器官移植医学伦理学英文.ppt

器官移植医学伦理学英文.ppt

《器官移植医学伦理学英文.ppt》由会员分享，可在线阅读，更多相关《器官移植医学伦理学英文.ppt（16页珍藏版）》请在冰点文库上搜索。

,ORGAN,TRANSPLANT,Thefirstsuccessfulliving-relatedkidneytransplantatBrighamHospitalinBoston:

AkidneywastransplantedfromRonaldHerrickintohisidenticaltwin,Richard.,UniformAnatomicalGiftActestablishestheUniformDonorCardasalegaldocumentforanyone18yearsofageoroldertolegallydonatehisorherorgansupondeath.,UNOSwasincorporatedasanindependent,non-profitorganization,committedtosavinglivesthroughunitingandsupportingtheeffortsofdonationandtransplantationprofessionals.,UNOSlaunchesUNetsm,asecure,Internet-basedtransplantinformationdatabasesystemforallorganmatchingandmanagementoftransplantdata.,UNOSlaunchesDonorNetsm,asecure,Internet-basedsysteminwhichorganprocurementcoordinatorssendoutoffersofnewlydonatedorganstotransplanthospitalswithcompatiblecandidates.,1954,1968,1984,1999,2006,Howorgansarematched,Thefirststep,Geographyplaysapart,Theright-sizedorgan,Beforeanorganisallocated,alltransplantcandidatesonthewaitinglistthatareincompatiblewiththedonorbecauseofbloodtype,height,weightandothermedicalfactorsareautomaticallyscreenedfromanypotentialmatches.Then,UNOScomputersystemdeterminestheorderthattheothercandidateswillreceiveoffers.,Thereare58localdonorserviceareasand11UNOSregionsthatareusedforU.S.organallocation.Heartsandlungshavelesstimetobetransplanted,soweusearadiusfromthedonorhospitalinsteadofregionswhenallocatingthoseorgans.,Properorgansizeiscriticaltoasuccessfultransplant,whichmeansthatchildrenoftenrespondbettertochild-sizedorgans.Althoughpediatriccandidateshavetheirownuniquescoringsystem,childrenessentiallyarefirstinlineforotherchildrensorgans.,GeneralnephrologyAllocationofresources:

individualversuspopulationAcuterenalfailure-whenisitfutiletocontinueClinicalandmoleculardiagnosisofinheriteddisordersDialysisESDRtreatmentinanunequalworldTransplantationSourceofdonororgansAnencephalicbabiesLivingdonors-paid-unpaid-coercion-minorsExecutedprisonersPatientsinapersistentvegetativestateEquitabledistributionoforgans,CadaversDonations,Deadrole,2,ExecutedPrisoner,1,LivingDonations,nondirecteddonation,2,directeddonationtoastranger,3,directeddonationtoalovedoneorfriend,1,race,religion,andethnicgroup,4,CASE,Bothparentsofachildwhowasdyingofrespiratoryfailureinsistedondonatinglobesoftheirlungsinadesperatebutunsuccessfulattempttosaveherlife.,Withdirecteddonationtolovedonesorfriends,worriesariseabouttheintensepressurethatcanbeputonpeopletodonate,leadingthosewhoarereluctanttodosotofeelcoerced.,directeddonationtoalovedoneorfriend,Equallyimportant,however,aresituationsinwhichpeoplefeelcompelledtodonateregardlessoftheconsequencestothemselves.,Physiciansareobligatedtopreventpeoplefrommakingpotentiallylife-threateningsacrificesunlessthechanceofsuccessisproportionatelylarge.,CASE,Amanwhoseemedpathologicallyobsessedwithgivingawayeverything,fromhismoneytohisorgans,sayingthatdoingsowas“asmuchanecessityasfood,water,andair.”Afterdonatingonekidneytoastranger,hewonderedhowhemightgiveawayallhisotherorgansinadramaticsuicide.,Theradicalaltruismthatmotivatesapersontomakeapotentiallylife-threateningsacrificeforastrangercallsforcarefulscrutiny.,nondirecteddonation,Otherpsychologicallysuspectmotivationsneedtoberuledoutaswell.Isthepersontryingtocompensatefordepressionorlowself-esteem,seekingmediaattention.,CASE,1.thefamilyofabrain-deadFloridamanagreedtodonatehisorgansbutinsistedthatbecauseofthemansracistbeliefs,therecipientsmustbewhite.2.AJewishmaninNewYorklearnedofaJewishchildinLosAngeleswhoneededakidneytransplant.Themanwantedtohelpsomeoneofhisownfaithanddecidedhewaswillingtodonateakidneytohelpthisparticularchild.,1.Althoughtheorganswereallocatedaccordingly,Floridasubsequentlypassedalawprohibitingpatientsorfamiliesfromplacingsuchrestrictionsondonation.,race,religion,andethnicgroup,2.Onemightviewthedonationaspermissible,sinceatleastsomepatientswouldbenefit（thechildwouldreceiveakidney,andthosebelowheronthewaitinglistwouldmoveuponenotch）andnoonewouldbeharmed,thoseabovethegirlonthewaitinglistwouldnotreceivethekidneyunderanycircumstances,becausethemanwouldnotgiveittothem.,Whetherdirecteddonationtostrangersviolatesstandardsoffairnessisthuscontroversial.Butifitispermitted,itwillbeverydifficulttoprohibitdiscriminatorypreferences,sincedonorscansimplyspecifythattheorganmustgotoaparticularperson,withoutsayingwhy,Somearguethatjustaswehavearighttodonatetothepoliticalpartiesandcharitiesofourchoice,soshouldwebeabletochoosetowhomtogiveourorgans.Inpractice,however,thismeansthatthosewhohavethemostcompellingstoriesandthemeanstoadvertisetheirplighttendtobetheoneswhogettheorgansratherthanthosemostinneed.,heothersubstantialcauseforconcernaboutthistypeofdonationisitspotentialformakingpossiblethebuyingandsellingoforgans.Thesepracticesarestrictlyprohibitedbylaw,yettheyseemtobeaninherentriskindirecteddonationstostrangers.,Thiseffort,however,doesnotgofarenough.Organtransplantationisbigbusiness,andeachcenterishighlymotivatedtoexpanditsshareofthepie.Theythereforehaveintolerableconflictsofinterestwhenitcomestoregulatingthemselves.,Thanks,