Philosophy of organ donation: Review of ethical facets
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摘要
Transplantation ethics is a philosophy that incorporates systematizing, defending and advocating concepts of right and wrong conduct related to organ donation. As the demand for organs increases, it is essential to ensure that new and innovative laws, policies and strategies of increasing organ supply are bioethical and are founded on the principles of altruism and utilitarianism. In the field of organ transplantation, role of altruism and medical ethics values are significant to the welfare of the society. This article reviewsseveral fundamental ethical principles, prevailing organ donation consent laws, incentives and policies related to the field of transplantation. The Ethical and Policy Considerations in Organ Donation after Circulatory Determination of Death outline criteria for death and organ retrieval. Presumed consent laws prevalent mostly in European countries maintain that the default choice of an individual would be to donate organs unless opted otherwise. Explicit consent laws require organ donation to be proactively affirmed with state registries. The Declaration of Istanbul outlines principles against organ trafficking and transplant tourism. World Health Organization's Guiding Principles on Human Cell, Tissue and Organ Transplantation aim at ensuring transparency in organ procurement and allocation. The ethics of financial incentives and non-financial incentives such as incorporation of non-medical criteria in organ priority allocation have also been reviewed in detail.
Transplantation ethics is a philosophy that incorporates systematizing, defending and advocating concepts of right and wrong conduct related to organ donation. As the demand for organs increases, it is essential to ensure that new and innovative laws, policies and strategies of increasing organ supply are bioethical and are founded on the principles of altruism and utilitarianism. In the field of organ transplantation, role of altruism and medical ethics values are significant to the welfare of the society. This article reviewsseveral fundamental ethical principles, prevailing organ donation consent laws, incentives and policies related to the field of transplantation. The Ethical and Policy Considerations in Organ Donation after Circulatory Determination of Death outline criteria for death and organ retrieval. Presumed consent laws prevalent mostly in European countries maintain that the default choice of an individual would be to donate organs unless opted otherwise. Explicit consent laws require organ donation to be proactively affirmed with state registries. The Declaration of Istanbul outlines principles against organ trafficking and transplant tourism. World Health Organization's Guiding Principles on Human Cell, Tissue and Organ Transplantation aim at ensuring transparency in organ procurement and allocation. The ethics of financial incentives and non-financial incentives such as incorporation of non-medical criteria in organ priority allocation have also been reviewed in detail.
Transplantation ethics is a philosophy that incorporates systematizing, defending and advocating concepts of right and wrong conduct related to organ donation. As the demand for organs increases, it is essential to ensure that new and innovative laws, policies and strategies of increasing organ supply are bioethical and are founded on the principles of altruism and utilitarianism. In the field of organ transplantation, role of altruism and medical ethics values are significant to the welfare of the society. This article reviewsseveral fundamental ethical principles, prevailing organ donation consent laws, incentives and policies related to the field of transplantation. The Ethical and Policy Considerations in Organ Donation after Circulatory Determination of Death outline criteria for death and organ retrieval. Presumed consent laws prevalent mostly in European countries maintain that the default choice of an individual would be to donate organs unless opted otherwise. Explicit consent laws require organ donation to be proactively affirmed with state registries. The Declaration of Istanbul outlines principles against organ trafficking and transplant tourism. World Health Organization's Guiding Principles on Human Cell, Tissue and Organ Transplantation aim at ensuring transparency in organ procurement and allocation. The ethics of financial incentives and non-financial incentives such as incorporation of non-medical criteria in organ priority allocation have also been reviewed in detail.
引文
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2 Stanford Encyclopedia of Philosophy.Auguste Comte.Available from:URL:http://plato.stanford.edu/entries/comte/
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2 Stanford Encyclopedia of Philosophy.Auguste Comte.Available from:URL:http://plato.stanford.edu/entries/comte/
3 Stanford Encyclopedia of Philosophy.The History of Utilitarianism.Available from:URL:http://plato.stanford.edu/archives/sum2009/entries/utilitarianism-history/
4 Moll J,Krueger F,Zahn R,Pardini M,de Oliveira-Souza R,Grafman J.Human fronto-mesolimbic networks guide decisions about charitable donation.Proc Natl Acad Sci USA 2006;103:15623-15628[PMID:17030808]
5 Stanford Encyclopedia of Philosophy.Egoism.Available from:URL:http://plato.stanford.edu/archives/win2010/entries/egoism/
6 Rhodes R,Schiano T.Transplant tourism in China:a tale of two transplants.Am J Bioeth 2010;10:3-11[PMID:20131159 DOI:10 .1080/15265160903558781]
7 Eghtesad B,Jain AB,Fung JJ.Living donor liver transplantation:ethics and safety.Transplant Proc 2003;35:51-52[PMID:12591303 DOI:10.1016/S0041-1345(02)03995-7]
8 Starzl TE,Marchioro TL,Porter KA,Brettschneider L.Homotransplantation of the liver.Transplantation 1967;5:Suppl:790 -uppl:803[PMID:4963511]
9 Ciria R,Briceno J,Rufian S,Luque A,Lopez-Cillero P.Donation after cardiac death:where,when,and how?Transplant Proc 2012;44 :1470-1474[PMID:22841187 DOI:10.1016/j.transproceed.2012.05.003]
10 Domínguez-Gil B,Delmonico FL,Shaheen FA,Matesanz R,O’Connor K,Minina M,Muller E,Young K,Manyalich M,Chapman J,Kirste G,Al-Mousawi M,Coene L,García VD,Gautier S,Hasegawa T,Jha V,Kwek TK,Chen ZK,Loty B,Costa AN,Nathan HM,Ploeg R,Reznik O,Rosendale JD,Tibell A,Tsoulfas G,Vathsala A,No?l L.The critical pathway for deceased donation:reportable uniformity in the approach to deceased donation.Transpl Int 2011;24:373-378[PMID:21392129 DOI:10.1111/j.1432-2277.2011.01243.x]
11 Gries CJ,White DB,Truog RD,Dubois J,Cosio CC,Dhanani S,Chan KM,Corris P,Dark J,Fulda G,Glazier AK,Higgins R,Love R,Mason DP,Nakagawa TA,Shapiro R,Shemie S,Tracy MF,Travaline JM,Valapour M,West L,Zaas D,Halpern SD.An official American Thoracic Society/International Society for Heart and Lung Transplantation/Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement:ethical and policy considerations in organ donation after circulatory determination of death.Am J Respir Crit Care Med 2013;188:103-109[PMID:23815722 DOI:10.1164/rccm.201304-0714ST]
12 World Health Organization.WHO guiding principles on human cell,tissue and organ transplantation.Transplantation 2010;90:229 -233[PMID:20664493 DOI:10.1097/TP.0b013e3181ec29f0]
13 Saunders B.Normative consent and opt-out organ donation.J Med Ethics 2010;36:84-87[PMID:20133401 DOI:10.1136/jme.2009.033423]
14 Simmons AJ.Moral principles and political obligations.Princeton:Princeton University Press,1979
15 Estlund D.Democratic authority:a philosophical framework.Princeton:Princeton University Press,2009
16 Gill MB.Presumed consent,autonomy,and organ donation.J Med Philos 2004;29:37-59[PMID:15449812 DOI:10.1076/jmep.29.1.37]
17 Council of Europe.International figures on donation and transplantation-2012.Available from:URL:http://www.transplantobservatory.org/Documents/NEWSLETTER2012.pdf
18 Matesanz R,Miranda B.A decade of continuous improvement in cadaveric organ donation:the Spanish model.J Nephrol 2002;15:22 -28[PMID:11936422]
19 Matesanz R.Spain:a leader in harvesting hearts for transplantation.Circulation 2007;115:f45-f46[PMID:17378021]
20 Matesanz R.Factors influencing the adaptation of the Spanish Model of organ donation.Transpl Int 2003;16:736-741[PMID:12844215 DOI:10.1007/s00147-003-0623-1]
21 Rodríguez-Arias D,Wright L,Paredes D.Success factors and ethical challenges of the Spanish Model of organ donation.Lancet 2010;376:1109-1112[PMID:20870101 DOI:10.1016/S0140-6736(10)61342-6]
22 Rosenblum AM,Horvat LD,Siminoff LA,Prakash V,Beitel J,Garg AX.The authority of next-of-kin in explicit and presumed consent systems for deceased organ donation:an analysis of 54nations.Nephrol Dial Transplant 2012;27:2533-2546[PMID:22121233 DOI:10.1093/ndt/gfr619]
23 Maraví-Poma E,Martín A,Maraví-Aznar A,Iturralde O,Compains E,Alvarez J,Cabal S,Maraví-Aznar E,Teijeira R,UnzuéJ,González R.[Transplant coordination and logistics of intra and extra-hospital cadaver donor tissue.“The Pamplona Model”.Sequence of tasks performed from 1992-2006].An Sist Sanit Navar 2006;29 Suppl 2:45-62[PMID:16998515 DOI:10.4321/S1137-66272006000400006]
24 Matesanz R.Transplants,money,and other miserable things.Nefrologia 2001;21:435-436[PMID:11795010]
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