Title

循環停止死亡後器官捐贈之倫理與法律議題

Translated Titles

The Ethical Legal Issues in Organ Donation after Circulatory Death

DOI

10.6320/FJM.201907_23(4).0001

Authors

黃馨葆(Sin-Bao Huang);蔡甫昌(Daniel Fu-Chang Tsai)

Key Words

循環停止死亡後器官捐贈 ; 心臟死器官移植 ; 無心跳器官捐贈 ; DCD ; donation after circulatory death ; donation after cardiac death ; non-heart beating donation ; NHBD

PublicationName

台灣醫學

Volume or Term/Year and Month of Publication

23卷4期(2019 / 07 / 25)

Page #

413 - 424

Content Language

繁體中文

Chinese Abstract

本文探討循環停止死亡後器官捐贈(organ donation after circulatory death,DCD)所涉醫學倫理與法律問題,首先介紹DCD之定義與發展歷史、概覽國內外死亡判定之法規政策、探討臨床實務之倫理考量及溝通,最後對我國指引之現狀提出反省與展望。作者指出DCD是當代屍體器官捐贈(cadaveric organ donation)越來越重要之來源及先進國家發展趨勢,我國在2017年建立國家政策之後應盡力宣導推廣以幫助更多有捐贈意願之國民,能於身後實踐大愛器捐胸懷以嘉惠龐大等候器官移植之病人。

English Abstract

This paper explores the ethical-legal issues concerning organ donation after circulatory death (DCD). The definition and history of DCD, the laws and policies for determination of death, and the ethical legal consideration and communication in DCD clinical practice are introduced and explored. Reflection on the current Taiwanese DCD guidelines and suggestion for future DCD practice are proposed. The authors argue that DCD plays an increasingly important role in the cadaveric organ donation, which is also a contemporary international trend. After Taiwan has established the National guideline and policy of DCD, continuous efforts for promoting DCD should be made so as to realize and respect the wishes for organ donation of our citizens, as well as to bring tremendous health welfare to the patients on the endless organ transplantation waiting list.

Topic Category 醫藥衛生 > 醫藥衛生綜合
Reference
  1. 1. Manara AR, Murphy PG, O'Callaghan G: Donation after circulatory death. Br J Anaesth 2012;108(S1):i108-21.
    連結:
  2. 2. Thuong M, Ruiz A, Evrard P, et al: New classification of donation after circulatory death donors definitions and terminology. Transpl Int 2016;29:749-59.
    連結:
  3. 5. Jericho BG: Organ donation after circulatory death: ethical issues and international practices. Anesth Analg 2019;128:280-5.
    連結:
  4. 9. Boucek MM, Mashburn C, Dunn SM, et al: Pediatric heart transplantation after declaration of cardiocirculatory death. N Engl J Med 2008;359:709-14.
    連結:
  5. 10. Gries CJ, White DB, Truog RD, et al: 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;188:103-9.
    連結:
  6. 11. Committee on Bioethics, American Academy of Pediatrics: ethical controversies in organ donation after circulatory death. Pediatrics 2013;131:1021-26.
    連結:
  7. 13. Wind J, Faut M, van Smaalen TC, et al: Variability in protocols on donation after circulatory death in Europe. Crit Care 2013;17:R217.
    連結:
  8. 14. Oniscu GC, Randle LV, Muiesan P, et al: In situ normothermic regional perfusion for controlled donation after circulatory death--the United Kingdom experience. Am J Transplant 2014; 14:2846-54.
    連結:
  9. 15. Miñambres E, Suberviola B, Dominguez-Gil B, et al: Improving the outcomes of organs obtained from controlled donation after circulatory death donors using abdominal normothermic regional perfusion. Am J Transplant 2017;17:2165-72.
    連結:
  10. 16. Shapey IM, Muiesan P: Regional perfusion by extracorporeal membrane oxygenation of abdominal organs from donors after circulatory death: a systematic review. Liver Transpl 2013;19:1292-303.
    連結:
  11. 17. Watson CJE, Hunt F, Messer S, et al: In situ normothermic perfusion of livers in controlled circulatory death donation may prevent ischemic cholangiopathy and improve graft survival. Am J Transplant 2019;19:1745-58.
    連結:
  12. 18. Dalle Ave AL, Shaw DM, Bernat JL: Ethical issues in the use of extracorporeal membrane oxygenation in controlled donation after circulatory determination of death. Am J Transplant 2016;16:2293-9.
    連結:
  13. 19. Bernat JL: The boundaries of organ donation after circulatory death. N Engl J Med 2008; 359:669-71.
    連結:
  14. 20. Ko WJ, Chen YS, Tsai PR, et al: Extracorporeal membrane oxygenation support of donor abdominal organs in non-heart-beating donors. Clin Transplant 2000;14:152-6.
    連結:
  15. 21. Ko WJ, Chen YS, Chen RJ, et al: Non-heart-beating donors under extracorporeal membrane oxygenation support. Transplant Proc 2002;34:2600-1.
    連結:
  16. 22. Hessheimer AJ, Domínguez-Gil B, Fondevila C, et al: Controlled donation after circulatory determination of death in Spain. Am J Transplant 2016;16:2239-40.
    連結:
  17. 23. Fondevila C, Hessheimer AJ, Ruiz A, et al: Liver transplant using donors after unexpected cardiac death: novel preservation protocol and acceptance criteria. Am J Transplant 2007;7: 1849-55.
    連結:
  18. 24. Barrou B, Billault C, Nicolas-Robin A: The use of extracorporeal membranous oxygenation in donors after cardiac death. Curr Opin Organ Transplant 2013; 18:148-53.
    連結:
  19. 25. Chen KH, Tsai MK, Ko WJ, et al: Renal transplantation from non-heart-beating donors with extracorporeal membrane oxygenation: preliminary results. Transplant Proc 2000;32: 1743-4.
    連結:
  20. 27. Ridley S, Bonner S, Bray K, et al: UK guidance for non-heart-beating donation. Br J Anaesth 2005;95:592-5.
    連結:
  21. 28. Domínguez-Gil B, Duranteau J, Mateos A, et al: Uncontrolled donation after circulatory death: European practices and recommendations for the development and optimization of an effective programme. Transpl Int 2016;29: 842-59.
    連結:
  22. 29. Miñambres E, Rubio JJ, Coll E, et al: Donation after circulatory death and its expansion in Spain. Curr Opin Organ Transplant 2018;23: 120-9.
    連結:
  23. 3. 王皇玉:刑法上死亡之認定評最高法院九十五年度台上字第一六九二號判決。月旦法學雜誌 2010;185:257-70。
  24. 4. Academy of Medical Royal Colleges: A code of practice for the diagnosis and confirmation of death.2008. https://www.aomrc.org.uk/reports- guidance/ukdec-reports-and-guidance/code-practice-diagnosis-confirmation-death/ Accessed July 3, 2019.
  25. 6. National Health and Medical Research Council (NHMRC): National Protocol for Donation after Cardiac Death.2010. https://donatelife. gov.au/sites/default/files/DCD%20protocol%20020311-0e4e2c3d-2ef5-4dff-b7ef-af63d0bf6a8a-1.PDF Accessed July 3, 2019.
  26. 7. Shemie SD, Baker AJ, Knoll G, et al: National recommendations for donation after cardiocirculatory death in Canada: donation after cardiocirculatory death in Canada. CMAJ 2006;175:S1.
  27. 8. UK Donation Ethics Committee: An Ethical Framework for Controlled Donation after Circulatory Death – Consultation.2011. https:// www.aomrc.rg.uk/reports-guidance/ ukdec-reports-and-guidance/ethical-framework-controlled-donation-circulatory-death-full-report/ Accessed July 3, 2019.
  28. 12. Institute of Medicine: Non-Heart-Beating Organ Transplantation: Practice and Protocols. Washington DC, The National Academies Press, 2000.
  29. 26. Institute of Medicine: Non-Heart-Beating Organ Transplantation: Medical and Ethical Issues in Procurement. Washington DC, The National Academies Press, 1997.