日本器官移植法之研究

日本自1968年的第一件腦死移植事件(和田移植)開始，引發密室醫療的爭議，並掀起社會大眾對於移植醫療的關注。但此時並未有任何法源根據將腦死移植視為合法，時至1979年日本才制訂角膜及腎臟移植法，但對於心臟、肝臟、肺臟等等器官的移植法令卻遲遲未決。但是由於1997年10月16日日本器官移植法之施行，包括腎臟及角膜移植在內，由腦死病患身上取得的心臟、肺臟、肝臟、腎臟等等器官終於可以合法的進行移植。並且在其施行細則中明定-施行三年後，將會加以提出修正。雖然已經有很多修正案地提出，但九年後的現在卻仍未加以修訂，因而引發不小爭議。日本與台灣雖然都以各自訂定器官移植法，但彼此對腦死基準的判定及施行狀況皆不盡相同。本論文構成之動機在於希望藉由研究中日雙方的器官移植法律，深入探討日本與台灣的器官移植制度，以其喚醒大眾對於移植醫療的關注與尊重之目的。在現代醫療科技不斷進步的過程之中，會產生很多前所未有的醫療法律問題。如何在尊重人權的社會中，找到醫療與法律的相互平衡點極為重要，需要有大眾適當的關切。器官移植涉及的範圍十分廣泛，遍及生命倫理、法律及宗教意識等，本文以探討日本器官移植法為出發點，探討器官移植法律與移植醫療間的相互關係，並針對日本與台灣器官移植與腦死現狀加以比較及研究。日本器官移植及腦死的推進不論在立法或施行方面皆遭遇種種困難及障璧。其中之一即為日本第一例移植事件(和田移植)給予社會對於醫療體系產生不信任感。由於是日本首例的心臟移植，國民皆對此抱以期待及厚望，可想而知事件爆發之後帶給日本國民多大的衝擊。此事件也使得醫學界內部整合問題浮上檯面，事隔多年之後，是否已經加以改善仍然令人存疑。其次，在器官提供的意思表示方面，也存在著重大的障璧。腦死標準的確立一方面是與法律是否構成剝奪生命犯罪有著密切的聯繫，又與醫療現場賦予新生命直接相關，實在是一個法律上、醫學上的大問題。日本採取「移植條件必須本人生前書面表示同意接受移植及腦死判定，死後家屬並未反對的情況下始可進行移植」的雙重規定，使得日本器官移植的推進受到重重阻礙。因此，即使本人同意接受器官移植，如果無法得到家屬的諒解及同意，仍舊無法進行移植。以結論上來說，日本在器官移植立法方面，採取一種互相調和的方式：在維持一般心臟死亡的基礎上，允許患者自行選擇腦死。因此筆者認為，將與台灣有著相近的地緣關係、法律模式的日本器官移植立法情況加以研究，且與台灣人體器官移植條例互相比較參照，取優截劣，並將許多問題點整理檢討，提出適當解決方案，以期創造移植醫療嶄新的里程碑，替人類謀求最大之福利，此乃為本論文最終宗旨之所在。

關鍵字

器官移植；日本

並列摘要

The "Organ Transplant Law" took effect on October 16, 1997 and legalized transplanting organs from brain dead donors in Japan. Approximately 30 years after the world's first heart transplant in South Africa, and over a decade after the establishment of United Network Organ Sharing (UNOS), "organ transplanting from brain dead donors" was finally made possible-something that had already been recognized as normal procedure in other advanced countries. It has been said that organ transplanting would not come to fruition in Japan because of the unique views of the Japanese people toward life, death, ethics and religion. Ever since the Wada heart transplant in 1968, there has been a deep-rooted sense of apprehension toward brain death and transplanting. Now, as light flickers at the end of the tunnel, it is time to reconsider the issues facing organ transplantation in Japan and to discuss the steps that need to be taken. There are a number of body parts that deteriorate through every day life or cease to function because of accidents or disease. Since long ago, various methods have existed for repair or replacement of these deteriorated or lost functions. Glasses and false teeth are common methods that use man made objects. Tissue transplants have been performed using human skin and corneas. Recently, technological advances in artificial kidneys have served to prolong the lives of renal failure patients, but they cannot completely replace renal functions. It is difficult to replace organs such as the kidney, heart or liver with mechanical devices because of their very complicated functions. As such, deterioration of these organs eventually results in death. Organ transplant is a course of treatment aimed at saving the life of a patient for whom drugs and mechanical devices have only a limited effect, and the only alternative is to replace the damaged organ with a healthy one. As the number of transplants and potential recipients increase, organ transplanting is no longer merely a health care issue. Organ transplanting is gradually becoming a social issue as well, because it involves more than the doctor-patient relationship; it requires the good will of a third party for an organ donation.

並列關鍵字

Organ Transplant ； Law ； Japan

參考文獻

．嚴久元「腎臟及其他器官移植的倫理與法理問題」「當代醫學」第四卷

．李聖隆「器官移植條例及相關之醫事法律」「健康世界」第四十一期民78年

・Rothman, David J.　1991　Strangers at the Bedside: A History of How Law and Bioehtics Transformed　Basic Books、酒井忠昭監訳、『医療倫理の夜明け──臓器移植・延命治療・死ぬ権利をめぐって』、昌文社、1999年

期刊(日文)