Ethical construction of recipients’ rights and interests protection in organ transplantation from expanded criteria donors
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摘要: 在移植器官严重短缺和公民逝世后器官捐献成为我国移植器官主要来源的背景下，扩大标准供者（ECD）器官已广泛应用于临床，但ECD存在基础疾病、高龄、外伤、休克或感染等情况，供器官质量会受到不同程度的影响，是影响移植疗效的重要因素之一。接受ECD器官移植受者也将承担ECD器官带来的额外风险和疗效的不确定性，需要重视受者权益保护。本文从ECD器官移植在受者保护方面面临的伦理问题、目前器官伦理委员会伦理审查上存在的不足进行综述，探讨器官移植受者权益的伦理审查机构与制度建设的建议，以期为促进ECD器官移植发展提供参考。Abstract: Under the background of severe shortage of donor organs and organ donation after citizen's death becoming the main source of donor organs in China, expanded criteria donor (ECD) has been widely applied in clinical practice. However, ECD has the disadvantages of basic diseases, old age, trauma, shock or infection, which will affect the quality of donor organs to varying degrees and become one of critical factors affecting clinical efficacy of organ transplantation. The recipients of ECD organ transplantation will also bear the additional risk and uncertainty of efficacy brought by ECD organs. Hence, it is necessary to pay attention to the protection of the recipients’ rights and interests. In this article, ethical issues faced by ECD organ transplantation in recipient protection and the shortcomings in the ethical review of organ ethics committee were reviewed, and suggestions on the ethical review institution and system construction of the rights and interests of organ transplantation recipients were elucidated, aiming to provide reference for promoting the advancement of ECD organ transplantation.
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[1] SHEPHERD HM, GAUTHIER JM, PURI V, et al. Advanced considerations in organ donors[J]. J Thorac Dis, 2021, 13(11): 6528-6535. DOI: 10.21037/jtd-2021-08. [2] HELLEMANS R, KRAMER A, DE MEESTER J, et al. Does kidney transplantation with a standard or expanded criteria donor improve patient survival? results from a Belgian cohort[J]. Nephrol Dial Transplant, 2021, 36(5): 918-926. DOI: 10.1093/ndt/gfab024. [3] NGUYEN NTQ, COURTNEY AE, NGUYEN HQ, et al. Early clinical and economic outcomes of expanded criteria living kidney donors in the United States[J]. J Nephrol, 2023, 36(4): 957-968. DOI: 10.1007/s40620-022-01541-4. [4] 景启明, 王睿, 陈鑫. 同种异体原位心脏移植36例临床分析[J]. 中国胸心血管外科临床杂志, 2019, 26(10): 968-972. DOI: 10.7507/1007-4848.201903041.JING QM, WANG R, CHEN X. Clinical analysis of 36 patients with allograft orthotopic heart transplantation[J]. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(10): 968-972. DOI: 10.7507/1007-4848.201903041. [5] BARBETTA A, BUTLER C, BARHOUMA S, et al. Living donor versus deceased donor pediatric liver transplantation: a systematic review and meta-analysis[J]. Transplant Direct, 2021, 7(10): e767. DOI: 10.1097/TXD.0000000000001219. [6] SALGUERO J, CHAMORRO L, GOMEZ-GOMEZ E, et al. Midterm outcomes of kidney transplantation from expanded criteria donors after circulatory death: a single-center retrospective cohort study[J]. Exp Clin Transplant, 2023, 21(6): 481-486. DOI: 10.6002/ect.2023.0076. [7] FANG X, WANG Y, LIU R, et al. Long-term outcomes of kidney transplantation from expanded criteria donors with Chinese novel donation policy: donation after citizens' death[J]. BMC Nephrol, 2022, 23(1): 325. DOI: 10.1186/s12882-022-02944-y. [8] 黄晨, 聂峰, 董建辉, 等. 单中心扩大标准公民逝世后器官捐献肾移植中长期疗效观察[J/CD]. 中华移植杂志(电子版), 2021, 15(3): 141-146. DOI: 10.3877/cma.j.issn.1674-3903.2021.03.003.HUANG C, NIE F, DONG JH, et al. Medium- and long-term curative effect of kidney transplantation from expanded criteria donors of donation after citizen′s death: a single-center report[J/CD]. Chin J Transplant (Electr Edit), 2021, 15(3): 141-146. DOI: 10.3877/cma.j.issn.1674-3903.2021.03.003. [9] DURAND F, RENZ JF, ALKOFER B, et al. Report of the Paris consensus meeting on expanded criteria donors in liver transplantation[J]. Liver Transpl, 2008, 14(12): 1694-1707. DOI: 10.1002/lt.21668. [10] 薛武军, 项和立, 丁晨光, 等. 公民逝世后器官捐献供者评估标准的研究[J]. 现代泌尿外科杂志, 2016, 21(2): 99-103. DOI: 10.3969/j.issn.1009-8291.2016.02.007.XUE WJ, XIANG HL, DING CG, et al. Study on the assessment standard of organ quality in China donation after citizen's death[J]. J Mod Urol, 2016, 21(2): 99-103. DOI: 10.3969/j.issn.1009-8291.2016.02.007. [11] ARGANI H. Expanded criteria donors[J]. Exp Clin Transplant, 2022, 20(Suppl 4): 13-19. DOI: 10.6002/ect.DonorSymp.2022.L13. [12] 张槊, 邓玉霞, 刘博, 等. 传统儒家生命伦理视域下器官移植伦理观构建与实践研究[J]. 中国社会医学杂志, 2021, 38(3): 250-252. DOI: 10.3969/j.issn.1673-5625.2021.03.004.ZHANG S, DENG YX, LIU B, et al. Study in the construction and practice of organ transplantation ethics from the perspective of traditional Confucian bioethics[J]. Chin J Soc Med, 2021, 38(3): 250-252. DOI: 10.3969/j.issn.1673-5625.2021.03.004. [13] 刘媛, 黄明涛, 陈旻. 医疗机构开展公民逝世后器官捐献移植伦理审查的经验与思考[J]. 中国医学伦理学, 2022, 35(6): 601-606. DOI: 10.12026/j.issn.1001-8565.2022.06.03.LIU Y, HUANG MT, CHEN M. Experience and reflection on the ethical review of organ donation and transplantation after citizens'death in medical institution[J]. Chin Med Ethics, 2022, 35(6): 601-606. DOI: 10.12026/j.issn.1001-8565.2022.06.03. [14] SHARIF A, STONE S, HUGHES S. ISHLT, transplant ethics and forced organ harvesting[J]. J Heart Lung Transplant, 2022, 41(12): 1657-1659. DOI: 10.1016/j.healun.2022.09.013. [15] 聂峰, 黄晨, 谭庆, 等. 关于扩大标准供者肾脏质量评估中的伦理学思考[J]. 中国医学伦理学, 2022, 35(4): 386-390. DOI: 10.12026/j.issn.1001-8565.2022.04.06.NIE F, HUANG C, TAN Q, et al. Ethical thoughts on the quality evaluation of the kidneys from expanded criteria donors[J]. Chin Med Ethics, 2022, 35(4): 386-390. DOI: 10.12026/j.issn.1001-8565.2022.04.06. [16] 江苏省医学会泌尿外科学分会肾移植学组. DCD供体选择及供肾质量评估—江苏专家共识[J]. 江苏医药, 2017, 43(9): 652-657. DOI: 10.19460/j.cnki.0253-3685.2017.09.014.Group of Kidney Transplantation of Branch of Urology of Jiangsu Medical Association. DCD donor selection and kidney quality assessment - Jiangsu expert consensus[J]. Jiangsu Med J, 2017, 43(9): 652-657. DOI: 10.19460/j.cnki.0253-3685.2017.09.014. [17] 孙福川, 王明旭. 医学伦理学[M]. 4版. 北京: 人民卫生出版社, 2013: 165-166, 186, 190. [18] 王明旭, 赵明杰. 医学伦理学[M]. 5版. 北京: 人民卫生出版社, 2018: 104. [19] CRONIN AJ. Ethical and legal issues related to the donation and use of nonstandard organs for transplants[J]. Anesthesiol Clin, 2013, 31(4): 675-687. DOI: 10.1016/j.anclin.2013.09.004. [20] KONERU B, FISHER A, HE Y, et al. Ischemic preconditioning in deceased donor liver transplantation: a prospective randomized clinical trial of safety and efficacy[J]. Liver Transpl, 2005, 11(2): 196-202. DOI: 10.1002/lt.20315. [21] HALPERN SD, SHAKED A, HASZ RD, et al. Informing candidates for solid-organ transplantation about donor risk factors[J]. N Engl J Med, 2008, 358(26): 2832-2837. DOI: 10.1056/NEJMsb0800674. [22] CRONIN AJ, DOUGLAS JF. Non-standard kidneys for transplants: clinical margins, medical morality, and the law[J]. Med Law Rev, 2013, 21(3): 448-473. DOI: 10.1093/medlaw/fwt015. [23] 高媛, 张世胜, 吕毅, 等. 中国与德国器官移植现状比较[J]. 器官移植, 2016, 7(2): 159-162. DOI: 10.3969/j.issn.1674-7445.2016.02.016.GAO Y, ZHANG SS, LYU Y, et al. Comparison of organ transplantation status between China and Germany[J]. Organ Transplant, 2016, 7(2): 159-162. DOI: 10.3969/j.issn.1674-7445.2016.02.016. [24] 崔洋海, 李小莹, 冀冰心, 等. 器官移植伦理委员会建设和规范化审查的思考[J]. 中国病案, 2021, 22(12): 27-29. DOI: 10.3969/j.issn.1672-2566.2021.12.012.CUI YH, LI XY, JI BX, et al. Construction and standardized review of organ transplantation ethics committee[J]. Chin Med Rec, 2021, 22(12): 27-29. DOI: 10.3969/j.issn.1672-2566.2021.12.012. [25] 郑金, 江一峰, 周吉银. 我国器官移植伦理委员会伦理审查能力建设[J]. 中国医学伦理学, 2022, 35(6): 607-612. DOI: 10.12026/j.issn.1001-8565.2022.06.04.ZHENG J, JIANG YF, ZHOU JY. Capacity building of ethical review of organ transplantation ethics committee in China[J]. Chin Med Ethics, 2022, 35(6): 607-612. DOI: 10.12026/j.issn.1001-8565.2022.06.04. [26] 甘亢, 李静, 应娇茜, 等. 公民逝世后器官捐献及移植伦理审查经验与思考[J]. 中国医学伦理学, 2019, 32(9): 1170-1173. DOI: 10.12026/j.issn.1001-8565.2019.09.16.GAN K, LI J, YING JQ, et al. Experiences and reflection of ethical review to DCD and transplant[J]. Chin Med Ethics, 2019, 32(9): 1170-1173. DOI: 10.12026/j.issn.1001-8565.2019.09.16. [27] WANG ZH, ZHOU GH, SUN LP, et al. Challenges in the ethics review process of clinical scientific research projects in China[J]. J Int Med Res, 2019, 47(10): 4636-4643. DOI: 10.1177/0300060519863539. [28] 中共中央办公厅国务院办公厅印发《关于加强科技伦理治理的意见》[EB/OL]. [2023-07-01]. https://www.gov.cn/zhengce/2022-03/20/content_5680105.htm. [29] 燕娟, 江文诗, 孙永康, 等. 公民逝世后器官捐献伦理审查的思考与建议[J]. 医学与哲学, 2022, 43(2): 28-32. DOI: 10.12014/j.issn.1002-0772.2022.02.06.YAN J, JIANG WS, SUN YK, et al. Reflections and suggestions on ethical review of Chinese organ donation after citizen's death[J]. Med Philos, 2022, 43(2): 28-32. DOI: 10.12014/j.issn.1002-0772.2022.02.06. [30] 李红英, 王亮良, 周吉银. 论我国器官捐献与移植伦理委员会能力建设[J/CD]. 实用器官移植电子杂志, 2022, 10(1): 4-7. DOI: 10.3969/j.issn.2095-5332.2022.01.002.LI HY, WANG LL, ZHOU JY. On the capacity building of the ethics committee for organ donation and transplantation in China[J/CD]. Pract J Organ Transplant (Electr Vers), 2022, 10(1): 4-7. DOI: 10.3969/j.issn.2095-5332.2022.01.002. [31] 薛武军. 中国器官移植发展的必由之路——器官移植学科体系化、器官捐献专业化、OPO建设学科化[J/CD]. 实用器官移植电子杂志, 2023, 11(2): 103-106. DOI: 10.3969/j.issn.2095-5332.2023.02.002.XUE WJ. The only way for the development of organ transplantation in China - systematization of organ transplantation discipline, specialization of organ donation, and disciplinary construction of OPO[J/CD]. Pract J Organ Transplant (Electr Vers), 2023, 11(2): 103-106. DOI: 10.3969/j.issn.2095-5332.2023.02.002. [32] 中国人体健康科技促进会人体器官和组织捐献专业委员会. 器官捐献: 我国新时代下多学科共创的新生学科[J]. 器官移植, 2020, 11(5): 614-621. DOI: 10.3969/j.issn.1674-7445.2020.05.015.Society of Organ & Tissue Donation of China Association for Promotion of Health Science and Technology. Organ donation: a novel discipline created by multi-disciplinary integration in the new era of China[J]. Organ Transplant, 2020, 11(5): 614-621. DOI: 10.3969/j.issn.1674-7445.2020.05.015. [33] 潘杰, 王海峰, 张东航, 等. 医院人体器官捐献与移植伦理体系构建探讨[J]. 中国医学伦理学, 2016, 29(3): 441-443. DOI: 10.12026/j.issn.1001-8565.2016.03.23.PAN J, WANG HF, ZHANG DH, et al. Discussion on the ethical system construction of organ donation and transplantation in hospitals[J]. Chin Med Ethics, 2016, 29(3): 441-443. DOI: 10.12026/j.issn.1001-8565.2016.03.23. [34] 黄柳. 制定“医学伦理审查法”为形势所趋[J]. 中国医院院长, 2019(7): 50.HUANG L. Developing the "medical ethics review law" as the trend of the situation[J]. China Hosp CEO, 2019(7): 50. [35] 王宏斌, 王樱儒. 法律视角下的医学伦理委员会制度之完善[J]. 医学与哲学, 2017, 38(17): 31-33. DOI: 10.12014/j.issn.1002-0772.2017.09a.07.WANG HB, WANG YR. Improvement of medical ethics committee system from the perspective of law[J]. Med Philo, 2017, 38(17): 31-33. DOI: 10.12014/j.issn.1002-0772.2017.09a.07. -
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