我国人体器官捐献补偿机制之建构

目的:《人体器官移植条例》(以下简称《条例》)于2007年5月1日起施行,规定器官捐献采用自愿、无偿原则,体现了对当事人自决权自由意志的充分尊重,但绝对的无偿在实际操作的过程中面临着诸多问题,而且可能会引发潜在的社会不公平。本文论证禁止器官买卖及探讨器官捐献的补偿机制来维护公正和激发公民的捐献意识的可行性。结论:严格禁止器官买卖的前提下,给予捐献者合理补偿。     

论器官分配原则与分配系统的关系

目的:器官移植不仅是医学问题,涉及到器官捐献、摘取与分配,涉及到社会的方方面面。在一些器官移植开展较多的发达国家,都有一个成熟的、系统的器官摘取、存贮与分配的机构,目前我国尚缺乏该系统。本文总结国外经验,提出了符合我国国情的器官分配原则,力图避免我国器官移植开展过程中器官分配的不公平现象。结论:构建高效供需体系可有效解决器官分配不公平现象。     

公民逝世后潜在供者器官捐献效率的影响因素分析

目的 探讨吉林省公民逝世后器官捐献中,潜在供者对于捐献成功率的影响因素,为提高器官捐献效率提供依据。方法 采用回顾性分析选取自2011年7月—2014年12月的291例潜在供者为研究对象,对转化率、同意率、捐献成功时间与捐献失败原因进行描述分析,对潜在供者人口学、临床指标等影响因素采用卡方检验。结果 捐献成功率即供体转化率为31.9%,家属同意捐献率为52.2%。捐献成功时间集中在夏秋季节。男性高于女性,但无统计学差异。捐献是否成功与潜在供者的年龄、学历、婚姻状况、职业、既往史、死因、公民逝世后器官捐献来源类型有统计学意义。捐献是否成功与潜在供者的性别、居住地无统计学意义。结论 目前吉林省器官捐献率不高,潜在供者转化率较低。潜在供者的自身条件及家属意见影响捐献效率。     

国内外医师执业模式比较研究

医师执业模式是国家医疗卫生体系的一个重要体现。目前,我国医师执业模式较为单一,多点执业进展缓慢,不利于我国医药卫生体制改革的进一步深化。本文通过国内外医师执业模式比较中发现,我国在医师培养、资质认定、法律保障、保险体系、医师监督管理等方面较国外发达国家有较大差距,建议我国从医师监督管理、法律保险、人事制度改革等方面加快完善多点执业配套制度,为我国深化医药卫生体制改革提供助力。     

医患纠纷私力救济盛行的原因分析及对策研究

以医闹为主的医患纠纷私力救济不利于医患纠纷公正解决,具有违法性。私力救济成本低、效率高的特点、现有解决渠道不畅、法律建设缺陷等是导致医患纠纷私力救济盛行的原因。通过打击医闹行为、提高私力救济违法成本,完善法律建设、拓展医患纠纷解决渠道等措施可以有效预防减少私力救济的发生。     

印度生物遗传资源和相关传统知识获取制度发展动态研究

印度是世界上生物多样性最丰富的国家之一,主张遗传资源主权归国家所有并实现遗传资源惠益公平分享。印度政府于2003年颁布了《生物多样性法》,2004年又补充颁布了《生物多样性条例》,明确规定国家对其生物资源及相关传统知识的主权、保护原则、主管部门和管理体系、获取和惠益分享等问题。2014年又制订发布了《生物资源及相关传统知识获取规则指南》,对生物考察和利用、商业开发的惠益形式与比例、成果转化程序与惠益分享方式、知识产权获取程序与惠益分享形式、第三方转让为研究或商业利用、豁免审批情况等都作出了详细明确的规定。从印度遗传资源获取与惠益分享制度体系发展动态来看,印度的制度构建过程是循序渐进,不断更新,逐步趋于完善、细化。印度的遗传资源制度体系建设紧跟国际发展形势,从原则性的规定发展到具体措施。印度与中国生物遗传资源及相关传统知识国情相似,国际谈判立场一致,印度的遗传资源获取与惠益分享管理制度体系构建思路值得中国在国内遗传资源获取与惠益分享国家制度体系构建借鉴。     

《名古屋议定书》在微生物领域的实施: 影响、最佳做法及我国立法选择

《名古屋议定书》继承了《生物多样性公约》在规范遗传资源的获取和惠益分享问题上采取的双边路径。但是, 这一路径不能完全按照《生物多样性公约》和《名古屋议定书》预设的前提和模式在微生物领域得到实施, 已有的旨在实施《名古屋议定书》的措施对微生物研究和开发活动产生了消极的影响。世界微生物菌种保藏联合会致力于推动《生物多样性公约》及其《名古屋议定书》在微生物领域的有效实施, 并为此制定了相关的行为守则和准则。2016年世界微生物菌种保藏联合会推出的TRUST准则代表了微生物领域的获取和惠益分享最佳做法, 该准则针对微生物遗传资源的原生境获取、保藏、非原生境获取以及惠益分享等问题提出了一系列务实的建议。为了实施《名古屋议定书》, 我国启动了遗传资源的获取和惠益分享立法进程, 当前立法已经进入到一个关键阶段。TRUST准则对我国遗传资源的获取和惠益分享立法具有重要的启示。立法机关可以借鉴TRUST准则提出的受规制活动类型及相对应的建议, 并结合我国国情构建一套适用于微生物遗传资源的获取和惠益分享法律规则。这套法律规则将由对植物、动物和微生物遗传资源都予以适用的法律规则和仅对微生物遗传资源适用的法律规则构成, 后者可被纳入我国获取和惠益分享立法的实施细则之中。     

我国公立医院法人治理结构下的管理者激励机制探讨

建立管理者有效激励机制,化解公立医院法人治理结构下的委托代理问题是公立医院体制改革的重要保障。该激励机制通过弥合管理者与所有者的价值及行为取向差异,促使管理者自觉自愿地履行并实现公共利益。但由于机制建立过程中存在效益目标不明晰、绩效水平难于考量等难题。为此,需以公共利益为导向设置董事机构,加强效益评价指标体系和外部监管制度建设,同时创新激励手段,从而提高公立医院法人治理结构下的整体绩效。     

细胞三维培养：组织工程的关键技术突破口

组织工程是有望从根本上解决组织,器官缺损或失能的医学难题的一门新兴边缘学科,组织,器官发育的细胞和分子机制的进一步揭示和体外构建工程组织,器官的细胞培养技术的进步将使组织工程在新的千年成为广泛应用的新的治疗模式。细胞三维培养要成为体外构建工程组织,器官的成熟技术体系需先解决以下问题;（1）细胞;（2）生物材料;（3）培养基;（4）培养装置;（5）异型细胞的共培养;（6）细胞三维培养物血管化。     

Heart transplantation in the Netherlands: quo vadis?

Heart transplantation is limited by the lack of donor organs. Twenty years after the start of the Dutch transplant programmes in Rotterdam and Utrecht the situation has even worsened, despite efforts to increase the donor pool. The Dutch situation seems to be worse than in other surrounding countries, and several factors that may influence donor organ availability and organ utilisation are discussed. The indications and contraindications for heart transplantation are presented, which are rather restrictive in order to select optimal recipients for the scarce donor hearts. Detailed data on donor hearts, rejected for transplantation, are shown to give some insight into the difficult process of dealing with marginal donor organs. It is concluded that with the current low numbers of acceptable quality donor hearts, there is no lack of capacity in the two transplanting centres nor is the waiting list limiting the number of transplants. The influence of our current legal system on organ donation, which requires (prior) permission from donor and relatives, is probably limited. The most important determinants of donor organ availability are: 1. The potential donor pool, consisting of brain dead victims of (traffic) accidents and CVAs and 2. Lack of consent to a request for donation. The potential donor pool is remarkably small in the Netherlands, due to relatively low numbers of (traffic) accidents, with an almost equal number of CVA-related brain dead patients compared with neighbouring countries. Lack of consent can only be pushed back by improved public awareness of the importance of donation and improved skills of professionals in asking permission in case there is no previous consent.     

The necessity of strengthening the cooperation between tissue banks and organ transplant organizations at national, regional, and international levels

The donation of tissues and organs increases significantly when tissue banks and organ transplant organizations work together in the procurement of organs and tissues at donor sources (hospitals, coroners system, organ procurement agencies, and funeral homes, among others). To achieve this important goal, national competent health authorities should considered the establishment of a mechanism that promote the widest possible cooperation between tissue banks and organ transplant organizations with hospitals, research medical institutions, universities, and other medical institutions and facilities. One of the issues that can facilitate this cooperation is the establishment of a coding and traceability system that could identify all tissues and organs used in transplant activities carried out in any country. The promotion of national, regional, and international cooperation between tissue banks and organ transplant organizations would enable the sharing of relevant information that could be important for medical practice and scientific studies carried out by many countries, particularly for those countries with a weak health care system.     

Access to organs and tissues for research from the organ donor pool within the UK

The donor organ transplant scenario offers one potential route to access high-quality human organs and tissues for research. There are well-established networks for co-ordinating organ donation events across many countries, including the UK, which include robust mechanisms for obtaining consent for ethically-approved research. Within the UK, the challenge for the next few years is to facilitate this research donation with respect to regulatory pathways directed by the Human Tissue Act, which covers all aspects of access to human tissues.     

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.     

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.     

Public awareness of organ donation.

A telephone survey of public attitudes toward organ donation and transplantation was conducted in a community in southwestern Ontario. The subjects were selected at random; the response rate was 57%. Of the 50 respondents 62% stated that they had signed the organ donor card accompanying their driver''s licence. These respondents were more likely than those who did not sign it to have discussed organ donation with their families. At least 80% of the respondents said they would agree to donate their organs and those of their next-of-kin, and 80% said that the organ donor card should be considered a legal document. Organ transplantation was regarded by all but one respondent as an acceptable medical procedure. Also discussed were concerns about organ donation and possible strategies to improve the availability of organs for transplantation.     

Compelled organ donation

Along with ethical considerations, compelling an individual to donate organs, tissues, or bodily fluids brings several legal doctrines into conflict. The privacy of one's body is generally considered sacrosanct by American courts, which have upheld a competent adult's right to refuse medical procedures, even in cases when they are necessary to save the life of another. Although medical and legal communities stress “respect for the individual” as being paramount under American jurisprudential principles, the doctrine of “substituted judgment” permits a court to act (for example, by consenting to organ donation) on behalf of an incompetent individual or child. Parents also have the right to cause a child to “donate” an organ, and although a means exists by which the child can refuse, this may not be realistically feasible for young children. The revised Uniform Anatomical Gift Act of 2006, while clarifying issues of who may make organ donation decisions, does not resolve all the practical issues of compelled organ donation for minors.     

A critical approach to the current understanding of Islamic scholars on using cadaver organs without prior permission

Chronic organ diseases and the increasing demand for organ transplantation have become an important health care problem within the last few decades. Campaigns and regulations to encourage people to donate organs after their death have not met much success. This article discusses the subject from an Islamic perspective. It begins with some basic information on how Muslims reach legal rulings on a particular issue, and goes on to debate contemporary thinking among Islamic scholars on the ethical-legal issues of organ donation and organ transplantation.
It is shown that there are two groups of scholars, one allowing organ donation and organ transplantation, the other refusing it in any circumstances. Both groups agree that it is fundamentally wrong to harvest organs from cadavers without the prior permission of the deceased or the relatives. This dogma is re-examined, and it is argued that, under the rule of necessity and the imperative to preserve life, there is enough moral and theological ground to allow the state to harvest organs from the deceased without prior permission.     

Influencing relatives to respect donor autonomy: Should we nudge families to consent to organ donation?

Refusing consent to organ donation remains unacceptably high, and improving consent rates from family or next‐of‐kin is an important step to procuring more organs for solid organ transplantation in countries where this approval is sought. We have thus far failed to translate fully our limited understanding of why families refuse permission into successful strategies targeting consent in the setting of deceased organ donation, primarily because our interventions fail to target underlying cognitive obstacles. Novel interventions to overcome these hurdles, incorporating an understanding of cognitive psychology and behavioral change therapy, may be beneficial. One potential intervention is to use the concept of nudge theory, where decision‐making is influenced by encouraging positive reinforcement and indirect suggestion. Purposefully nudging families to given consent for organ donation by understanding, and then overcoming, their inherent cognitive biases is novel but also controversial. This article explores the roles of relatives in decisions about organ donation, how nudge theory translates to organ donation and discusses the arguments for and against its application.     

Should We Formulate an Incentivized Model Facilitating Kidney Donation from Living Donors? A Focus on Turkey's Current System

Kidney transplantation is a lifesaving medical treatment. However, very high demand for kidneys with low kidney donation causes a black market that exploits patients’ desperation and donors’ vulnerability. The current kidney donation programs fail to produce promising results to avoid illegal and unethical kidney trafficking and commercialism. Even though the primary goal of kidney donation is to increase the number of deceased organ donations, in some countries, like Turkey, due to religious or cultural concerns, it is impossible to supply adequate deceased kidney donations. In this view, the aim of this paper is to examine kidney trafficking in the scope of Turkey's current organ donation system and propose a new model, named the Incentivized Kidney Donation Model (IKDM), to increase kidney donation from living donors. The model encompasses the following benefits offered to kidney donors; lifetime health insurance, exemptions from copayments/contribution shares, priority when receiving an organ, priority when finding a job, income tax exemptions for salaried employees, and free or discounted public utilities. This normative model has the potential to promote donors’ altruistic acts as well as the solidarity and loyalty among members of a society without violating ethical values and internationally accepted principles.