心死後器官捐贈之倫理與法律議題— 開啟對話重建社會信任

Ethical and Legal Deliberation on Organ Donation after Circulatory Death in Taiwan— Open the Dialogues and Repair the Social Trust

黃馨葆(Sin-Bao Huang)

指導教授 ： 蔡甫昌

國立臺灣大學/醫學院/醫學教育暨生醫倫理研究所/碩士(2016年)

https://doi.org/10.6342/NTU201602624

摘要

歷史上，器官捐贈移植的發展是從心死後捐贈，其後才有腦死後捐贈，近年來因各國器官供給與需求差距日益擴大，許多國家已經重啟心死後捐贈流程。心死後捐贈在2014年之台北市長選舉中成為焦點，然而，許多對心死後捐贈的批評並非為了理性討論與相互對話，也可能傷害社會大眾對器官移植的信任。本文的目標在於開啟理性對話，以重建社會信任。
本論文之內容在於：
第一、釐清何謂心死後捐贈。從歷史、供需、各國制度的角度看探討台灣施行心死後捐贈的必要性。
第二、從社會對話的角度，討論如何落實民眾之器官捐贈意願徵詢與註記。
第三、從病人自主的角度，建議應該增加器官捐贈意願之選項徵詢，例如是否接受心死後捐贈、願意捐贈的器官種類、是否接受改善器官品質之死亡前介入措施。
第四、探討心死後捐贈曾有過的倫理爭議，包括死亡判定、利益衝突的迴避、死亡前及死亡後介入措施。
第五、探討心死後捐贈是否如何符合台灣現行法律，並比較英、美法律對死亡之定義，以釐清概念。
最後，本文認為心死後捐贈需完善之法規與倫理規範，現在的台灣，已經具備這樣的可能性。然而，在執行上應循序漸進，確保器官捐贈能更公開透明，在尊重病人自主的前提下，用更多的對話重建社會信任。

關鍵字

器官捐贈 ； 心死後捐贈 ； 腦死後捐贈 ； 倫理 ； 法律 ； 人體器官移植條例

並列摘要

Historically, the development of organ donation began with donation after circulatory death (DCD), followed by donation after brain death (DBD). Many countries reestablished DCD protocol due to the increasing gap between vital organs demand and supply in recent years. DCD became a focus of debates in the 2014 Taipei City mayor election. However, many criticisms of DCD were not intended for rational discussion and dialogue and have hurt the trust for organ donation in the society. The goals of this thesis are to invite a rational dialogue and repair the damaged social trust.
The thesis emphasizes the following:
First, to clarify the definition and content of DCD. The necessity to apply DCD in Taiwan was explored, considering history, supply and demand, and global trends.
Second, to facilitate mutual dialogue in the society, the methods to implement inquiry and registry of the willingness for organ donation in the general public were discussed.
Third, to fulfill the principle of respect for autonomy, additional options in the organ donation registration form were suggested. For example, would the patient accept death determination based on circulatory death criteria, kinds of organ the patient wish to donate, and would the patient accept interventions intended to improve organ quality in end-of-life care.
Fourth, to explore the ethical issues arising from DCD, including the determination of death, how to avoid conflict of interests, and antemortem and postmortem interventions.
Fifth, to explore if the practice of DCD is legal under current Taiwanese laws. Relevant U.K. and U.S.A. laws were compared to clarify the concepts.
Finally, I argue that the implementation of DCD needs comprehensive laws and ethical norms, and Taiwanese society already possesses such potential for the introduction and practice of DCD now. We should make sure, however, that DCD be established on an open and transparent basis and performed in a stepwise and orderly way. Under the premise of respect for autonomy, further mutual dialogue is needed to rebuild social trust.

並列關鍵字

organ donation ； donation after circulatory death ； donation after brain death ； ethics ； law ； Human Organ Transplant Act

參考文獻

63. 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, 185:257-270.

1. Ko WJ, Chen YS, Tsai PR, Lee PH: Extracorporeal membrane oxygenation support of donor abdominal organs in non-heart-beating donors. Clin Transplant 2000, 14(2):152-156.

2. Chen YY, Ko WJ: Further deliberating burying the dead donor rule in donation after circulatory death. The American journal of bioethics : AJOB 2011, 11(8):58-59.

3. Bernat JL: Life or death for the dead-donor rule? The New England journal of medicine 2013, 369(14):1289-1291.

4. Veatch RM: The dead donor rule: true by definition. The American journal of bioethics : AJOB 2003, 3(1):10-11.