架的初步构想及其伦理使命

借鉴国内外相关成功经验,结合我国实际情况,对“人体器官移植工作体系”的构成以及各系统职能进行初步探讨。研究了该体系在阻止人体器官商业化、提高人体移植器官分配的公平高效性等方面发挥的作用。     

论开展亲属活体供肾移植的风险与对策

肾脏移植是救治终末期肾功能衰竭的最佳手段。亲属活体捐献肾脏是扩大供肾来源的有效手段。当前国内开展亲属肾移植存在伦理、法律和健康风险,主要来自供体和医疗两方面。为防范风险,医务人员应严格审查供受者的血缘关系,签署完整规范的法律文书,进行全面细致的术前评估,制定完善的手术方案。     

对肾移植输血问题的思考

就肾移植受者输血的几个问题进行了回顾和探讨。提出肾移植受者输血应该考虑的问题有：如何权衡输血对肾移植受者的有益作用与输血风险,输血医学的发展如何为肾移植提供更有力的保障,应该深入探讨输血有益于肾移植的机制,推进供者特异性输血在我国的应用。     

From agape to organs: religious difference between Japan and America in judging the ethics of transplant

This essay argues that Japan's resistance to the practice of transplanting organs from persons deemed "brain dead" may not be the result, as some claim, of that society's religions being not yet sufficiently expressive of love and altruism. The violence to the body necessary for the excision of transplantable organs seems to have been made acceptable to American Christians at a unique historical "window of opportunity" for acceptance of that new form of medical technology. Traditional reserve about corpse mutilation had weakened and, especially as presented by the theologian Joseph Fletcher, organ donation was touted as both expressive of agape and a way of "updating" Christianity via the ethics of Utilitarianism. Many Japanese, largely Buddhist and Confucian in their orientation, view these changed valorizations as neither necessary nor patently more ethical than those of their own traditions.     

Functional recovery of skilled forelimb use in rats obliged to use the impaired limb after grafting of the frontal cortex lesion with homotopic fetal cortex

The long-term effect of transplanting embryonic frontal cortex into a unilateral frontal cortex lesion has been studied in adult rats. Before surgery, activity in an open field, muscular strength of both forelimbs, and performance in a paw-reaching-for-food task were scored in 26 rats. In 21 animals a unilateral cortex lesion was then made in the forelimb motor area of the hemisphere contralateral to the preferred paw in the paw-reaching-for-food task, while the other 5 animals were sham-operated. On retesting, the lesion animals changed the preferred paw. A solid homotopic transplant of embryonic tissue (embryonic day 17) was then placed in the lesion cavity in 11 of the lesion rats. Three months later neither lesion alone nor lesion plus transplantation affected open field behavior and muscular strength, but the lesion permanently affected performance in the paw-reaching-for-food task, as shown by a change of preferred paw and a functional deficit in the paw contralateral to the lesion. Transplantation ameliorated the deficits caused by the lesion, but this was only evident when animals were forced to reach with the paw contralateral to the lesion plus transplant. The behavioral results were independent of the size of the lesion and graft. Connections between graft and host tissue were studied by means of the fluorescent tracer 1,1'-dioctadecyl-3,3,3'3'-tetramethylindocarbocyanine perchlorate (DiI). A dense array of labeled fibers was found in the host cortex adjacent to the transplant. The results suggest that functional recovery depends on grafting but is only evident when the animal is obliged to use the affected limb.     

The ‘redefinition of death’ debate: Western concepts and western bioethics

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by claiming neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the “dying”. This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises. Ms. Jones is an intensive care clinical nursing specialist. Dr. Kessel is a public health physician and medical ethicist.     

人体器官买卖成因和对策的法学思考

器官供需严重不平衡导致了人体器官买卖的产生,器官买卖对供体和受体均存在潜在风险,对社会危险性也不容忽视.分析了器官买卖链条中供体、受体和中介各自的角色和地位,并提出了立法推动尸体器官捐献、加强医院和医务人员承担的法律责任、打击买卖中介和加强网络监管等建议.     

The Adaptation of Patients During the Hospitalization Period of Bone Marrow Transplantation

A longitudinally study was conducted among 42 bone marrow transplantation (BMT) patients to investigate the association between pretransplant psychosocial variables and psychophysiological outcomes during the immediate convalescence period. Family relationships (cohesion, expressiveness, and conflict) and coping resources (cognitive, social, emotional, spiritual/philosophical, and physical resources) were assessed on the admission day (Day –7 Time 1). Data on psychological distress and pain intensity were obtained on Day +7 (Time 2) and Day +14 (Time 3). The average scores at Times 2 and 3 were computed to indicate the overall adjustments of the patients during the hospitalization period after the day of actual transplant (Day 0). It was shown that higher expressiveness family relationships and higher resources to cope effectively with stressful situations were associated with less psychological distress during the above period. Both pretransplant psychosocial variables were not associated with pain intensity during hospitalization. Allogeneic transplant patients reported higher pain intensity than did autologous transplant patients. Psychological distress and pain intensity were positively correlated with each other. Our findings show that pretransplant family relationships and coping resources associate moderately with psychological distress during the immediate convalescent period of BMT. The present findings support the family-centered approach to BMT care and provide a scientific basis for pretransplant psychosocial interventions.     

A Self-Management Program for Adolescents and Children with Renal Transplantation

This paper describes the development and implementation of a self-management program designed to address noncompliance in adolescents with renal transplants. Transplantation provides the best treatment alternative for End-Stage Renal Disease (ESRD), but is a procedure that subsequently demands recipients follow a life-long medication regimen. Nonadherance to medical therapy is a serious problem for adolescents; it is one of the most common causes of chronic graft rejection in this population. To improve compliance rates for this population, a self-management program was designed: (1) to provide social support; (2) to review information about medications and transplant management; and (3) to both teach and provide transplantation patients the opportunity to practice self-management skills. Details about the program, including recruitment issues and session content, are provided. Evaluations by participants indicated that the program was effective in creating a supportive environment for both patients and their parents, and in addressing health-related concerns.     

异体造血干细胞移植问题、发展与思考

异体造血干细胞移植(Allo-HSCT)已成为治疗恶性血液病及其他各种疾病的有效方法之一。在Allo-HSCT中由于供体和受体免疫屏障的存在。从而一开始就是一个供受体矛盾的对立统一的过程。对其中矛盾的研究和解决充满了辩证唯物的哲学思想。也促使Allo-HSCT技术不断发展。新的方法和理念不断出现。使Allo-HSCT治疗白血病的疗效不断提高。