器官移植醫(yī)學(xué)倫理學(xué)英文課件

ORGANTRANSPLANTORGANTRANSPLANT1Thefirstsuccessfulliving-relatedkidneytransplantatBrighamHospitalinBoston:AkidneywastransplantedfromRonaldHerrickintohisidenticaltwin,Richard.UniformAnatomicalGiftActestablishestheUniformDonorCardasalegaldocumentforanyone18yearsofageoroldertolegallydonatehisorherorgansupondeath.UNOSwasincorporatedasanindependent,non-profitorganization,committedtosavinglivesthroughunitingandsupportingtheeffortsofdonationandtransplantationprofessionals..UNOSlaunchesUNetsm,asecure,Internet-basedtransplantinformationdatabasesystemforallorganmatchingandmanagementoftransplantdata.UNOSlaunchesDonorNetsm,asecure,Internet-basedsysteminwhichorganprocurementcoordinatorssendoutoffersofnewlydonatedorganstotransplanthospitalswithcompatiblecandidates.19541968198419992006Thefirstsuccessfulliving-re2HoworgansarematchedThefirststepGeographyplaysapartTheright-sizedorganBeforeanorganisallocated,alltransplantcandidatesonthewaitinglistthatareincompatiblewiththedonorbecauseofbloodtype,height,weightandothermedicalfactorsareautomaticallyscreenedfromanypotentialmatches.Then,UNOS’computersystemdeterminestheorderthattheothercandidateswillreceiveoffers.Thereare58localdonorserviceareasand11UNOSregionsthatareusedforU.S.organallocation.Heartsandlungshavelesstimetobetransplanted,soweusearadiusfromthedonorhospitalinsteadofregionswhenallocatingthoseorgans.Properorgansizeiscriticaltoasuccessfultransplant,whichmeansthatchildrenoftenrespondbettertochild-sizedorgans.Althoughpediatriccandidateshavetheirownuniquescoringsystem,childrenessentiallyarefirstinlineforotherchildren’sorgans.HoworgansarematchedThefirs3GeneralnephrologyAllocationofresources:individualversuspopulationAcuterenalfailure-whenisitfutiletocontinueClinicalandmoleculardiagnosisofinheriteddisordersDialysisESDRtreatmentinanunequalworldTransplantationSourceofdonororgansAnencephalicbabiesLivingdonors-paid-unpaid-coercion-minorsExecutedprisonersPatientsinapersistentvegetativestateEquitabledistributionoforgansGeneralnephrology4Cadavers’DonationsDeadrole2ExecutedPrisoner1Cadavers’DonationsDeadrole2E5LivingDonationsnondirecteddonation2directeddonationtoastranger3directeddonationtoalovedoneorfriend1race,religion,andethnicgroup4LivingDonationsnondirecteddo6CASEBothparentsofachildwhowasdyingofrespiratoryfailureinsistedondonatinglobesoftheirlungsinadesperatebutunsuccessfulattempttosaveherlife.CASEBothparentsofachildwh7Withdirecteddonationtolovedonesorfriends,worriesariseabouttheintensepressurethatcanbeputonpeopletodonate,leadingthosewhoarereluctanttodosotofeelcoerced.directeddonationtoalovedoneorfriendEquallyimportant,however,aresituationsinwhichpeoplefeelcompelledtodonateregardlessoftheconsequencestothemselves.Physiciansareobligatedtopreventpeoplefrommakingpotentiallylife-threateningsacrificesunlessthechanceofsuccessisproportionatelylarge.Withdirecteddonationtolov8CASEAmanwhoseemedpathologicallyobsessedwithgivingawayeverything,fromhismoneytohisorgans,sayingthatdoingsowas“asmuchanecessityasfood,water,andair.”Afterdonatingonekidneytoastranger,hewonderedhowhemightgiveawayallhisotherorgansinadramaticsuicide.CASEAmanwhoseemedpathologi9Theradicalaltruismthatmotivatesapersontomakeapotentiallylife-threateningsacrificeforastrangercallsforcarefulscrutiny.nondirecteddonationOtherpsychologicallysuspectmotivationsneedtoberuledoutaswell.Isthepersontryingtocompensatefordepressionorlowself-esteem,seekingmediaattention.Theradicalaltruismthatmoti10CASE1.thefamilyofabrain-deadFloridamanagreedtodonatehisorgans—butinsistedthatbecauseoftheman'sracistbeliefs,therecipientsmustbewhite.2.AJewishmaninNewYorklearnedofaJewishchildinLosAngeleswhoneededakidneytransplant.Themanwantedtohelpsomeoneofhisownfaithanddecidedhewaswillingtodonateakidneytohelpthisparticularchild.CASE1.thefamilyofabrain-de111.Althoughtheorganswereallocatedaccordingly,Floridasubsequentlypassedalawprohibitingpatientsorfamiliesfromplacingsuchrestrictionsondonation.race,religion,andethnicgroup2.Onemightviewthedonationaspermissible,sinceatleastsomepatientswouldbenefit(thechildwouldreceiveakidney,andthosebelowheronthewaitinglistwouldmoveuponenotch)andnoonewouldbeharmedthoseabovethegirlonthewaitinglistwouldnotreceivethekidneyunderanycircumstances,becausethemanwouldnotgiveittothem.1.Althoughtheorganswereall12Whetherdirecteddonationtostrangersviolatesstandardsoffairnessisthuscontroversial.Butifitispermitted,itwillbeverydifficulttoprohibitdiscriminatorypreferences,sincedonorscansimplyspecifythattheorganmustgotoaparticularperson,withoutsayingwhySomearguethatjustaswehavearighttodonatetothepoliticalpartiesandcharitiesofourchoice,soshouldwebeabletochoosetowhomtogiveourorgans.Inpractice,however,thismeansthatthosewhohavethemostcompellingstoriesandthemeanstoadvertisetheirplighttendtobetheoneswhogettheorgans—ratherthanthosemostinneed.Whetherdirecteddonationtos13heothersubstantialcauseforconcernaboutthistypeofdonationisitspotentialformakingpossiblethebuyingandsellingoforgans.Thesepracticesarestrictlyprohibitedbylaw,yettheyseemtobeaninherentriskindirecteddonationstostrangers.heothersubstantialcausefor14Thiseffort,however,doesnotgofarenough.Organtransplantationisbigbusiness,andeachcenterishighlymotivatedtoexpanditsshareofthepie.Theythereforehaveintolerableconflictsofinterestwhenitcomestoregulatingthemselves.

Thiseffort,however,doesnot15Thanks

Thanks16ORGANTRANSPLANTORGANTRANSPLANT17Thefirstsuccessfulliving-relatedkidneytransplantatBrighamHospitalinBoston:AkidneywastransplantedfromRonaldHerrickintohisidenticaltwin,Richard.UniformAnatomicalGiftActestablishestheUniformDonorCardasalegaldocumentforanyone18yearsofageoroldertolegallydonatehisorherorgansupondeath.UNOSwasincorporatedasanindependent,non-profitorganization,committedtosavinglivesthroughunitingandsupportingtheeffortsofdonationandtransplantationprofessionals..UNOSlaunchesUNetsm,asecure,Internet-basedtransplantinformationdatabasesystemforallorganmatchingandmanagementoftransplantdata.UNOSlaunchesDonorNetsm,asecure,Internet-basedsysteminwhichorganprocurementcoordinatorssendoutoffersofnewlydonatedorganstotransplanthospitalswithcompatiblecandidates.19541968198419992006Thefirstsuccessfulliving-re18HoworgansarematchedThefirststepGeographyplaysapartTheright-sizedorganBeforeanorganisallocated,alltransplantcandidatesonthewaitinglistthatareincompatiblewiththedonorbecauseofbloodtype,height,weightandothermedicalfactorsareautomaticallyscreenedfromanypotentialmatches.Then,UNOS’computersystemdeterminestheorderthattheothercandidateswillreceiveoffers.Thereare58localdonorserviceareasand11UNOSregionsthatareusedforU.S.organallocation.Heartsandlungshavelesstimetobetransplanted,soweusearadiusfromthedonorhospitalinsteadofregionswhenallocatingthoseorgans.Properorgansizeiscriticaltoasuccessfultransplant,whichmeansthatchildrenoftenrespondbettertochild-sizedorgans.Althoughpediatriccandidateshavetheirownuniquescoringsystem,childrenessentiallyarefirstinlineforotherchildren’sorgans.HoworgansarematchedThefirs19GeneralnephrologyAllocationofresources:individualversuspopulationAcuterenalfailure-whenisitfutiletocontinueClinicalandmoleculardiagnosisofinheriteddisordersDialysisESDRtreatmentinanunequalworldTransplantationSourceofdonororgansAnencephalicbabiesLivingdonors-paid-unpaid-coercion-minorsExecutedprisonersPatientsinapersistentvegetativestateEquitabledistributionoforgansGeneralnephrology20Cadavers’DonationsDeadrole2ExecutedPrisoner1Cadavers’DonationsDeadrole2E21LivingDonationsnondirecteddonation2directeddonationtoastranger3directeddonationtoalovedoneorfriend1race,religion,andethnicgroup4LivingDonationsnondirecteddo22CASEBothparentsofachildwhowasdyingofrespiratoryfailureinsistedondonatinglobesoftheirlungsinadesperatebutunsuccessfulattempttosaveherlife.CASEBothparentsofachildwh23Withdirecteddonationtolovedonesorfriends,worriesariseabouttheintensepressurethatcanbeputonpeopletodonate,leadingthosewhoarereluctanttodosotofeelcoerced.directeddonationtoalovedoneorfriendEquallyimportant,however,aresituationsinwhichpeoplefeelcompelledtodonateregardlessoftheconsequencestothemselves.Physiciansareobligatedtopreventpeoplefrommakingpotentiallylife-threateningsacrificesunlessthechanceofsuccessisproportionatelylarge.Withdirecteddonationtolov24CASEAmanwhoseemedpathologicallyobsessedwithgivingawayeverything,fromhismoneytohisorgans,sayingthatdoingsowas“asmuchanecessityasfood,water,andair.”Afterdonatingonekidneytoastranger,hewonderedhowhemightgiveawayallhisotherorgansinadramaticsuicide.CASEAmanwhoseemedpathologi25Theradicalaltruismthatmotivatesapersontomakeapotentiallylife-threateningsacrificeforastrangercallsforcarefulscrutiny.nondirecteddonationOtherpsychologicallysuspectmotivationsneedtoberuledoutaswell.Isthepersontryingtocompensatefordepressionorlowself-esteem,seekingmediaattention.Theradicalaltruismthatmoti26CASE1.thefamilyofabrain-deadFloridamanagreedtodonatehisorgans—butinsistedthatbecauseoftheman'sracistbeliefs,therecipientsmustbewhite.2.AJewishmaninNewYorklearnedofaJewishchildinLosAngeleswhoneededakidneytransplant.Themanwantedtohelpsomeoneofhisownfaithanddecidedhewaswillingtodonateakidneytohelpthisparticularchild.CASE1.thefamilyofabrain-de271.Althoughtheorganswereallocatedaccordingly,Floridasubsequentlypassedalawprohibitingpatientsorfamiliesfromplacingsuchrestrictionsondonation.race,religion,andethnicgroup2.Onemightviewthedonationaspermissible,sinceatleastsomepatientswouldbenefit(thechildwouldreceiveakidney,andthosebelowheronthewaitinglistwouldmoveuponenotch)andnoonewouldbeharmedthoseabovethegirlonthewaitinglistwouldnotreceivethekidneyunderanycircumstances,becausethemanwouldnotgiveittothem.1.Althoughtheorga