构建国内器官捐献救助体系的思考

背景：进入21世纪,器官移植事业飞速发展,器官移植供体的短缺极大的限制了这项技术在临床领域的充分运用,而中国1：30的数量比更是阻碍中国器官移植事业发展的“瓶颈”。目的：探讨建立人体器官捐献救助体系的意义、内容及途径,分析目前中国器官捐献救助存在的问题,提出器官捐献救助的措施。方法：在CNKI和PubMed通过关键词“器官捐献、器官移植、救助”查阅相关文献,对来源于核心期刊的文章进行综合分析。同时,深入临床,通过交谈法了解器官捐献者和医务人员的呼声,为文章救助措施的提出提供了具有现实意义的依据。结果与结论：为了器官移植事业的快速发展,从社会、经济、心理等方面对器官捐献者给予一定的人道主义救助乃大势所趋,同时,从法律援助、制度设计、组织构建、工作人员配置几个方面提出构建符合中国国情的器官捐献救助体系,确保救助措施落到实处。     

关于中国器官捐献协调员的职业化建设

背景：器官捐献协调员是开展器官捐献工作的骨干力量,是提高中国器官捐献率的重要保证,而加快器官捐献协调员队伍建设的核心问题是实现职业化。目的：通过器官捐献协调员职业化建设的重大意义、内涵探析、现状总结以及建议对策等4个方面进行了尝试性探索。方法：以“器官捐献/器官移植/协调员/职业化,遗体捐献,心死亡”为中文捡索词,以“organ donation /organ transplantation /coordinator / profession/occupation/,body donation, cardiac death”为英文检索词,检索维普和中国知网（CNKI）期刊全文数据库、万方、Pubmed,Medline,Highwire和外文生物医学期刊全文数据库（Foreign Journals Integration System）2003年1月至2013年8月有关器官捐献报告中主要涉及器官捐献协调员的相关报道。然后二次人工检索器官捐献协调员后,纳入有关器官捐献协调员,以及器官捐献移植相关政策法规的文献,排除临床研究和基础研究性的文章,通过对文献归纳,总结分析目前中国器官捐献协调员的现况,提出器官捐献协调员职业化建设的对策。结果与结论：文章详细阐述了器官捐献协调员的深刻内涵、职业要求和社会定位,系统分析了国内目前器官捐献协调员队伍建设中存在的问题,粗略构建了中国器官捐献协调员职业化建设的基本框架,总结探索了器官捐献协调员职业化建设应采取的路径和方法。     

国内外人体器官捐献规范化的现状与研究进展

在器官移植领域,我国目前已取得了一定成绩,越来越多的患者进入等待移植的名单,但由于器官资源的紧缺,对器官移植事业的进一步发展造成了极大的障碍。规范器官移植是否合法及合理,仍需经过不断探讨及经验的累积。从对国内外人体器官捐献的法律现状、捐献机制、宣传力度、民众意识、捐献进展等方面的分析表明,国内外人体器官捐献都有一定的发展并日益规范化,但我国器官捐献,无论是从法律、捐献体系还是从捐献的例数来看,明显滞后于发达国家。因此,国内外都必须寻求解决器官短缺的共同问题,尤其是我国,应该在现行的法律法规框架下,结合国内外先进经验,从实践中摸索出适合我国国情的人体器官捐献模式。加强人体器官捐献的规范管理,扩大器官供者的来源,建立和完善相关的法规、政策,加强医学科普知识的宣传,建立畅通的捐献渠道,提高全民捐献意识,循序渐进地推动我国人体器官捐献的开展,从而保证我国器官移植事业的健康发展。     

解析器官移植技术中的激励原则

背景:器官移植供体缺乏现状虽然在逐步得到改善,但是仍然是器官移植技术进步的主要瓶颈之一。目的:对器官供体捐献激励原则的进一步研究。方法:应用计算机检索CNKI和VMIS数据库中2001-01/03关于器官移植的文章,在标题和摘要中以"器官移植、供体"、"器官移植、激励"和"器官移植、捐赠机制"为检索词进行检索。入选21篇文献和5本医学伦理学书籍进行综述。结果与结论:研究器官移植过程中的激励原则,是提高捐赠者参与社会捐赠积极性,解决器官移植发展瓶颈的主要内容之一。     

器官移植供体短缺之解决途径:器官捐献

○器官移植体的现状:没有供体,就没有器官移植,国内器官移植供需矛盾日益突出.○亲属器官移植的利弊:亲属活体供体是最好的器官,但亲属活体移植仍存在诸多困难.○供体短缺的主要原因:伦理道德、医疗技术、立法?○器官移植供体短缺解决途径:减少需求、避免浪费、扩展来源,解决立法,推动器官捐献体系工作的开展     

关于活体器官供者的伦理思考

背景:活体器官伦理问题逐渐成为人们视野中的焦点和难点。目的:对活体器官供体伦理问题进一步研究。方法:应用计算机检索CNKI和VMIS数据库中2001-01/2011-05关于器官移植的文章,在标题和摘要中以"活体、供体"和"器官移植、伦理"为检索词进行检索。纳入与活体供体关联度高、本领域内的文献,主要选择权威杂志、核心期刊或者近期发表的文章。排除与此文目的无关的、内容和观点陈旧的及重复研究的文献。入选18篇文献和4本医学伦理学书籍进行综述。结果与结论:为了生命的健康续存,必须完善器官移植和捐献的法律法规,规范供体来源渠道,避免由于科技利益和经济利益的驱使任由活体供体买卖现象的存在空间,研究器官移植活体供体伦理问题,可促使人们提高活体供体捐赠积极性和主动性,解决器官移植供体短缺状况。     

中国传统文化和观念对器官捐献意愿的影响分析

背景：中国需要接受器官移植的患者数量还以每年超过10%的增量扩大,由于缺乏公民自愿捐献,中国较世界其他国家面临着更为严峻的供体短缺问题。导致目前中国器官供体短缺的具体原因是什么？中国公民究竟如何看待遗体器官捐献,他们对遗体器官捐献的态度如何？是哪些因素影响了中国公民遗体器官捐献行为的实施？目的：了解中国传统观念对中国公民逝世后器官捐献意愿的影响程度。方法：采用随机整群抽样法,选取来自不同社会阶层的900名接受问卷调查者为研究对象,应用自制的公众对人体器官捐献的认知、态度和行为调查表进行问卷调查。〈br〉 结果与结论：①有55.16%的民众认为进行器官捐献的主要目的是想帮助他人,有24.22%的民众认为进行器官捐献的主要目的是一种社会公德的体现,11.94%的民众认为进行器官捐献其实是自己生命的延续。②有70.00%的民众认为捐献的器官应该用于器官移植事业,以便挽救更多患者的生命,其平均得分为2.53分;而建议将捐献器官应用于医学教学用和病理解剖用的比较接近,平均得分依次为1.72和1.75。③有65.01%的民众支持采取心肺死亡的标准来判断人死亡,24.33%的民众支持采取脑死亡的标准判断人死亡,还有10.66%的民众认为不清楚采取什么方式。④有50.52%的民众认为影响器官捐献的主要因素是中国传统文化和观念的影响,其次是捐献程序和家属感情。调查结果发现,中国传统文化和观念是影响民众进行器官捐献的主要因素,大部分民众认为以心肺死亡的标准来判断人死亡为最佳方法,认为捐献器官的主要目的是想帮助别人,捐献的器官应首先应用于器官移植,以便挽救更多的生命。     

国际标准化心脏死亡器官捐献家属器官捐献前的评估及干预

<正>器官捐献在我国尚属新生事物,也是世界敏感的社会问题[1]。目前临床上器官捐献有国际标准化脑死亡器官捐献(DBD)、国际标准化心脏死亡器官捐献(DCD)、中国过渡时期脑-心双死亡标准器官捐献(DBCD),但由于国情、习惯等,我国器官捐献量较少。人体器官捐献协调员由人体器官捐献办公室聘任、培训和管理。协调员由相关机构的专业人员担任,主要职责为开展人体器官捐献宣传、发现潜在捐献者、组织协调登记等。     

器官移植的护理伦理问题

进入21世纪，随着人体器官移植成功率的不断上升，大量处于器官功能衰竭末期的病人重新看到了生存的希望，器官移植不仅仅只是供体与受体之间简单的供应关系，还要考虑到相应的伦理性问题。如：为给一位器官功能衰竭末期的病人捐献器官而使另一位健康的人增添了身体或精神上的痛苦或由此引起身体上的疾病是否正确？如何界定器官提供者的范围？是不是只要身体健康并本人同意即可进行器官捐献？采用人工流产的胎儿、健康的婴儿和未成年人以及有身体或精神障碍的病人的器官进行器官移植是否正确？此外，[第一段]     

中国医学生对活体肝脏捐献的态度

背景:了解中国大学生尤其是医学生对人体器官捐献的态度与认知对器官移植事业的发展具有重要的意义.目的:调查中国医学生对活体肝脏捐献的态度,以及影响这种态度的相关因素.方法:在中国医科大学临床医学专业随机选取250名学生作为研究对象,按年级进行分层,每年级50人.应用调查问卷评价医学生对活体肝脏捐献的态度及其影响因素.问卷调查采取匿名方式,由受调查者自行填写.使用SPSS统计分析软件,分别应用t检验和χ2检验进行双变量分析.结果与结论:共回收有效问卷243份,回收率为97.2%.其中13.2%(n=32)的受调查者愿意对非亲属进行活体肝脏捐献,66.3% (n=161)的学生只愿意捐献给自己的亲属,6.6%(n=16)的学生不愿意捐献给任何人,还有14.0%(n=34)的学生表示不确定.与医学生对活体肝脏捐献的态度有关的因素包括:医学生对捐献家人器官的态度、对尸体器官捐献的态度、对活体肾脏捐献的态度和接受他人捐献的活体肝脏的态度.总体看来,中国的医学生对活体肝脏捐献表示支持.但目前中国的医学生缺乏关于器官捐献和移植的教育,应在医学生的课程中引入这方面的内容.

Abstract：

BACKGROUND: A better understanding of medical students' attitude towards living liver donation in China would be of importance significance in the development of organ transplantation. OBJECTIVE: To investigate the medical students' attitude toward living liver donation in China and to analyze the factors that affect such an attitude.METHODS: A random sample of 250 medical students was taken and stratified by grades with 50 students in each grade. The attitude was evaluated by a modified psychosocial questionnaire from Spain. The questionnaire was completed anonymously and was self-administered. A bivariate analysis including the Student's t test and the Chi-square test was performed using SPSS software. RESULTS AND CONCLUSION: The questionnaire completion rate was 97.2% (n=243) for the medical students. Among the respondents, only 13.2% (n=32) of them were in favor of unrelated living liver donation. Another 66.3% (n=161) were only in favor if the donation was for a relative. Of the rest, 6.6% (n=16) did not agree with living liver donation, and the remaining 14.0% (n=34) were undecided. The factors related to this attitude were the decision of donating the organs of a family member (P=0.002), attitude toward deceased donation (P=0.000), a willingness to receive a donated living liver organ if one were needed (P=0.000), attitude toward living kidney donation (P=0.000). The medical students have a favorable attitude toward living liver donation in China. The students' attitude toward other types of organ donation and the willingness to accept living donated liver influence their attitude toward living liver donation. There is a great lack of education about the organ donation and transplantation for the medical students in China and more education programs should be incorporated into their traditional curriculum.     

Protection behaviour: a phenomenon affecting organ and tissue donation in the 21st century?

UK statistics show that whilst waiting lists for transplantation surgery continue to increase, donor numbers are static. This paper describes the hermeneutic phase of a mixed method study and puts forward the concept of protection behaviour as one explanation for nurses' reticence to discuss post-mortem donation wishes with patients' relatives. The desire to protect appears to influence attitudes, confidence levels and perceived ability to become involved in donor identification and donation discussion, consequently affecting the availability of transplantable organs and tissue. By understanding more fully why protective behaviours are employed, it increases the likelihood of a solution being found.     

Undergraduate nursing students' attitudes towards organ donation: a survey in an Italian university

ZAMPIERON A., CORSO M. & FRIGO A.C. (2010) Undergraduate nursing students' attitudes towards organ donation: a survey in an Italian university. International Nursing Review 57 , 370–376 Aims: To examine undergraduate nursing students' attitudes towards organ donation and to determine whether or not attitudes were related to the students' education and training. Background: Nurses' knowledge and personal opinion can influence patient's willingness to donate organs or to hold an organ donor card. It is unclear how Italy's future nurses view organ donation. Methods: The study's source population consisted of third‐year undergraduate nursing students enrolled in seven nursing schools from an Italian university during 2008. Respondents completed self‐administered quantitative questionnaire with 61 questions, including the Organ Donation Attitude Scale. Findings: Of the 378 students contacted, 183 (48%) completed all survey questions; 140 were females (76.5%) and the mean age of students was 25. The median score of students' attitude scores towards organ donation was 151 (the attitude is positive when the score is higher than 161). No significant correlations were found to exist between organ‐donation attitude and sex, age, clinical practice in hospitals with a transplant unit, nursing care to patients waiting for a transplant or dialysis patients. Only 16% of the students had previously signed a donor card consenting to their own organ donation. The study revealed that doubts about transplantable organs still exist within the student body. Conclusions: This study highlighted that students' awareness of organ donation was not adequate and that attitude levels were lower than in other countries. If these future workers would receive adequate training, they could promote organ donation to the general public and to other hospital personnel.     

Xenogeneic stem cell transplantation: Research progress and clinical prospects

Organ transplantation is the ultimate treatment for end-stage diseases such as heart and liver failure. However, the severe shortage of donor organs has limited the organ transplantation progress. Xenogeneic stem cell transplantation provides a new strategy to solve this problem. Researchers have shown that xenogeneic stem cell transplantation has significant therapeutic effects and broad application prospects in treating liver failure, myocardial infarction, advanced type 1 diabetes mellitus, myelosuppression, and other end-stage diseases by replacing the dysfunctional cells directly or improving the endogenous regenerative milieu. In this review, the sources, problems and solutions, and potential clinical applications of xenogeneic stem cell transplantation will be discussed.     

Maternal organ donation and acute injuries in surviving children

Purpose

The purpose of this study is to test whether maternal deceased organ donation is associated with rates of subsequent acute injuries among surviving children after their mother’s death.

Methods

This is alongitudinal cohort analysis of children linked to mothers who died of a catastrophic brain event in Ontario, Canada, between April 1988 and March 2012. Surviving children were distinguished by whether their mother was an organ donor after death. The primary outcome was an acute injury event in surviving children during the year after their mother’s death.

Results

Surviving children (n = 454) had a total of 293 injury events during the year after their mother’s death, equivalent to an average of 65 events per 100 children per year and a significant difference comparing children of mothers who were organ donors to children of mothers who were not organ donors (21 vs 82, P < .001). This difference in subsequent injury rates between groups was equal to a 76% relative reduction in risk (95% confidence interval, 62%-85%).

Conclusions

Deceased organ donation was associated with a reduction in excess acute injuries among surviving children after their mother’s death. An awareness of this positive association provides some reassurance about deceased organ donation programs.     

我国器官移植立法存在的问题与思考

通过对我国器官移植相关法律法规的分析,讨论了当前我国器官移植立法中存在的问题：①活体器官捐赠门槛提高,导致器官供应严重不足;②隐性器官交易难以防范;③器官分配过程不透明,存在分配不公的问题。而解决上述问题的根本途径在于：完善器官移植的相关法律法规,建立器官捐献的保障和补偿机制,建立公平合理的器官资源分配机制以及确立脑死亡标准,为器官末期病患者提供更为广泛的器官来源。     

Intensive care unit acquired infection and organ failure

Objective To assess the temporal relationship between ICU-acquired infection (IAI) and the prevalence and severity of organ dysfunction or failure (OD/F). Design and setting Observational, single center study in a mixed intensive care unit of a university hospital. Patients We analyzed 1,191 patients hospitalized for more than 2 days during a 2-year observation period: 845 did not acquire IAI, 306 of whom had infection on admission (IOA); 346 did acquire IAI, 125 of whom had IOA. Measurements and results The SOFA score was calculated daily, both SOFAmax, the sum of the worst OD/F during the ICU stay, and SOFApreinf, the sum of the worst OD/F existing before the occurrence of the first IAI. The SAPS II and SOFA score of the first 24 h were significantly higher in patients with than in those without IAI. SOFApreinf of IAI patients was also higher than the SOFAmax of patients without IAI both in patients with (12.1 ± 4.6 vs. 8.9 ± 4.7) and those without IOA (9.2 ± 4.0 vs. 6.7 ± 3.5). SOFApreinf represented 85.7% of the value of SOFAmax in patients with IAI. SOFApreinf increased significantly with the occurrence of sepsis, severe sepsis, or septic shock during ICU stay. Severe sepsis and septic shock during ICU stay as well as SOFApreinf were part of the factors associated with hospital mortality. Conclusions IAI is significantly associated with hospital mortality; however, its contribution to OD/F is minor. Moreover, severity of IAI seems to be related to previous health status. This article is discussed in the editorial available at: .     

器官捐献和移植教育影响医学生认知和态度的系统评价

背景：医务工作人员在器官捐献和移植过程中发挥着重要的作用,但作为未来的医务工作人员—医学生对器官捐献和移植呈现出知识的不足和矛盾的态度。
　　目的：系统评价器官捐献和移植教育对医学生认知和态度的影响。
　　方法：检索外文数据库PubMed、WILEY ONLINE LIBRARY、ProQuest Health、Medline、EMbase、中文数据库中国知网、维普及万方数据库,全面检索对医学生进行器官捐献和移植教育的研究,纳入符合标准的文献,应用澳大利亚JBI循证卫生保健中心对随机对照试验和类实验性研究文献真实性评价的原则进行评价,以GRADE指南进行质量分级,主要评价结局指标为医学生对器官捐献和移植的认知和态度。
　　结果与结论：来自3个国家的8篇文献符合纳入标准,1篇为随机对照试验,质量评价为高质量;1篇类实验研究评价为高质量;5篇类实验研究质量评价为中级;1篇类实验研究质量评价为低级。6篇研究评价了教育对医学生知识水平的影响,6篇研究评价了教育对医学生态度的影响。通过系统评价得出运用教育能够提高医学生对器官捐献和移植的认知,改变对器官捐献和移植的态度。由于纳入的文献多为类试验研究,结论有待于高质量的随机对照试验进一步验证。     

上腹部器官簇移植术后抗排斥治疗1例并文献复习

目的:探讨上腹部器官簇移植术后的抗排斥治疗方案。方法:总结我院1例成功的上腹部器官簇移植病例,其抗排斥方案为:两剂量赛呢哌方案诱导,联合使用FK506、激素和骁悉方案抗排斥治疗。结果:患者术后一般情况恢复良好,移植肝、十二指肠、胰腺功能恢复良好,未发现有排斥反应。结论:使用赛呢哌诱导,联合FK506、激素和骁悉方案可以有效预防器官簇移植术后排斥反应的发生。     

经直肠超声在未婚妇女盆腔器官检查中的应用——附42例报告

目的：探讨经直肠超声在未婚妇女盆腔器官检查中的临床价值。方法：使用经直肠超声对４２例未婚妇女进行盆腔器官检查,并与经腹超声对照。结果：经直肠超声对未婚妇女子宫,卵巢细致结构的显示优于经腹超声,且安全,未见不良反应。结论：对于未婚妇女盆腔器官的检查,可使用经直肠超声代替经阴道超声。