器官移植-医学伦理学-英文ppt课件

.,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,yettheyseemtobeaninherentriskindi