Approaching Religious Guidelines for Chimera Policymaking

Recent developments in the use of cow egg cells to clone human somatic cells, and the grafting by researchers at several universities of human neurons into mice, bring the notion of the chimera, a mixture of several living organisms, from myth into reality. In his article “Cross‐Species Chimeras: Exploring a Possible Christian Perspective,” Neville Cobbe considers the religious arguments overlying the creation of human‐nonhuman chimeras. In my commentary I focus on the distinction between germline‐ and tissue transplant‐related chimeric techniques implicit in Cobbe's essay and argue that the former poses more serious moral difficulties than the latter if the chimeric product is brought to term. The substantive view of the imago Dei, or image of God, serves as a scaffold by which to judge the permissibility of chimera creation using stem cell and other tissue implants. While useful for judging the rights of such artificially generated beings, I argue that specific criteria such as proportion of tissue uptake, mental capacity, and adherence with the organism's telos are more appropriately considered within a composite image of the living being reflecting its unique integrality. Human co‐creativity with the Divine will inevitably prompt attempts to generate medically useful chimeras. Religious dialogue, combined with the categories of religious moral argument appearing in Cobbe's essay, will help to establish the outline of feasible policy guidelines addressing the complexities inherent in the creation of chimeras.     

The Dream of Consensus: Finding Common Ground in a Bioethical Context

Consensus is the holy grail of bioethics, the lynch pin of the assumption that well informed, well intentioned people may reach generally acceptable positions on ethically contentious issues. It has been especially important in bioethics, where advancing technology has assured an increasing field of complex medical dilemmas. This paper results on the use of a multicriterion decision making system (MCDM) analyzing group process in an attempt to better define hospital policy. In a pilot program at The Hospital for Sick Children, Toronto, a series of small scale focus groups was constituted to examine criteria defining organ transplant eligibility. Criteria were organized hierarchically using the Analytic Hierarchy Process, an MCDM approach, and the resulting data was analyzed using Expert Choice 9.0, software designed to facilitate AHP analysis. Qualitative and quantitative analysis map barriers to practical consensus in a way not previously possible.     

开展活体器官移植的伦理学思考

活体器官移植起源于器官移植技术的最初阶段,目前已经成功开展了肾脏,肝脏,肺脏、小肠、脾脏等器官的活体移植手术,事实表明该技术不仅有其科学依据,而且有其伦理学依据,即以人类自身伟大的奉献精神来关爱他人。但开展这一技术时务必需要遵循知情自愿原则,生命价值原则,利益和风险并存原则。当然在积极肯定这一技术的同时,也应该看到这一技术也存在一些伦理学方面尚未解决的问题。     

解读我国首部全国性人体器官移植法规

我国首部全国性人体器官移植法规《人体器官移植技术临床应用管理暂行规定》即将于今年7月1日起实行,标志着长期以来困扰我国器官移植领域无法可依局面的结束,它必将为推动我国的器官移植事业做出不可估量的贡献,为下一步其他相关法律法规的制定提供更多的理论指导和实践依据。分析了该法规的特点,并对其存在的问题提出了思考意见。     

Noncompliance in end-stage renal disease: A threat to quality of care and cost containment

Noncompliance to treatment regimen after kidney transplantation is a threat to health outcomes and cost containment. Although there are methodological challenges to obtaining reliable compliance data, the results of noncompliance are increased morbidity and mortality in posttransplant patients. In addition, recent research suggests that patients who incur repeated rejection episodes leading to graft failure have higher levels of medical utilization. Some psychosocial factors related to compliance and medical utilization are potentially modifiable through cognitive-behavioral intervention.     

Gender differences in patterns of emotional distress following heart transplantation

The study provides the first empirical evaluation of gender differences in psychological symptomatology and DSM-III-R major depressive disorder (MDD) across the first year following heart transplantation. An important goal was to identify physical health-related and psychosocial factors that could account for, or mediate, any association between gender and psychological distress. The sample for the present analyses was drawn from a larger cohort of 172 heart recipients and included all 28 women in the cohort plus 118 men who were matched demographically with the group of women. Detailed patient assessments were completed at 2, 7, and 12 months posttransplant. As expected, women's symptom levels were consistently higher than men's. However, while men's symptom levels in all areas declined with time posttransplant, women's distress in the area of depression initially improved but then worsened by the 12-month assessment. The distribution of episodes of MDD showed a temporal pattern of gender differences similar to that of depressive symptoms. The most important mediators of the gender-depression relationship were factors related to early posttransplant daily functional limitations: women reported more impairments in daily activities. Higher levels of such impairments, in turn, predicted subsequently higher depression levels by 12 months posttransplant. Several additional variables pertaining to transplant-related concerns and a low sense of personal mastery—while not serving as mediators—exerted their own independent effects on 12-month depression levels. The findings are relevant to the tailoring of educational and clinical interventions to the individual needs of women and men who receive heart transplants.Roberta G. Simmons, Ph.D., died on February 15, 1993, during data collection for this paper.     

器官移植伦理审查委员会实践难题的伦理思考

器官移植伦理审查委员会在器官移植技术的临床应用中意义重大,但其在实践中面临着缺乏明确的伦理原则和沟通技巧、对需要审查内容的理解不深刻等难题,这影响了其伦理使命的充分实现。为此,伦理审查委员会必须制定明确的伦理原则、深入理解需审查的内容、在伦理学知识、行动纲领和沟通技巧方面对其成员进行培训。     

MMPI Profiles of Liver and Heart Transplant Candidates With and Without Significant Histories of Heavy Alcohol Use

This study compared the Minnesota Multiphasic Personality Inventory (MMPI) profiles of liver and heart transplant candidates with (n = 104) and without (n = 253) significant histories of heavy alcohol consumption. The alcohol and nonalcohol groups had similar overall mean profiles with significant or marginally significant (i.e., T 69) clinical elevations on Scales 1, 2, and 3. However, significantly higher proportions of those in the liver transplant group than in the heart transplant group scored within the clinical range on Scales F, 4, 6, and 8. In addition, the proportions of respondents obtaining clinically elevated scores were significantly higher for the alcohol than for the nonalcohol group on Scale 4 and the MacAndrew Scale; the proportion was higher for the nonalcohol than for the alcohol group on Scale K. The overall similarity of the mean profiles indicates that candidates for liver or heart transplantation with and without histories of heavy alcohol use generally display similar psychological presentations. The observed differences between the liver and the heart transplant groups may reflect impairments in mental status among liver transplant candidates due to metabolic consequences of liver disease. The differences between the alcohol and the nonalcohol groups may be more a reflection of past behavioral patterns than present psychological status.     

肾移植性别失衡的现状、影响因素及思考

肾移植的性别失衡问题在全球已经很普遍。本文回顾国内外相关文献,着重综述肾移植中存在的性别失衡现状及相关因素,并对肾移植中的性别失衡所产生的临床后果和社会问题进行思考,提出相应的建议和意见,以期改善肾移植中性别不一致现状,优化肾移植治疗效果。     

论移植医学新角色——移植协调员的工作职责

随着移植医学的蓬勃发展,许多国家纷纷制定了人体器官捐赠和移植法令,建立了移植协调机构等配套管理措施和制度。随之,一个新型的专业角色——移植协调员应运而生。在研究国外移植协调员的工作基础上,借鉴国外的经验和模式,根据我国实际状况,提出我国移植协调员的工作职责。