器官移植的伦理问题

器官移植分为自体移植和异体移植,自体移植较少伦理方面的问题,如烧伤病人自体皮肤的移植等;异体移植涉及到器官的来源问题,情况往往变得很复杂。异体器官只谈来源人体的器官,不涉及其它物种来源的器官。过去较为成功的是从双胞胎具有双个的器官（如肾）、再生器官（如骨髓）,但大量的器官可能来自于尸体或其它来源,因此这方面的伦理问题最多。     

医患信任的伦理困境及解决策略

当现代医患关系受到广泛诟病,医患不信任愈演愈烈之时,人们试图回归传统去寻求解决思路。传统的古代医患关系以信义为基础,强调以患者为本,医者需以德为先,同时注重医患沟通。然而古代医患信任关系也存在医家择病、择人及病家试医、择医等诸多弊端陋习。本文综述古代医患信任关系的伦理困境及解决策略,借古鉴今,在前人处理医患关系的利弊得失中,寻求医患信任关系建立的最佳处事之道,为当今医患信任关系的建立提供可资借鉴的思路和经验。     

美国器官移植体系对我国的借鉴意义

今年来我国器官移植技术在突飞猛进,尚未建立起完善的器官移植体系,使得我国的器官移植效率并不高。本文通过对美国器官移植体系进行介绍,分析其组成结构及优越性,总结值得借鉴之处。从而结合我国具体的国情,使我国器官移植体系的构建更加成功。     

我国活体器官移植伦理学问题再思考

器官移植为器官衰竭的患者带来了福音,同时也带来诸多伦理学问题,值得深思。本文从当前器官移植研究的现状及进展情况入手,对器官移植的医学、法学以及伦理学问题进行剖析与研究,同时在此基础上提出相应的建议。     

医师对器官移植供体艾滋病确定的伦理与法律责任

强调医师在器官移植过程中必须遵循法律与伦理道德,依照国家、国务院颁布的对艾滋病管理的法律条款及法规来进行供体艾滋病确定及器官移植,以免发生医疗纠纷,甚至触犯法律。     

异种器官移植中的补体系统

异种器官作为器官移植的供体显示出很大的潜力。但是,异种器官移植中出现的超急性排斥反应是当前将其应用于临床的最大障碍。补体系统在超急性排斥反应中发挥了重要的作用。通过抑制补体系统的活性,可以达到延长移植物生存时间的目的。通过转基因的方法,使人的补体调节蛋白基因在供体体内表达,则可能从根本上抑制超急性排斥反应的发生。     

我国公立医院的“公立”障碍及解决思路

通过了解公立医院公益淡化的过程，分析公立医院所遭遇的“公立”障碍，试图从制度设计、医院治理模式、政府监管部门、配套制度等角度提出相应的解决思路。     

Th17细胞及其在器官移植排斥反应中的作用

最近发现的辅助T细胞17（T helper cell 17,Th-17）是不同于辅助T细胞1型（Thelpercell1,Th-1）,辅助T细胞2型（Thelpercell2,Th-2）及调节性T细胞（regulatory T cell,Treg）的T细胞亚群,有其独立的分化和发育调节,且互相影响。它由初始T细胞在转化生长因子B（transforming growth factor B,TGF—B）与白细胞介素6（interleukin6,IL-6）、白细胞介素23（interleukin23,1L23）联合作用及转录因子维甲酸相关孤儿素受体γt（retinoic acid related orphan nuclear receptorm,ROR-γt）的协同诱导精细的调节下分化而来。其主要分泌的生物效应分子白细胞介素17（Interleukin17,IL-17）是一种促炎性反应细胞因子,在免疫和造血系统等发挥重要的作用。而器官移植排斥反应的本质就是炎性反应。因此深入研究Th-17细胞分化及其相关生物效应,有助认识其在器官移植排斥中的病理机制,也为治疗移植排斥反应提供新的靶点和途径。     

Th17分化调节机制及其在器官移植中的研究进展

Th17细胞是新近发现的第三类CD4+ T辅助细胞亚群,其所分泌的IL-17、IL-22等细胞因子在中性粒细胞趋化、组织重塑与修复及介导抗体蛋白的产生等具有重要作用.但Th17分化调节受外界环境影响较大,如转录因子、细胞因子、Th1、Th2和调节T细胞(Tregs)等,这些均具有决定初始CD4+ T细胞向Th17细胞的分化方向和免疫反应方向的调控作用.目前Th17在器官移植物免疫耐受中的作用越来越受到重视,明确Th17分化调节的各种影响因素,将为器官移植免疫耐受研究提供新思路.     

器官移植病人戊型肝炎病毒慢性化感染及治疗

戊型肝炎是由戊型肝炎病毒(Hepatitis E virus,HEV)感染引起的急性病毒性肝炎,其发病率居急性病毒性肝炎之首。戊型肝炎通常呈急性感染病程,2008年以来陆续发现器官移植病人等免疫抑制患者感染HEV后可能迁延为慢性化。在无抗病毒药物治疗的情况下,器官移植病人感染HEV后迁延为慢性感染的比例超过60%,其中10%的病人慢性感染HEV后可能出现肝纤维化,并且在较短的时间内进展为失代偿性肝硬化导致死亡。本文简要综述器官移植病人HEV慢性化感染及治疗。     

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.     

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.     

实体器官移植术后隐球菌感染诊治的研究进展

隐球菌是实体器官移植术后最常见的致病性真菌之一,主要通过呼吸道入侵机体并播散至全身,尤嗜中枢神经系统。隐球菌感染如不及时治疗,病死率极高。实体器官移植术后隐球菌感染的主要危险因素包括术前发热、术后免疫抑制剂和抗生素使用、术后导管留置时间、术后感染及大剂量糖皮质激素使用等。其临床症状缺少特异性,早期诊断较困难。实体器官移植术后抗隐球菌治疗主要包括两性霉素B、氟胞嘧啶、氟康唑等,具体方案通常视患者免疫状态和器官功能而定。本文综述了实体器官移植术后隐球菌病诊断和治疗方面的研究进展。     

临床医生在基因检测咨询中面对伦理两难问题态度与选择 ——基于情景案例分析

目的 通过情景案例分析,聚焦基因检测咨询中的伦理两难事件,探究临床医生的伦理道德抉择及可能的影响因素。 方法 采用分层随机抽样方法,对624名临床医生进行了匿名问卷调查。 结果 对于XY染色体女性案件,88%的应答者选择告知敏感性信息;对于父系信息的披露,近60%的应答者选择单独告诉母亲;对于是否告知患儿其他亲属相关遗传病信息的案件,应答者的意见则相对分散。 结论 针对三个典型的基因检测咨询中的伦理两难问题,应结合国际相关指南的要求,进一步加大相关的法律与伦理理念、知识的教育与普及。     

Promoting organ donation registration with the priority incentive: Israeli transplantation surgeons' and other medical practitioners' views and ethical concerns

Because the number of organs available for transplantation does not meet the needs of potential recipients, some have proposed that a potentially effective way to increase registration is to offer a self-benefit incentive that grants a 'preferred status' or some degree of prioritization to those who register as potential donors, in case they might need organs. This proposal has elicited an ethical debate on the appropriateness of such a benefit in the context of a life-saving medical procedure. In this paper we review arguments and ethical concerns raised by scholars, and studies of views of members of the public regarding the prioritization incentive system. We also report on our study of the views of those involved in organ transplant and of other medical professionals in Israel, as over half a decade ago Israel implemented a prioritization incentive system. Bioethicists propose that key stakeholders' views can provide additional arguments and perspectives on controversial issues. Proponents justify the prioritization incentive drawing mainly on arguments related to its potential effectiveness, reciprocity and fairness. Opponents point to the fact that registering is not binding and not an actual donation, and raise concerns regarding equity, autonomy and gaming the system. Ethical concerns raised by the practitioners in the study were examined in light of scholars' arguments and actual registration and donation data. Practitioners involved in transplantation raised ethical concerns corresponding to those raised by scholars as well as additional concerns. They also challenged proponents' assumptions regarding the utility of the incentive system from their own experience and argued that proponents obscure the meaning of reciprocity.     

Mitochondrial dysfunction in liver disease and organ transplantation

The mitochondria play a crucial role in maintaining hepatocyte integrity and functions. Mitochondrial defects are either inherited or acquired. Mitochondria dysfunction occurs when the hepatocyte experience excessive physiologic stress. Its clinical presentation depends on the severity of the stress. It varies from mild abnormalities in liver biochemical tests to manifestations of acute or chronic liver failure. Mitochondria dysfunction is implicated in most liver disease and in early graft dysfunction after liver transplantation. This review will address the role of mitochondria in liver disease.     

Against the family veto in organ procurement: Why the wishes of the dead should prevail when the living and the deceased disagree on organ donation

The wishes of registered organ donors are regularly set aside when family members object to donation. This genuine overruling of the wishes of the deceased raises difficult ethical questions. A successful argument for providing the family with a veto must (a) provide reason to disregard the wishes of the dead, and (b) establish why the family should be allowed to decide. One branch of justification seeks to reconcile the family veto with important ideas about respecting property rights, preserving autonomy, and preventing harm. These arguments are ultimately unsuccessful. Another branch of arguments is consequentialist, pointing out the negative consequences of removing the veto. Whether construed as concerning family distress or as a potential drop in the organs available, these arguments are unsuccessful; the first fails to recognize the tremendous distress associated with waiting for an organ, while the second has little supporting evidence. A final section considers and rejects whether combining some of the arguments just examined could justify the family veto. We should thus remove the family veto in organ donation.     

Ethical obligation and legal requirements: On informed consent practices in Bangladesh

Informed consent to medical intervention is fundamental in both ethics and law. But in practice it is often not taken seriously in developing countries. This paper provides an appraisal of informed consent practices in Bangladesh. Following a review of the ethical and legal principles of informed consent, it assesses the degree to which doctors adhere to it in Bangladesh. Based on findings of non-compliance, it then investigates the reasons for such non-compliance through an appraisal of informed consent practices in Bangladesh and provides recommendations aimed at improving such practices. The significance of this paper lies in unveiling the interdependence between the ethical and legal traits of informed consent and their ramifications on strengthening the patient-oriented approach of duty to care.     

Monoclonal antibodies in organ transplantation

Monoclonal antibody (mAb) technology has made possible the production of designer proteins, specifically reactive with almost any conceivable biological molecule. Using these reagents, the surface molecules on cells crucial for allograft rejection have been identified and described in detail. These structures can now be selectively targeted by mAb-based therapy in order to prevent rejection. For instance, the CD3 molecule, expressed on all mature T lymphocytes, triggers T cell activation, a key event in rejection. OKT3, an anti-CD3 mAb, disrupts T cell function and is now the agent of choice for the treatment of severe rejection episodes. MAbs targeting other T cell molecules are currently being investigated. Some of the most promising, the anti-CD4, anti-ICAM-1, and anti-interleukin 2 receptor mAbs, have already induced donor-specific tolerance in rodent models. These hosts accept permanently a genetically incompatible graft after only a limited period of mAb therapy. Interestingly, anti-ICAM-1 also diminishes the ischemic injury of preservation. The development of these new molecular agents, effectively directed to specific cellular targets, will likely play an increasingly important role in future clinical protocols, and perhaps finally provide a means to achieve long-term tolerance in human allograft recipients.