当代基因伦理研究问题探析

基因伦理研究是生命伦理学的一个重要分支。围绕着基因中心文化现象、基因检测技术、生物样本库建设以及基因增强带来的伦理问题,既关注＂我们应该做什么＂的实质伦理学研究,也进行＂我们应该怎样做＂的程序伦理学研究,探讨中国文化背景和社会转型下基因伦理研究的重要工作,为下一步的基因伦理研究提供启示。     

什么是生命伦理学？——从历史发展的视角

生命伦理学是20世纪60年代兴起于美国的一门新兴学科,旨在应对生命科学和生物技术的发展或医疗保健的演变使人类面临的种种伦理难题。生命伦理学的兴起有着特殊的社会历史背景。它在发展过程中出现的一些里程碑式的案例,对生命伦理学的发展产生了深远的影响。从其发展特征上看,生命伦理学和医学伦理学紧密联系,有着更为广泛的研究内容和独特的专业特性。生命伦理学要有效回应现代医学和生命科学的发展给人类带来的伦理难题,既要准确地界定伦理问题,又要以适当的方式将伦理学基础理论应用到具体问题当中。对生命伦理学的基本理论进行概述。     

医学研究伦理学的发展现状与前景

创新技术的开展和转化医学的注重给医学的发展注入了新的活力,但同时,也带来了一系列社会伦理问题和法律问题。生命医学伦理学的兴起和发展催生了医学研究伦理学分支学科形成,目的在于推进解决涉及人体的医学研究的伦理问题。当前,面临的最突出的伦理问题在于,对医学研究合法性、先进性及伦理性的把握,对医学研究伦理审查必要性的认知,对医学研究方案设计与伦理道德的匹配,对医学研究知情同意的告知,对医学研究风险与受益的平衡。逐步与国际接轨,加强伦理委员会制度建设;提高伦理审查能力建设,形成高水平的伦理审查队伍;学术组织和团体共同努力,推进医学研究伦理学的发展,这将助推医学研究伦理学的发展。     

2008年国内外生物技术研究进展（上）——干细胞、人造生命、器官移植

2008年国内外生物技术领域研究发展迅速：干细胞研究有了新突破,可以避开伦理学的限制开展广泛研究;人工合成生命有了新进展,表现出了巨大的生命力和广阔的应用前景;基因组快速测序技术的出现,使人类个性化医疗向前迈出了重要的一步;对癌基因进行测序,发现了更多的致癌基因和器官移植的成功实例,使人们看到了治疗疑难病的希望……     

异源器官移植研究进展

本文针对异源器官移植中面临的免疫排斥及病原微生物的感染等主要问题,综述了近年来国内外相关方面的最新研究进展,同时对解决这些难题的方法和技术路线进行了总结,并展望了异源器官移植领域的发展道路。     

调节性T细胞过继回输在移植免疫耐受诱导中的临床应用研究

调节性细胞在器官移植的排斥反应和自身免疫性疾病发生发展中起到重要作用。调节性T细胞的过继回输治疗,能够维持免疫细胞的平衡,提供供体特异的免疫调节作用,达到很好的临床治疗效果。实体器官移植的调节性细胞治疗,在动物研究中,已经得到很好的验证,临床应用前景巨大。但是在临床的试验中,还有很多亟待解决的问题。新的理论突破,比如免疫互噬理论和免疫嵌合等理论能够给临床调节性细胞的应用带来新思路。     

21世纪医患关系的伦理学评判

随着医疗技术的迅猛发展,医疗水平不断提高,为人们带来福音的同时,使得医患关系的矛盾尤为凸显。21世纪的医患矛盾已经不仅仅是医生和患者之间的矛盾与冲突,而是两大社会群体之间的问题。在法律还无法规范的前提下,医学伦理学的评判标准可以为新时期医患关系提出更根本的指引与解释。     

转基因动物器官移植的安全问题及对策研究

从转基因动物器官移植的概念入手,就转基因动物器官移植的安全问题作了分析,指出了目前转基因动物器官移植遇到的最大障碍是跨物种感染,并就加强转基因动物器官移植安全管理提出了一些对策.     

基因修饰猪作为异种器官移植供体的研究进展

器官移植是治疗脏器器官终末病变的根本方法,目前器官移植的最大障碍是供体器官的缺乏。异种器官移植为解决上述难题打开了一扇门。猪与人类在解剖学和生理学等方面非常相似,是理想的器官移植的供体。基因修饰猪在异种器官移植中有着重要的应用,该文就猪–人异种器官移植发生免疫排斥的机制及其对策、器官移植后的生理功能以及潜在的病毒感染风险等方面的研究进行了综述和讨论,为异种器官移植提供理论基础。     

猪作为异种器官移植供体的研究进展

异种器官移植是现代和未来医学的重要研究领域之一,转基因猪有望为人类提供移植所需的器官,本对猪作为异种器官移植供体的可能性,移植引起的免疫排斥反应及病毒感染等问题进行了综述和讨论。     

Ethical and legal issues in xenotransplantation

In most western countries, there is a 'human organ shortage' with waiting lists for the performance of transplantation. In a recent report of the UNOS Ethics Committee it is stated that there are approximately 31,000 potential recipients on waiting lists, but only one fourth of potential donors gave their specific consent.
Xenotransplantation – defined as the transplantation of animal cells, tissues or organs into human beings – is associated with particular ethical dilemmas, namely the problems of efficiency and safety of this medical procedure. The objective of this study is to analyse the ethical dilemmas in xenotransplantation with the background of a personal view of moral life. Also, xenotransplantation will be evaluated as far as the legal regulation of transplantation is concerned. In particular, we will consider patients rights in accordance with existing laws on organ and tissue transplantation, animal research and clinical trials.     

我国器官移植中的伦理困境及解决思路

我国的器官移植近10年来有了发展,无论从技术层面、移植数量和质量、临床管理以及法规建设上都有了长足的进步。然而,由于我们在开展器官移植方面的先天不足,例如从事器官移植的技术队伍主要是来自海外学成归来的专家;技术主要靠引进西方的临床技术,在基础研究和创新方面相对薄弱;在法律和管理制度的建设方面相对滞后,没有建立一个从制度上保证器官移植健康开展的系统,使得在器官供体来源和器官的公正分配上存在许多欠缺。因此有必要对我国的器官移植历史进行回顾和总结,对我国在器官移植中存在的错误观念和伦理困境进行剖析,寻找适合我国开展器官移植的正确途径,促进我国的器官移植事业健康发展。     

RESEARCH INTEGRITY IN CHINA: PROBLEMS AND PROSPECTS

In little more than 30 years, China has recovered from the intellectual stagnation brought about by the Cultural Revolution to become a global leader in science and technology. Like other leading countries in science and technology, China has encountered some ethical problems related to the conduct of research. China's leaders have taken some steps to respond to these problems, such as developing ethics policies and establishing oversight committees. To keep moving forward, China needs to continue to take effective action to promote research integrity. Some of the challenges China faces include additional policy development, promoting education in responsible conduct of research, protecting whistle‐blowers, and cultivating an ethical research environment.     

Organ transplantation in Nepal: Ethical,legal, and practical issues

In Nepal, live donor organ transplantation is only 14 years old with the first successful kidney transplant made in 2008 and a successful liver and bone marrow transplant made in 2016. However, transplantation of cadaveric cornea dates back to 1998. There are still no cases of animal-to-human organ transplantation in Nepal. There are stringent laws to regulate human body organ transplantation in Nepal which are amended from time to time. However, there is a racket of human traffickers who lure rural people from this low-income country into the illegal organ trade. Furthermore, there is a substantial lack of awareness of organ donation among the general public. This article focuses on the stipulations of ethical, legal, and practical issues of obtaining organs procured from living and brain-dead donors that support the process of transplantation in Nepal. In addition, the article also explores the legal and practical issues of organ trafficking and organ donation awareness in Nepal on the basis of factual data and findings from other studies.     

On the acceptability of xenografts

Transplantation represents a major advance in modern medicine with a major impact on the interactions between individuals and society. The numbers of patients undergoing organ transplantation increased steadily over the years and around 250,000 individuals are living nowadays in Europe with a transplanted organ. On the other hand, the numbers of cadaveric (brain-dead) donors used for organ transplantation remains stable, at around 5,000 each year, and the numbers of transplantation from living donors only slowly increase in Europe. Therefore, a gap is growing between the numbers of patients in need of a transplant and the numbers of organs available for transplantation. About 45,000 patients are currently on renal transplant waiting lists in Europe and, depending on the countries considered, 15 to 30 % of candidates for liver or heart transplantation die before a life-saving transplant becomes available to them. There is therefore an urgent need to implement innovative research and to take full advantage of recent biotechnological advances to explore new avenues in xenotransplantation, and to simultaneously address the ethical, societal and public health issues related to organ replacement. Much progresses have been accomplished in the understanding of xenograft rejection processes that include hyperacute, acute vascular and cellular rejection mechanisms. Strategies to promote xenograft survival that are currently under evaluation include genetic engineering of donor pigs, adapted immunosuppressive treatments and tolerance induction. Also, the psychological acceptance has been evaluated.     

Ethics of fetal tissue transplantation.

Now that the Clinton Administration has overturned the ban on federal funding for fetal tissue transplantation, old ethical issues renew their relevance and new ethical issues arise. Is fetal tissue transplantation necessary and beneficial? Are fetal rights violated by the use of fetal tissue in research? Is there a moral danger that the potential of fetal tissue donation will encourage elective abortions? Should pregnant women be allowed to designate specific fetal transplant recipients? What criteria should be used to select fetal tissue transplants? Whose consent should be required for the use of fetal tissue for transplantation? We review the current state of clinical research with fetal tissue transplantation, the legal history of fetal tissue research, the major arguments against the use of fetal tissue for transplantation, and the new postmoratorium ethical dilemmas. We include recommendations for guidelines to govern the medical treatment of fetal tissue in transplantation.     

Xenotransplantation becoming reality

To bridge the gap between organ demand and supply, xenotransplantation has long been considered as a realistic option for end-stage organ failure. Early this year this promise became reality for David Bennett Sr., the first patient whose own failing heart was replaced with a xeno-pig heart. To get here has been a rollercoaster ride of physiological hurdles seemingly impossible to overcome, technological breakthroughs and ethical and safety concerns. It started in 1984, with Stephanie Fae Beauclair, also known as baby Fae, receiving a baboon heart, which allowed her to survive for another 30 days. For ethical reasons primate work was soon abandoned in favour of the pig. But increased phylogenetic distance also brought with it an increased immunological incompatibility. It has been the development of ever more sophisticated genetic engineering tools, which brought down the physiological barriers, enabled humanisation of porcine organs and helped addressing safety concerns. This renewed the confidence in xenotransplantation, brought new funding opportunities and resulted finally in the first in human trial.

     

THE ETHICS OF UTERUS TRANSPLANTATION

Human uterus transplantation (UTx) is currently under investigation as a treatment for uterine infertility. Without a uterus transplant, the options available to women with uterine infertility are adoption or surrogacy; only the latter has the potential for a genetically related child. UTx will offer recipients the chance of having their own pregnancy. This procedure occurs at the intersection of two ethically contentious areas: assisted reproductive technologies (ART) and organ transplantation. In relation to organ transplantation, UTx lies with composite tissue transplants such as face and limb grafts, and shares some of the ethical concerns raised by these non‐life saving procedures. In relation to ART, UTx represents one more avenue by which a woman may seek to meet her reproductive goals, and as with other ART procedures, raises questions about the limits of reproductive autonomy. This paper explores the ethical issues raised by UTx with a focus on the potential gap between women's desires and aspirations about pregnancy and the likely functional outcomes of successful UTx.     

Ethical issues raised by uterus transplantation: A report from the People's Republic of China

The recent advances in assisted reproductive technology, such as hormonal stimulation, IVF, and intracytoplasmic sperm injection (ICSI), have made it possible to circumvent many causes of male and female factor infertility. However, uterine infertility is still considered an ‘‘unconditionally infertile’’ condition. Owing to the continued advances in organ transplantation, microvascular anastomosis techniques, and immunosuppressive medicine, the transplantation of organs is no longer restricted to the ones necessary for continued life. Quality-of-life enhancing types of transplantation, such as uterine transplantation, in recent years, have also entered the clinical arena. This undoubtedly brings new hope to such women, but also creates ethical challenges. Selection of the donor, the impact on the recipient and offspring, as well as challenges to moral and social norms are issues that cannot be ignored. In the present review, the ethical issues of transplantation of the uterus will be discussed in light of recent progress in the procedure.     

Psychosocial implications of disfigurement and the future of human face transplantation

Although the first face transplants have been attempted, the social and psychological debates concerning the ethics and desirability of the procedure continue. Critics contend that these issues have not yet been sufficiently addressed. With this in mind, the present article seeks to elaborate on key psychological and social factors that will be central for addressing the ethical and psychosocial challenges necessary to move face transplantation into mainstream medicine. The goals of this article are to (1) discuss the psychosocial sequelae of facial disfiguration and how face transplantation may relieve those problems, and (2) delineate inclusion and exclusion criteria for the selection of research subjects for face transplantation. The article uses concepts from symbolic interaction theory in sociology to articulate a theoretically coherent scheme for comprehending the psychosocial difficulties of facial disfiguration and the advantages offered by facial transplantation. The authors conclude that the psychosocial implications of disfigurement warrant surgical intervention and that research in the area of face transplantation should continue.