台灣基層透析協會: 回應李伯璋院長對洗腎治療之誤解

[jihonc]

回應李伯璋院長對洗腎治療之誤解
#李伯璋 #腎臟移植 #腎移植 #非親屬器捐 #TCDA台灣基層透析協會

關於器官捐贈移植登錄中心董事長、部立台南醫院院長李伯璋日前(2014-1-17)於自由電子報報導關於腎臟移植放寬非親屬器捐一文中所提及台灣洗腎現況，以及器官捐贈風氣，其中有些誤解，在此要代表日夜兢兢業業照顧台灣尿毒患者的腎臟科基層醫師們予以澄清和說明。

李院長說到相對於腎臟移植更危險的肝臟移植，在台灣做的活體肝移植數量高於腎移植，是因為洗腎利益大，所以醫師很少建議。這種說法與事實不符，而且汙名化國內照顧腎衰竭患者所有相關醫療人員。主要原因不是因為洗腎利益高，而是因為腎衰竭後，還有透析治療可以選擇。不像肝衰竭後，只剩換肝一途（註：洗肝只是短時間維持生命）。因此，腎衰竭患者相較於肝衰竭患者，多了一項透析治療可選（不論是血液透析，或是腹膜透析），這是全世界醫療發達國家腎衰竭患者皆可選擇的治療項目，和沒有透析治療可當退路的肝衰竭患者，唯一的治療是肝移稙，是不能相提並論的。

另外，在台灣，開刀治療的風氣原本就比歐美國家來得低，我們可以粗略的比較，從我們國家元首和美國國家元首罹患冠狀動脈疾病後，如何選擇治療自己，得到一些訊息，我們的元首是裝了好幾個心臟支架，而美國元首則選擇了冠狀動脈繞道手術。

身為一位台灣的腎臟科醫師，患者在進入透析時，健保署就規定一定的說明流程，讓腎衰竭的患者了解有三種腎臟替代療法：腎移植，血液透析和腹膜透析。所以我們必須善盡說明的義務，平時查房看診時，若遇到合適的患者，年輕，沒有肝炎，和家庭支持力較好者，我們一定會鼓勵換腎治療。

台灣因為人口老化，糖尿病患者增多，尿毒症患者也持續增加，一直是健保的沈重負擔。腎臟移植，特別是活體腎臟捐贈是解決這個問題很有效的方法，要達到這個目標，還需要腎臟科和移植外科醫師共同來努力。

#鄭集鴻 醫師 #台灣基層透析協會 理事長 2014.1.18

[jihonc]

自由電子報 - 腎臟移植 李伯璋 放寬非親屬器捐 http://www.libertytimes.com.tw/2014/new ... -life6.htm …

[梅花鹿]

[李誠民]

主旨：
活體移植(Living donor transplant)

內容：
又是一個台灣的世界第一的笑話!!!..... 談到非親屬移植,就是活體移植(Living organ transplant),還規定限制在五親等,可以需要器官移植的受贈者間互換,就是Paired donor(我不知如何翻譯?!); 但是活體移植就避免不掉買賣的行為發生(法律是無法 律定的);...很簡單的道理,有需求(器官需求永遠大於捐贈者); 所以事實上是買賣行為,確解是為發揮"大愛",請問法律如何規範?!....."病人送錢感謝捐贈者 干醫事人員啥事啊"......???受刑者捐贈器官,中國大陸的衛生部副部長,在2009 年就在有名醫學雜誌上,公開聲明了!!!......台灣出了國際笑話,就是不如中國大陸的醫學倫理(或法律)笑話!!!!.....待續!!!Doctor testifies to China's reuse of prisoners' organs BMJ2001;323doi: 10.1136/bmj.323.7304.69/a(Published 14 July 2001) Cite this as:BMJ2001;323:69.2 Organ Transplantation and Regulation in China--Doctors Against Forced Organ Harvesting, Washington, DC (Dr Trey) (torsten.trey@dafoh.org); Department of Psychiatry, New York Medical College, New York, New York (Dr Halpern); and Department of Medicine, Sydney Medical School, Sydney, Australia (Dr Singh). JAMA:2011(17)_1864 China starts to move away from using organs from executed prisoners for transplantations BMJ2009;339doi: 10.1136/bmj.b3567(Published 2 September 2009) Cite this as:BMJ2009;339:bmj.b3567 ---‧ Article 范上達 香港結核病 胸腔與心臟學會主席 Faculty:medicine liver transplant ‧ Related content ‧ Article metrics 黃潔夫 衛生部副部長 1. Jane Parry--回覆後,再討論!!!
李伯璋教授曾經邀約, 討論器官移植問題, 個人覺得理念相差太遠, 所以挽拒了!!!......

[jihonc]

自由電子報 - 回應李伯璋院長對洗腎治療之誤解 http://www.libertytimes.com.tw/2014/new ... day-o5.htm

[李誠民]

於您的提問 【活體移植(Living donor transplant)】回復如下：


李先生您好：
所傳郵件，業已收悉。
有關本部研擬修訂活體器官捐贈移植之規定，請台端參閱本部網站(http://www.mohw.gov.tw/CHT/Ministry/Index.aspx/焦點新聞)「人體器官移植條例部分條文修正草案，將改善腎臟移植等待窘境，並對仲介器官者或違反無償捐贈者課以刑責」1月16日之新聞稿。至於中國大陸器官移植制度之諸多問題，已有多位大陸人士、醫師、受害家屬或駐大陸記者出書揭露或在美國國會、歐洲議會聽證會作證，確不可效尤。.....您看得懂嗎?!....有關加拿大醫師接露法輪功死刑犯捐贈腎臟, 文獻多在2009年前;....之後,也沒有國際媒體報導!!!

簡單請教衛福部有活體買移植, 就有買賣行為, 如何區分是發揮"大愛 ", 還是"買賣行為"?

[李誠民]

所傳郵件，業已收悉。
一、有關本部網站(http://www.mohw.gov.tw/CHT/Ministry/ Index.aspx/焦點新聞)「人體器官移植條例部分條文修正草案，將改善腎臟移植等待窘境，並對仲介器官者或違反無償捐贈者課以刑責」之新聞稿，請台端點選右下方MORE/103年衛生福利部新聞/ 1月新聞 /2014/01/16)後參閱。
二、查人體器官移植條例(以下簡稱本條例)第12條「提供移植之器官，應以無償捐贈方式為之。」，器官捐贈應符合本條例第6條及第7條規定，以無償、自主及自願之大愛原則，如涉及壓力及任何金錢或對價之交易行為，即屬買賣行為，應依本條例第16條規定得處新臺幣九萬元以上四十五萬元以下之罰鍰。
三、至於所述「美國有許多人上網捐贈腎,NEJM去年就有文章討論…」，本次人體器官移植條例部分條文修正草案，業將活體腎臟配對移植納入，將透過已建置之器官捐贈移植登錄系統辦理之。......

有活體移植, 就免不掉買賣行為發生,我問的是上Facebook公開捐贈,等到買主,再去登錄中心登錄, 請問如何證明是發揮"大愛"?還是"買賣"?!.......這可是刑法問題!!!

[lotus425]

還卡債， 代繳銀行房貸 就不算器官買賣了。
沒金錢贈予，誰也查不出，心甘情悅的器官捐贈

[李誠民]

英國BMJ因為腎臟買賣行為太多, 在Twitter成立網站公開討論;; 有各式各樣的理由捐腎(買賣腎?!),其中有醫學學生因學貸負擔不起,公開賣腎!!!.......造成英國有史以來的全國性醫師大罷工(2012年底)!!!................

[李誠民]

"還卡債， 代繳銀行房貸 就不算器官買賣了。"? (咦)
那也要賣了腎才行(有錢還銀行!)

北京有17歲(未成年)為了買iPad賣掉一個腎!!!中國大陸還找不到法條(南京金陵大學法學院長口述!!!).....台灣只要判刑或吊銷醫師執照,就可以解決了(?是解決問題的辦法嗎?!).........

[李誠民]

The high cost of organ transplant commercialism
Gabriel M Danovitch1
1David Geffen School of Medicine at UCLA, Kidney Transplant Program, Los Angeles, California, USA
Correspondence: Gabriel M. Danovitch, John J. Kuiper Chair of Nephrology and Renal Transplantation, David Geffen School of Medicine at UCLA, Kidney Transplant Program, 7-155 Factor Building, 10833 Le Conte Boulevard, Los Angeles, California, 90095-1689, USA. E-mail: gdanovitch@mednet.ucla.edu
這是今年二月Kid.Int.的文章;活體 器官移植就會有買賣行為, 如果像李理事長對台灣開放活體移植(腎 肝 胰 肺等器官移植; 或細胞移植--幹細胞, 骨髓移植)還是傳統醫師倫理觀念, 只會讓活體移植更複雜, 對實質活體的推動只是反效果---法不合宜, 醫師倫理錯亂!!!......

The Madrid resolution on organ donation and transplantation: national responsibility in meeting the needs of patients, guided by the WHO principles. Transplantation 2011; 91: S29.
這是2011年WHO針對伊斯坦堡宣言所做出的移植原則(Principles of organ donation&Transplanttion)....

A Welcomed New National Policy in China
Delmonico, Francis L.
Author Information
The author declares no funding or conflicts of interest.
The Transplantation Society International Headquarters, Montreal, Quebec, Canada.
Address correspondence to: Francis L. Delmonico, M.D., The Transplantation Society International Headquarters, 1255 University Street, Suite 605, Montreal, Quebec, Canada H3B 3V9.
E-mail: Francis_Delmonico@neob.org
這是中國大陸衛生部副部長對2009年的死刑犯移植(主要加拿大醫師支持法輪功的死刑犯移植); 在今年所做出的決定(死刑犯不會廢止,但對死刑犯器官移植將停止, ....對基本人權的回應!!!); 登載在Transplantation(移植的主要醫學雜誌!!!)

所以李理事長的發言極為不當, 也對WHO 與伊斯坦堡宣言的不理解?!---可以嗎?....台灣器官移植還要放寬成活體移植,---怎麼推動?!實在是制定極為不適當(對世界潮流或醫師倫理)的衛福部制訂法條!!!.....還有旅遊醫學的倫理不瞭解(器官移植或代孕 孕母!!!)

[李誠民]

李先生您好：

所傳郵件，業已收悉。

腎臟移植者眾，其權益亦應尊重，活體移植亦為各國接受之方式，而本次「人體器官移植條例部分條文修正草案」業經行政院院會通過函請立法院審議，將於立法院依三讀審議程序進行之。

感謝您的來信，祝您健康、快樂!
衛生福利部 敬復

然後呢?!--判刑, 罰款, ...撤銷醫師執照!!!.....實質上有意義嗎?!

要談活體移植,就避免不了買賣行為,如何界定是"大愛"還是商業行為?!.....這是公共議題, 在台灣就將經立法院三讀審議通過; 這種法有甚麼意義!!!!.......

[李誠民]

Transplant Tourism in the United States: A Single-Center Experience

: Transplant “tourism” typically refers to the practice of traveling outside the country of residence to obtain organ transplantation. This study describes the characteristics and outcomes of 33 kidney transplant recipients who traveled abroad for transplant and returned to University of California, Los Angeles (UCLA) for follow-up. 這是UCLA單一醫學中心報告....---CJASN November 2008 vol. 3 no. 6 1820-1828(在2009年發表, 是在中國大陸衛生部副部長,正式宣告大陸拒絕旅行器官移植-Transplanplant organ donor後.....)

transplantation in China (44%), Iran (16%), and the Philippines (13%). Living unrelated transplants were most common
Conclusions: Tourists had a more complex posttransplantation course with a higher incidence of acute rejection and severe infectious complications.
要談旅遊換腎, 就必須追朔至1960年代末,土耳其至印度換腎----但感染瘧疾, 原蟲病等; 到現在印度的MRS(Methallin Resistance Stap.--超級細菌)的問題,......

要開放活體移植,就避免不掉買賣行為,要用法律規範, 只會使事實更糟, 更複雜!!!.....

[李誠民]

兄弟檔




李 伯 皇

李 伯 璋


生日

36.11

43.04


學歷

臺大醫學院

臺大醫學院

臨床醫學博士

美國匹茲堡大學

外科器官移植研究員

台北醫學院

美國加州大學

洛杉磯分校外科研究員

日本京都府立醫科大學

第二外科研究員


現任

台大外科教授

台大外科部主任

成大外科教授

成大外科部主任


專長

"一般外科

肝臟移植：140幾例

腎臟移植：數百例"--李伯皇醫師

"一般外科

外科重症加護

腎臟移植：6、7百例"--李伯璋醫師

.........
.........
是因為李董事長是肝臟移植專家的關係!!!
.........???
興趣

象棋、圍棋

網球、高爾夫球


個性

內斂、敦厚

熱情、好動


相處之道

兄友弟恭、哥哥引領弟弟走入外科領域；弟弟開導哥哥重視生活品質

[李誠民]

更正::
應為 " 李董事長的兄長--李伯皇醫師是肝臟移植專家(?!)"

[李誠民]

我国自愿捐献器官的公民亲属在医疗、教育等方面享受救助，而死囚虽犯了罪，但最后做了件好事，善举要得到认可。
(還是沒浪費有限的器官,...所以死球仍是可捐贈器官!!!)—— 全国政协委员、前卫生部副部长黄洁夫......摘錄自2014-3-13百度中文網

[李誠民]

請問施醫師肇榮理事::受刑犯(死刑犯)是被剝奪自由的人,所以簽署任何意願書等,都是無效的!!!--這是法律的基本精神!!!.....請教下列問題:;:

伊斯坦堡宣言[編輯]
維基百科，自由的百科全書
跳轉到： 導覽、 搜尋
伊斯坦堡宣言（英語：Declaration of Istanbul），國際醫學界對於器官移植與器官捐贈的倫理指引方針。於2008年4月30日至5日1日，由國際器官移植學會於土耳其伊斯坦堡召開的會議後，這個宣言被正式提出。這個宣言針對器官移植旅遊（Transplant Tourism），器官捐贈與商業行為等議題做出澄清與界定。在這個宣言通過之後，世界上有超過100個國家強化了他們對於器官捐贈的國內法律，反對商業化器官移植與器官移植旅遊。有買賣的行為嗎?(事實上在台灣存在,有喪葬補助--助府的 各地縣 市又有不同補助, 各宗教團體, 財團醫院....等等)

亞大舉辦「國際器官勸募政策」研討會！--- 2013-02-25
????有協辦單位嗎?

三 四 年前有亞洲大學與衛生署國民局舉辦有關移植研討會,協辦單位有台灣腎臟醫學會!!!....主持人是湖南旺旺醫院總顧問--前台大校長陳維昭醫師,'; 結果可知!!!

"李美玲副院長(衛服部副部長?)指出，移植器官短缺乏成為全球性共同關注議題。台灣需要器官做移植的病患逐年增加，如何增加器官捐贈及加提升國內的勸募，成為政府及國人共同關心的重要議題。由於信仰、民情的關係，亞洲國家器官捐贈比率遠遠落後歐美國家，使得病患無法在可預期的等候時間等到器官移植手術。因此亞洲病患大量前往中國，巴基斯坦，菲律賓等國家接受器官移植手術，卻又面臨醫療安全及器官來源不明所牽涉之道德及法律風險。--所以要放寬活體移植?!(在立院等三讀!!!這是公共議題!!!明文的道德與法律每年都在變,更人性化-Humannity).......還是政府主辦(?!.....李美玲)

死刑犯器官捐贈　醫院接收意願不高
ETtoday ＞ 社會 ＞ 社會 2012年12月22日 01:08


目前全世界只有大陸和台灣使用死囚的器捐，引發國際爭論。----???

醫界坦言，國際上確實有一紙「伊斯坦堡宣言」，禁止使用死刑犯器官，這紙宣言也讓全台灣八千名等待器官捐贈的病患，少了重生的機會...--伊斯坦堡宣言只有禁止商業化移植與旅遊移植


[/color]......十二名死囚中有四人想要捐贈器官，但沒有醫院接受。根據本刊掌握，由於國際醫學會拒絕幫死囚移植器官的醫師發表論文，導致國內大型教學醫院都拒絕器捐。目前定讞的五十名死囚中，還有十四人有意願器捐，這些想得到救贖的死囚，都會因器捐無門而心願難了。
「由於林口長庚臨時通知不接受器捐，再找其他醫院已來不及，因此雖然有死囚簽署器捐，但還是無法完成最後的心願。」............犧牲了極度缺乏的器官!!!!......「其中台中的張文蔚弟兄，最令我感傷和遺憾。他在一審被判死刑時，才受洗認耶穌是主，當時他就認罪，做了最壞的打算，決定死後將器官捐出來，以贖前愆。為了讓捐贈的器官健壯有用，他戒菸，勤練身體努力運動多年。」
「張文蔚告訴我說，如果在死後還有一點用處，願意將器官捐出來，請我做見證人。言猶在耳，但書面文件尚未準備齊全，卻無預警下即被處決，遺願也被意外剝奪，本來能救人的器官竟被糟蹋了。.....
就連去年十二月底，曾經為死刑犯陳金火執行器官捐贈摘除的中國醫藥大學附設醫院，院內也已開會決定不再接受死囚器官捐贈....--又讓所謂國際學者看到台灣奇蹟!!!......台灣移植醫學學會理事長、台大醫院外科部醫師王水深表示，雖然很感激死囚捐贈器官.........
魏崢則持不同立場，他表示，從事的四百例心臟移植中，有三例是死囚。站在救命的立場，他不會去拒絕，只要病人需要，他都會去救 ........ (咦) (咦) (咦)

[施肇榮]

請問施醫師肇榮理事::受刑犯(死刑犯)是被剝奪自由的人,所以簽署任何意願書等,都是無效的!!!--這是法律的基本精神!!!.....

1.受刑犯(死刑犯)是被剝奪<<行動>>自由的人

2.所以，簽署任何意願書等,都是無效的!?

受刑犯(死刑犯)如果合於法律程序，要處分(立遺囑)他的身後財產也會無效嗎??

預立遺囑，也是一種書面意願的意思表示

[施肇榮]

請問施醫師肇榮理事::受刑犯(死刑犯)是被剝奪自由的人,所以簽署任何意願書等,都是無效的!!!--這是法律的基本精神!!!.....請教下列問題:;:

伊斯坦堡宣言[編輯]
維基百科，自由的百科全書
跳轉到： 導覽、 搜尋
伊斯坦堡宣言（英語：Declaration of Istanbul），國際醫學界對於器官移植與器官捐贈的倫理指引方針。於2008年4月30日至5日1日，由國際器官移植學會於土耳其伊斯坦堡召開的會議後，這個宣言被正式提出。這個宣言針對器官移植旅遊（Transplant Tourism），器官捐贈與商業行為等議題做出澄清與界定。在這個宣言通過之後，世界上有超過100個國家強化了他們對於器官捐贈的國內法律，反對商業化器官移植與器官移植旅遊。有買賣的行為嗎?(事實上在台灣存在,有喪葬補助--助府的 各地縣 市又有不同補助, 各宗教團體, 財團醫院....等等)

亞大舉辦「國際器官勸募政策」研討會！--- 2013-02-25
????有協辦單位嗎?

三 四 年前有亞洲大學與衛生署國民局舉辦有關移植研討會,協辦單位有台灣腎臟醫學會!!!....主持人是湖南旺旺醫院總顧問--前台大校長陳維昭醫師,'; 結果可知!!!

"李美玲副院長(衛服部副部長?)指出，移植器官短缺乏成為全球性共同關注議題。台灣需要器官做移植的病患逐年增加，如何增加器官捐贈及加提升國內的勸募，成為政府及國人共同關心的重要議題。由於信仰、民情的關係，亞洲國家器官捐贈比率遠遠落後歐美國家，使得病患無法在可預期的等候時間等到器官移植手術。因此亞洲病患大量前往中國，巴基斯坦，菲律賓等國家接受器官移植手術，卻又面臨醫療安全及器官來源不明所牽涉之道德及法律風險。--所以要放寬活體移植?!(在立院等三讀!!!這是公共議題!!!明文的道德與法律每年都在變,更人性化-Humannity).......還是政府主辦(?!.....李美玲)

死刑犯器官捐贈　醫院接收意願不高
ETtoday ＞ 社會 ＞ 社會 2012年12月22日 01:08


目前全世界只有大陸和台灣使用死囚的器捐，引發國際爭論。----???

醫界坦言，國際上確實有一紙「伊斯坦堡宣言」，禁止使用死刑犯器官，這紙宣言也讓全台灣八千名等待器官捐贈的病患，少了重生的機會...--伊斯坦堡宣言只有禁止商業化移植與旅遊移植


[/color]......十二名死囚中有四人想要捐贈器官，但沒有醫院接受。根據本刊掌握，由於國際醫學會拒絕幫死囚移植器官的醫師發表論文，導致國內大型教學醫院都拒絕器捐。目前定讞的五十名死囚中，還有十四人有意願器捐，這些想得到救贖的死囚，都會因器捐無門而心願難了。
「由於林口長庚臨時通知不接受器捐，再找其他醫院已來不及，因此雖然有死囚簽署器捐，但還是無法完成最後的心願。」............犧牲了極度缺乏的器官!!!!......「其中台中的張文蔚弟兄，最令我感傷和遺憾。他在一審被判死刑時，才受洗認耶穌是主，當時他就認罪，做了最壞的打算，決定死後將器官捐出來，以贖前愆。為了讓捐贈的器官健壯有用，他戒菸，勤練身體努力運動多年。」
「張文蔚告訴我說，如果在死後還有一點用處，願意將器官捐出來，請我做見證人。言猶在耳，但書面文件尚未準備齊全，卻無預警下即被處決，遺願也被意外剝奪，本來能救人的器官竟被糟蹋了。.....
就連去年十二月底，曾經為死刑犯陳金火執行器官捐贈摘除的中國醫藥大學附設醫院，院內也已開會決定不再接受死囚器官捐贈....--又讓所謂國際學者看到台灣奇蹟!!!......台灣移植醫學學會理事長、台大醫院外科部醫師王水深表示，雖然很感激死囚捐贈器官.........
魏崢則持不同立場，他表示，從事的四百例心臟移植中，有三例是死囚。站在救命的立場，他不會去拒絕，只要病人需要，他都會去救 ........ (咦) (咦) (咦)

1.反對受刑犯(死刑犯)簽署的器官捐贈同意書，
是因為擔心受刑犯(死刑犯)不是在真正的自由意願下所做的決定
譬如說會下地獄，捐贈才能得救贖，或其他的因素等等...

2.事實上，國內有些醫院拒絕接受死囚器官捐贈的原因之一
是因為，為保存器官可用，死刑執行後，死囚是還未死亡(有時甚至也沒有腦死)
在這種情形下，就會發生死囚到底是<病人>還是<死人>，
醫師是在救人，還是在殺人的爭議
在醫師有替國家執行死刑而違反醫學倫理以及其他的疑慮下
醫院進而拒絕之

3.以上這些爭議，我會尊重及保留給真正的專家去處理

[李誠民]

"1.受刑犯(死刑犯)是被剝奪<<行動>>自由的人

2.所以，簽署任何意願書等,都是無效的!?

受刑犯(死刑犯)如果合於法律程序，要處分(立遺囑)他的身後財產也會無效嗎??

預立遺囑，也是一種書面意願的意思表示"

受刑犯(死刑犯)是被剝奪自由的人,您怎知是在自由意志下, 簽署的處分財產意願書?!

這就是法律人與醫師不同信仰與基本人權認知上的不同,(至少我!!! 因為這是公共議題!!!醫師(Society )有社會責任!!!.....不會因您是全聯會理事(或理事長)而改變!!!....問問您叔叔!!!....那就沒有"美麗島事件"了!!!.......

它是 每天叉鼻胃管三次,超過一年多(?照三餐!!!),.......意志堅定(?)的人?!

[施肇榮]

"1.受刑犯(死刑犯)是被剝奪<<行動>>自由的人

2.所以，簽署任何意願書等,都是無效的!?

受刑犯(死刑犯)如果合於法律程序，要處分(立遺囑)他的身後財產也會無效嗎??

預立遺囑，也是一種書面意願的意思表示"

受刑犯(死刑犯)是被剝奪自由的人,您怎知是在自由意志下, 簽署的處分財產意願書?!

這就是法律人與醫師不同信仰與基本人權認知上的不同,(至少我!!! 因為這是公共議題!!!醫師(Society )有社會責任!!!.....不會因您是全聯會理事(或理事長)而改變!!!....問問您叔叔!!!....那就沒有"美麗島事件"了!!!.......

它是 每天叉鼻胃管三次,超過一年多(?照三餐!!!),.......意志堅定(?)的人?!

如果對於受刑犯(死刑犯)是被剝奪自由的人,是否在自由意志下,

簽署的處分財產意願書有爭議時，那了不起就對簿公堂囉。

每個成年人都可以有自己的想法及不同的信仰

你總不會任何事都去問你的父母吧

[李誠民]

我也不是專家(狹隘的說; 因為我無教職, 只是個開業醫); 但您能否定我對器官移植不是專家嘛!!!....只因為我關心台灣政治(策),會影響我的病人;;..... 何況這是公共議題(不一定需要專家,因為每個人都有表達言論自由的權利!!!一個安寧緩和條例或是王貴芬事件等的立法,對醫病關係有推進嗎?! 何況活體腎移植已經三讀在立法院等著成為法!!!......可以嗎?討論空間比"反服貿"更複雜,更廣泛影響人民基本人權!!!

[李誠民]

"如果對於受刑犯(死刑犯)是被剝奪自由的人,是否在自由意志下,

簽署的處分財產意願書有爭議時，那了不起就對簿公堂囉....就像美國醫療糾紛最後變成各科的醫療成本的大多數成本!!!。

每個成年人都可以有自己的想法及不同的信仰

你總不會任何事都去問你的父母吧
......您總不會脫了褲子 放屁吧?!

我早就告訴你了,你是台北醫學大學(北醫)畢業的!!!就因為陳振文院長是我敬重的 佩服的人,請施理事代問候,也要尊重一點!!!!

(別以為理是有好大!在大野沒理事長大!!!.....鼻屎大?!)

[李誠民]

兩 三年以前,有健康電子報的主編, 在本網站問"慢性腎臟病講習班"的問題;我已經知道這個衛生署國民健 康局舉辦的講習班,; 已經是國際腎臟專家拋棄的 話題(eGFR:與腎功能的關係......?!---2008年),; 逐漸由Acute Kidney Injury(AKI)取代,因為eGFR往往低估了實際腎功能(GFR), 也無法定標準決定是否應開始替代性腎病治療(Repacement Renal Therapy,--RRT);因為知道政府的推廣腎臟病防治(?)是無 效的,也是不切合實際的; 但是沒有台灣資料!!!所以只有在腎臟科的會議(年會)不斷提出質疑(--專家?會議)..........;現在可提出世界都接受的觀念: AKI--急性腎臟傷害,對臨床醫師(GP or Family Dr.--非腎臟科醫師?)的基本腎臟功能知識!!!!

A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines on Acute Kidney Injury: Part 1: definitions, conservative management and contrast-induced nephropathy

†
The broad clinical syndrome of acute kidney injury (AKI) encompasses various aetiologies, including specific kidney diseases (e.g. acute interstitial nephritis), non-specific conditions (e.g. renal ischaemia) as well as extrarenal pathology (e.g. post-renal obstruction). AKI is a serious condition that affects kidney structure and function acutely, but also in the long term. Recent epidemiological evidence supports the notion that even mild, reversible AKI conveys the risk of persistent tissue damage, and severe AKI can be accompanied by an irreversible decline of kidney function and progression to end-stage kidney failure
1: AKI definition
1.1: Definition and classification of AKI
• 1.1.1 We recommend using a uniform definition of AKI, based on urinary output and on changes in serum creatinine (SCr) level. It is important that both criteria are taken into account. (1C)

• 1.1.2 We recommend diagnosing and indicating the severity of AKI according to the criteria in the table below: (ungraded statement)
Stage 1: one of the following:
• Serum creatinine increased 1.5–1.9 times baseline
• Serum creatinine increase >0.3mg/dl (26.5 µmol/l)
• Urinary ouotput < 0.5ml/kg/h during a 6 hour block
Stage 2: one of the following
• Serum creatinine increase 2.0–2.9 times baseline
• Urinary output <0.5ml/kg/h during two 6 hour blocks
Stage 3: one of the following:
• Serum creatinine increase >3 times baseline
• Serum creatinine increases to >4.0mg/dl (353 µmol/l)
• Initiation of renal replacement therapy
• Urinary output <0.3ml/kg/h during more than 24 hours
• Anuria for more than 12 hours

A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines on Acute Kidney Injury: part 2: renal replacement therapy

TIMING OF RENAL REPLACEMENT THERAPY IN AKI
1. Initiate RRT when life-threatening changes in fluid, electrolyte and acid–base balance exist that cannot be managed by conservative treatment. (not graded)
2. Consider the broader clinical context, the presence of conditions that can be modified with RRT, and trends of laboratory tests—rather than single blood urea nitrogen (BUN) and creatinine thresholds alone—when making the decision to start RRT. (not graded)
VASCULAR ACCESS FOR RENAL REPLACEMENT THERAPY IN AKI
1. We suggest initiating RRT in patients with AKI via an uncuffed non-tunnelled dialysis catheter, rather than a tunnelled catheter. (2D)
2. We suggest to use (in a descending order of preference) the right jugular vein, the femoral vein, the left jugular vein or the subclavian vein for insertion of a dialysis catheter in patients with AKI. (not graded)
3. We suggest using ultrasound guidance for dialysis catheter insertion. (2A)
4. We recommend obtaining a chest radiograph promptly after placement and before first use of an internal jugular or subclavian dialysis catheter. (ungraded statement)
5. We suggest not using topical antibiotics over the skin insertion site of a non-tunnelled dialysis catheter in ICU patients with AKI requiring RRT. (2C)
6. We suggest not using antibiotic locks for prevention of catheter-related infections of non-tunnelled dialysis catheters in AKI requiring RRT. (2C)
MODALITY OF RENAL REPLACEMENT THERAPY FOR PATIENTS WITH AKI
1. We recommend to use continuous and intermittent RRT as complementary therapies in AKI patients. (1A). We suggest to use the RRT modality which is most advantageous for each individual patient in each specific clinical situation. (ungraded statement)
2. We suggest using CRRT or extended low-efficient dialysis rather than high-efficient standard intermittent RRT, for haemodynamically unstable patients. (ungraded statement)
3. In this patient group, we recommend to pay special attention to the connection procedure, to start with low blood and dialysate flows, and to consider using cooler dialysate temperatures. (ungraded statement)
4. We suggest using CRRT, extended low-efficient dialysis or peritoneal dialysis, rather than intermittent RRT, for AKI patients with acute brain injury or other causes of increased intracranial pressure or generalized brain oedema. (2D)
DOSE OF RENAL REPLACEMENT THERAPY IN AKI
1. We do not recommend using Kt/V as a measure of dose of dialysis in AKI when using intermittent or extended RRT in AKI. (1A)
2. The dose of CRRT to be delivered should be prescribed before starting each session of CRRT as mL//kg/h filtration rate, dialysis volume or a combination thereof. (not graded) We suggest regular assessment of the actually delivered dose. (1B)
3. We recommend delivering an effluent volume of 20–25 mL/kg/h for post-dilution CRRT in AKI. (1A) This dose should be increased when pre-dilution is applied.
4. We recommend to adapt the administration of medication in terms of dosing and timing, to the intensity of dialysis, taking into account pharmacokinetics and dialytic clearance of the drug.
Nephrol. Dial. Transplant. (2013) 28 (12): 2940-2945. doi: 10.1093/ndt/gft297

[李誠民]

現在腎臟移植放寬到活體移植(等立法院三讀通過,就成法條!!!);....台灣活體腎移植也不是沒有?!(--親屬移植在 五等親內); 但是就沒有捐贈者與受贈者的資料(至少我找不到!!!.....李伯璋醫師也有腎移植數百例的經驗,若連他哥哥--早期就更多了?!).......為甚麼??--原因是她說的 嗎?!.......所以台灣許多公共議題--尤其是有關醫療的,都是 未有充分討論; 或是政治因素, 就倉促立法,製造更多問題!!!--如安寧緩和條例!!!或王貴芬的"醫院暴力"法條!!!........所以法多是落後國家的表徵!!!

就以日本來說::心臟死亡在器官移植就是死亡!!! 後來多年後,美國 歐盟國家 大英國協的移植Guideline 將死亡死定義為腦死或心臟死,都是死亡(要捐贈器官,發揮大愛的人會在意腦死,財是死亡嗎?!--無意義支撐心臟跳動,卻要等到法律上的死亡--腦死?!...還需.......兩個醫師見證!!!)

現在日本嘗試將腎臟捐贈者年齡放寬到70歲(目前證明捐腎者年齡大於60歲與小於60 歲者,在存活率或是腎臟存活時間無異!!!.......太累了!!!....再說吧!!!!

[李誠民]

以下是日本熊本市移植團隊, 在去年在13屆亞太移植學會發表的的文章; 也等於回答健康電子報主編的問題回應; .......

Long-Term Safety of Living Kidney Donors Aged 60 and Older


In Japan, kidney transplantation procedures are usually dependent upon live donors. As the recipient ages have been increasing, so has there been a corollary increase in the age of the live donors. Despite this being controversial, the use of older donors is becoming increasingly common…
…. Thirty-three were ≥60 years and 55 donors were <60 years. The mean follow-up term was 7 years and 4 months. Predonation, older donors had a lower estimated glomerular filtration rate (eGFR) level (77.1 ± 9.5 mL/min/1.73 m2) than younger donors (85.8 ± 14.6 mL/min/1.73 m2; P < .01), More older donors had a history of hypertension (42.4% vs 9.1%; P < .01). In both groups, eGFR levels decreased about 40% immediately after nephrectomy. Residual renal function though was stable on long-term follow-up………In older donors, there were no perioperative complications that required extended hospital stays. Graft survival over a period of 10 years was similar in both groups.
……In Japan, live kidney transplantation accounts for 85% of all kidney donations because there is a lack of cadaveric donors. As recipients' ages increase, the ages of live donors is also rising. About 40% of live donors in Japan are aged 60 and older. Even though these older donors are being accepted, there are few studies about the long-term safety of older donors. In this study, we evaluated the long-term safety of older living kidney donors and graft survival.
About 40% of the live donors in Japan are 60 years old or older. Recently, the number of older kidney donors has also been increasing in our center. The Japanese Society for Clinical Renal Transplantation recommends careful evaluation of predonation parameters for older donors, older than 70 years.
In our study, the incidents of de novo hypertension and proteinuria were not different in either group. Although the eGFR value was lower and the prevalence of hypertension was higher in older donors predonation, renal function was stable after nephrectomy
At our center though, there were no perioperative complications that required an extended hospital stay in older donors, perhaps as a result of our individualized care system.
……In a recent meta-analysis of 12 clinical studies, the 5-year patient and graft survival rate was worse for recipients of kidneys from older live donors compared with from younger donors; however, this association was less prominent over time across the studies [6]. Our study showed current intermediate-term graft survival was not different in either group.
……In conclusion, in our survey, donor age did not influence either the deterioration of renal function after nephrectomy or graft survival. If we screen carefully, donation by older people is safe. Regardless of age, careful evaluation and follow-up are important for the donor's long-term safety after donation.


RENAL OUTCOME 25 YEARS AFTER DONOR NEPHRECTOMY
The Journal of Urology
Volume 166, Issue 6, December 2001, Pages 2043–2047

The extended outcome after kidney donation has been a particular concern ever since the recognition of hyperfiltration injury. Few published reports have examined donor renal outcome after 20 years or greater. Kidney transplantation has been performed at the Cleveland Clinic Foundation since 1963, at which there is extensive experience with live donor transplantation. We assess the impact of donor nephrectomy on renal function, urinary protein excretion and development of hypertension postoperatively to examine whether renal deterioration occurs with followup after 20 years or greater
Overall, renal function is well preserved with a mean followup of 25 years after donor nephrectomy. Males had significantly higher protein and albumin excretion than females but no other clinically significant differences in renal function, blood pressure or proteinuria were noted between them or at age of donation. Proteinuria increases with marginal significance but appears to be of no clinical consequence in most patients. Patients with mild or borderline proteinuria before donation may represent a subgroup at particular risk for the development of significant proteinuria 20 years or greater after donation. The overall incidence of proteinuria in our study is in the range of previously reported values after donor nephrectomy.
In Japan, kidney transplantation procedures are usually dependent upon live donors. As the recipient ages have been increasing, so has there been a corollary increase in the age of the live donors. Despite this being controversial, the use of older donors is becoming increasingly common…
…. Thirty-three were ≥60 years and 55 donors were <60 years. The mean follow-up term was 7 years and 4 months. Predonation, older donors had a lower estimated glomerular filtration rate (eGFR) level (77.1 ± 9.5 mL/min/1.73 m2) than younger donors (85.8 ± 14.6 mL/min/1.73 m2; P < .01), More older donors had a history of hypertension (42.4% vs 9.1%; P < .01). In both groups, eGFR levels decreased about 40% immediately after nephrectomy. Residual renal function though was stable on long-term follow-up………In older donors, there were no perioperative complications that required extended hospital stays. Graft survival over a period of 10 years was similar in both groups.
……In Japan, live kidney transplantation accounts for 85% of all kidney donations because there is a lack of cadaveric donors. As recipients' ages increase, the ages of live donors is also rising. About 40% of live donors in Japan are aged 60 and older. Even though these older donors are being accepted, there are few studies about the long-term safety of older donors. In this study, we evaluated the long-term safety of older living kidney donors and graft survival.
About 40% of the live donors in Japan are 60 years old or older. Recently, the number of older kidney donors has also been increasing in our center. The Japanese Society for Clinical Renal Transplantation recommends careful evaluation of predonation parameters for older donors, older than 70 years.
In our study, the incidents of de novo hypertension and proteinuria were not different in either group. Although the eGFR value was lower and the prevalence of hypertension was higher in older donors predonation, renal function was stable after nephrectomy
At our center though, there were no perioperative complications that required an extended hospital stay in older donors, perhaps as a result of our individualized care system.
……In a recent meta-analysis of 12 clinical studies, the 5-year patient and graft survival rate was worse for recipients of kidneys from older live donors compared with from younger donors; however, this association was less prominent over time across the studies [6]. Our study showed current intermediate-term graft survival was not different in either group.
……In conclusion, in our survey, donor age did not influence either the deterioration of renal function after nephrectomy or graft survival. If we screen carefully, donation by older people is safe. Regardless of age, careful evaluation and follow-up are important for the donor's long-term safety after donation.


RENAL OUTCOME 25 YEARS AFTER DONOR NEPHRECTOMY
The Journal of Urology
Volume 166, Issue 6, December 2001, Pages 2043–2047

The extended outcome after kidney donation has been a particular concern ever since the recognition of hyperfiltration injury. Few published reports have examined donor renal outcome after 20 years or greater. Kidney transplantation has been performed at the Cleveland Clinic Foundation since 1963, at which there is extensive experience with live donor transplantation. We assess the impact of donor nephrectomy on renal function, urinary protein excretion and development of hypertension postoperatively to examine whether renal deterioration occurs with followup after 20 years or greater
Overall, renal function is well preserved with a mean followup of 25 years after donor nephrectomy. Males had significantly higher protein and albumin excretion than females but no other clinically significant differences in renal function, blood pressure or proteinuria were noted between them or at age of donation. Proteinuria increases with marginal significance but appears to be of no clinical consequence in most patients. Patients with mild or borderline proteinuria before donation may represent a subgroup at particular risk for the development of significant proteinuria 20 years or greater after donation. The overall incidence of proteinuria in our study is in the range of previously reported values after donor nephrectomy.
這是專業(腎臟科, 腎移植團隊)的 基本知識(常識);但對基層醫師(GP, Family Dr.)就不見得有需要這種知識;但邏輯思考(--安寧緩和治療條例)是相通的?!.......

[李誠民]

日本現在是談ABO incomptable的文章; (自1990年就收集腎移植的案例); .....台灣還在談組織配(型)對?!;;
如果談活體移植(會增加腎移植的機率嗎?! 不會有透過仲介禁行買賣行為嗎?!);; 如果修一個活體移植條例(法!!),將不是阻礙腎臟移植嘛!!!........僅是提一個只有在台灣會發生的事!!!--專業Guideline 就交給專業(醫界, 器官移殖專業等團體,做出決定!!!; 修法只會讓事情複雜化!!!!.....有了個安寧緩和條例, 台灣還不會學到經驗嗎?!

Patient and graft outcomes from older living kidney donors are similar to those from younger donors despite lower GFR
Kidney International (2004) 66, 1654–1661

Donor age adversely affects deceased-donor kidney transplant outcomes, but its influence on living-donor transplantation is less well characterized.
Conclusion
Older donor age does not preclude excellent results from living-donor kidney transplantation but should be appreciated as being associated with relatively lower GFR.

Accepting Kidneys from Older Living Donors: Impact on Transplant Recipient Outcomes
1. A. Young1,2,*,
2. S. J. Kim3,
3. M. R. Speechley2,
4. A. Huang4,
5. G. A. Knoll5,
6. G. V. Ramesh Prasad3,
7. D. Treleaven6,
8. M. Diamant1,2,
9. A. X. Garg1,2 and
10. for the Donor Nephrectomy Outcomes Research (DONOR) Network†
Article first published online: 14 MAR 2011
DOI: 10.1111/j.1600-6143.2011.03442.x
©2011 The Authors Journal compilation©2011 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 11, Issue 4, pages 743–750, April 2011
Abstract:
Older living kidney donors are regularly accepted. Better knowledge of recipient outcomes is needed to inform this practice. This retrospective cohort study observed kidney allograft recipients from Ontario, Canada between January 2000 and March 2008. Donors to these recipients were older living (≥60 years), younger living, or standard criteria deceased (SCD). Review of medical records and electronic healthcare data were used to perform survival analysis. Recipients received 73 older living, 1187 younger living and 1400 SCD kidneys. Recipients of older living kidneys were older than recipients of younger living kidneys. Baseline glomerular filtration rate (eGFR) of older kidneys was 13 mL/min per 1.73 m2 lower than younger kidneys. Median follow-up time was 4 years. The primary outcome of total graft loss was not significantly different between older and younger living kidney recipients [adjusted hazard ratio, HR (95%CI): 1.56 (0.98–2.49)]. This hazard ratio was not proportional and increased with time. Associations were not modified by recipient age or donor eGFR. There was no significant difference in total graft loss comparing older living to SCD kidney recipients [HR: 1.29 (0.80–2.08)]. In light of an observed trend towards potential differences beyond 4 years, uncertainty remains, and extended follow-up of this and other cohorts is warranted.
In conclusion, this study extends current understanding of the utility of older living kidney donors by observing outcomes among Ontario kidney transplant recipients in the most recent era, with better follow-up and supplementation of electronic health data with more detailed techniques for data ascertainment. Recipients of older living donor kidneys had similar 4-year total graft survival when compared to recipients of SCD deceased donor kidneys. As for outcomes when using older versus younger living donor kidneys, the difference was not statistically significant. In light of an observed trend towards potential differences beyond 4 years, uncertainty remains and extended follow-up of this and other cohorts is warranted.

Mortality among Living Kidney Donors and Comparison Populations
N Engl J Med 2010; 363:797-798

Outcome of the living kidney donor
Nephrol. Dial. Transplant. (2012) 27 (1): 41-50

Conclusions
Harmful outcomes for the living kidney donors seem limited. The living kidney donation may be considered as safe. This safety is, however, dependent on the selection criteria retained for kidney donation. In this view, the percentage of obese or proteinuric subjects eventually selected for kidney donation in the USA is somewhat questionable. Harmonization for the follow-up of the donors should also be welcome. From our point of view, the living kidney donors should be followed for HTA, proteinuria and GFR. In this view, we think that donors should benefit from repeated measured GFR for better assessment of the GFR slope. Additional studies, notably in specific donors (obese, African-American), are still needed to better comprehend the outcomes of these subjects who have given a part of their healthy body to a diseased human.


Impact of Recipient Aging on Kidney Allograft in Living Donor Transplantation


ABO-incompatible kidney transplantation

• Abstract
• Owing to the shortage of deceased donors in Japan, since 1989, we have performed ABO-incompatible kidney transplantation (ABO-IKTx) to expand the indication for living donor kidney transplantation. During the past two decades, about 2000 ABO-IKTxs were performed. Since 2001 the success rate for these kidney transplants has reached 96% for 1-year, 91% for 5-year and 83% for 9-year graft survival, similar to outcomes of ABO-compatible kidney transplantation (ABO-CKTx). This dramatic improvement in results means that ABO-IKTx has become accepted as a therapeutic alternative for end-stage renal failure. Today ABO-IKTx accounts for approximately 30% of all living donor kidney transplantations performed in Japan.
We have been making a lot of efforts to elucidate the mechanism of acute antibody-mediated rejection in ABOI-KTx in order to overcome the ABO barrier and to improve the outcome………..
3.1. Excellent long-term outcomes of ABOI-KTx in Japan
In Japan, 1878 ABO-IKTxs were performed between January 1, 1989 and December 31, 2010…….
The aging of recipients is becoming increasingly important in organ transplantation.
Conclusion
Recipient age did not affect allograft deterioration in living donor kidney transplantation, although it was an independent risk factor of recipient death.
只因台灣腎臟醫學會沒有這種Q&A; 只因本網站有Medical Student Assdociation的Logo!!!

[李誠民]

今年一月二十七日,中國大陸主席--習進平宣布打貪防腐(建立乾淨 公平的社會--For clean and fair society); 改革大陸政治與法律;.... 接著在三月25-26日的法國國事訪問提出:世界都怕大陸這頭獅子,但是這頭獅子醒了,是隻善良, 可親, 與和平的獅子!!!----台灣的領導人有這種胸襟與幽默感嗎?!

台灣法務部昨天(2014-4-30)槍決了五位死刑犯,卻沒有一個捐贈器官, 在台灣極度缺乏企 官移植的當下,白白浪費了這些資源?值得嗎?!
台灣不執行死刑犯捐贈器官, 是因為世界移植學會(TTS--The Transplant Society)反對(主要是針對大陸移值醫師, 若做死刑犯器官移植, 將不刊登其著作等學術活動!!!這是2010年的事,現在WHO&TTS對大陸執行死刑犯的器官捐贈態度, 已經改變!?.....節錄這期(四月二十七日的)Transplantation的文章::

Open Letter to Xi Jinping, President of the People’s Republic of China: China’s Fight Against Corruption in Organ Transplantation
The January 13, 2014, article in the China Daily, “For a clean and fair society,” reported your guidelines for political and legal reform.
The international media have recently focused attention on the resolve of China’s new leadership to combat the rampant corruption within its society. The January 13, 2014, article in the China Daily, “For a clean and fair society,” reported your guidelines for political and legal reform. The judicial system is now charged to “carry the sword of justice and scale of equality” for all of China. “The Chinese dream” you have proposed amounts to a call for a culture of human rights linking the dignity of a great nation to the dignity of each citizen. Therefore, it is timely for the international transplant community to urge China to address the unethical practices in organ transplantation as another measure of your commitment to rid Chinese society of corruption.
China is the only country in the world that still systematically takes organs from executed
The Transplantation Society (TTS) has expressed its strong objection to this practice through an academic embargo that prevents Chinese physicians who engage in this practice from presenting at international congresses, publishing articles in the medical literature, and achieving membership in TTS.
Organs and tissues should always be given freely and without coercion, a principle articulated in the Declaration of Istanbul in May 2008 and affirmed for more than 25 years by the World Health Organization, most recently at the 63rd World Health Assembly in a May 2010 resolution adopted by all member states, including China.
First-hand reports from our Chinese colleagues and a number of investigations suggest that the practice of obtaining organs from prisoners in China involves notorious transactions between transplant surgeons and local judicial and penal刑事的，刑法上的officials.
Regrettably, China’s attempt to develop an ethical organ transplantation program is undermined by the corrupt practices of doctors and officials who obtain organs from executed prisoners illegally for sale to wealthy foreign patients from around the world.
The World Health Organization and TTS were closely associated with the development of the Human Organ Transplantation Regulation before its final approval by the State Council of China in 2007
The World Health Organization and TTS were closely associated with the development of the Human Organ Transplantation Regulation before its final approval by the State Council of China in 2007
TTS remains skeptical about the enforcement of Chinese government’s policy and law. Chinese media report that even as the new program is being piloted, it has already been infiltrated by persons driven by the same corrupt practices who have assumed authority for the distribution of organs. A report in the New York Times on November 10, 2013, “No quick fixer,” describes Chinese Red Cross officials confronting hospitals over organs in a manner contrary to the NHFPC regulation that mandates all organs be allocated through the Chinese national organ allocation computer system. Furthermore, that foreign patients are still undergoing transplantation in China suggests that some hospitals are boldly and irresponsibly violating Chinese government regulations, thereby rendering the law a mere “paper tiger.
Thus, we ask the Chinese government for an immediate and sustained resolve, to monitor compliance by Chinese professionals in performing organ donation and transplantation in accordance with NHFPC and international standards. The fledgling national organ allocation computer system that has been developed must be authorized as the sole distributor of organs to ensure transparency and fairness. Otherwise, the perception will be that one corrupt system of organ donation in China has simply been replaced by another.
As the government under your leadership has stepped up its fight against corruption, a favorable domestic and international environment has now been created for Chinese medical professionals to establish an ethical and internationally respectable national organ donation and transplantation system. Resolving this decade-long malpractice would not only improve China’s image in the world but also give China legitimacy in advancing the field of transplantation throughout Asia. China can position itself on the world stage by contributing to the development of transplantation globally and by ensuring that this lifesaving medical practice provides maximal benefit to the Chinese people in an indisputably ethical manner.

[vsdog]

也不必回應
就把洗腎患者轉給他治療就好了
看看非透析治療下會發生什麼事

[李誠民]

台灣活體移植正在立法院等待三讀通過; 在李伯璋理事長的想法, 仍在20 年前的觀念; 就是討論重點在非心臟停止(Circulation death--循環停止), 而是腦死來定義死亡;WHO都是如此定義死亡; 因為既然是發揮大愛(altruism-利他主義); 器官捐贈者絕不會在意是心臟死或腦死; 但是要腦死才能定義死亡,很可能捐贈器官就變成不可用了, 或器官存活率大幅降低;有甚麼意義?!只是要符合法律!!!.....卻剝奪了醫學專業判斷;這也是世界先進民主國家(甚至中國大陸, 東歐, 中南美國家都根據WHO指導原則做判斷!!!...... 台灣健保制度下,有許多世界先進國家,無法想像的法規(法律); 所以前衛生署長楊志良說:台灣有30%以上醫師有違法紀錄?!(公共學者要批評醫師的專業???); 一點也不奇怪!!!!.......

Public Attitudes and Beliefs About Living Kidney Donation: Focus Group Study
Transplantation
Issue: Volume 97(10), 27 May 2014, p 977–985
Tong, Allison1,2,6; Ralph, Angelique1,2; Chapman, Jeremy R.3; Gill, John S.4; Josephson, Michelle A.5; Hanson, Camilla S.1,2; Wong, Germaine1,2,3; Craig, Jonathan C.1,2
Background: With the rising prevalence of end-stage kidney disease worldwide, the proportion of the general community who might subsequently be called upon to consider living related kidney donation is also increasing. Knowledge about the attitudes and beliefs among the general public about living kidney donation is limited. We aimed to describe public perspectives on living kidney donation.
Conclusion: The expected benefits for recipients bolster支持public support for living kidney donor transplantation; however, ethical dilemmas and concerns for the donor instilled ambivalence about living donation. Protecting equity and autonomy自治；自治權, and an implicit不言明的；含蓄的trust in health professionals to protect donors and recipients mitigated some of these uncertainties. Developing interventions, practices, and policies that address community skepticism懷疑論and values may promote awareness and trust in living kidney donation.

Broader canvassing遊說; 拉選票; 徵求意見of public opinion on living kidney donation is needed, particularly because public engagement in health policy has been advocated to promote public confidence in healthcare and policy

……….
Financial Consequences
The financial burden resulting from donors’ taking time off work, medical workup, and accommodation and travel expenses were an important consideration particularly in the middle-aged groups. Some thought donors might suffer career disruption or jeopardize their livelihood, or expected employers might not be supportive. They questioned whether donors would pay increased health insurance premiums.


Donation After Circulatory Death: Current Practices, Ongoing Challenges, and Potential Improvements
Trans[lantation:Volume 97(3), 15 February 2014, p 258–264
Morrissey, Paul E.1,3; Monaco, Anthony P.2
Abstract
Organ donation after circulatory death (DCD) has been endorsed by the World Health Organization and is practiced worldwide. This overview examines current DCD practices, identifies problems and challenges, and suggests clinical strategies for possible improvement. Although there is uniform agreement on DCD donor candidacy (ventilator-dependent individuals with nonrecoverable or irreversible neurologic injury not meeting brain death criteria), there are variations in all aspects of DCD practice. Utilization of DCD organs is limited by hypoxia, hypotension, reduced – then absent – organ perfusion, and ischemia/reperfusion syndrome. Nevertheless, DCD kidneys exhibit comparable function and survival to donors with brain death kidneys, although they have higher rates of primary graft nonfunction, delayed graft function, discard, and retrieval associated injury. Concern over ischemic organ injury underscores the reluctance to recover extrarenal DCD organs since lack of medical therapy to support inadequate allograft function limits their acceptability. Nevertheless, limited results with DCD pancreas, liver, and lung allografts (but not heart) are now approaching that of donors with brain death organs. Pretransplant machine perfusion of DCD kidneys (vs. static storage) may reduce delayed graft function but has no effect on long-term organ function and survival. Normothermic regional perfusion used during DCD abdominal organ retrieval may reduce ischemic organ injury and increase the number of usable organs, although critical confirmative studies have yet to be done. Minor increases in usable DCD kidneys could accrue from increased use of pediatric DCD kidneys and from selective use of DCD/ECD kidneys, whereas a modest increase could result through utilization of donors declared dead beyond 1 hr from withdrawal of life support therapy. A significant increase in transplantable kidneys could be achieved by extension of the concept of living kidney donation in relation to imminent death of potential DCD donors. Progress in research to identify, prevent, and repair DCD-associated organ retrieval injury should improve utilization of DCD organs. Recent results using ex situ pretransplant organ perfusion of DCD organs has been encouraging in this regard.

………………
Solid organs for transplantation are recovered from deceased donors with brain death (DBD) or by donation after circulatory death (DCD). Originally called non-heart-beating-donation and later donation after cardiac death, the current terminology (donation after circulatory death) more precisely reflects identification of the cessation of peripheral blood flow by the absence of peripheral pulses and blood pressure over asystole to declare death. In the United States, most organ procurement agencies (OPOs) abandoned DCD after brain death legislation was adopted in 1968, although some centers continued to use DCD donors (1). In the 1990s, the Maastricht (Netherlands) group rekindled interest in DCD in Europe where it is currently practiced in 10 of 27 EU nations (2, 3) as well as the United States, Canada, Australia, Japan, China, the Far East, and a few South American nations (4, 5).

In the United States, the DHHS and IOM (6) endorsed non-heart-beating donation, the OPTN mandated that all transplant programs develop protocols for DCD, and the Joint Commission on Accreditation of Healthcare Organizations required hospitals to implement written policies and procedures for organ and tissue recovery (7). The World Health Organization (WHO) (5) has encouraged all societies to develop responsible policies concerning donation after death and the adoption of DCD worldwide. This review describes recent experience with DCD donors and focuses on clinical strategies to safely expand the number of useable DCD organs.


Organ Donation After Assisted Suicide: Practically
and Ethically Challenging
Elaine Chen, MD1,2
Key Words: Ethics, Organ donation, Assisted suicide.
(Transplantation 2014;00: 00Y00)
In this issue of Transplantation, David Shaw discusses a
controversial and emotionally fraught topic of potential
organ donation after assisted suicide (DAS) in Switzerland,
to increase organ availability where assisted suicide (AS) has
already been practiced for many years (1). To start, I introduce
myself as an American physician who does not practice nor
endorse AS. Although AS is legal in the states of Oregon,
Washington, and Vermont, it is considered legally and ethically
unacceptable in the rest of the United States. As a Palliative and
Critical Care provider, my current practice in terminally ill or
imminently dying patients is to maximally alleviate symptoms
without the intention of either hastening or prolonging death.
Although Dr. Shaw’s piece provides many concepts to ponder, I
am unconvinced that DAS will be a game-changing solution.
From a practical perspective, Shaw optimistically claims
that an additional 250 donors, or about half of AS cases, could
provide 1,000 donor organs: a potential surplus. Even with improvements
in donation after circulatory death (DCD) practices,
current best rates for DCD donors are 3.71 organs transplanted
per standard criteria donor (2), without any comorbidities that
may exist in a patient with terminal illness. Because approximately
half of AS cases in Switzerland are cancer patients, Shaw’s claim
assumes that nearly 100% of non-cancer patients agree to organ
donation, transportation and locale logistics are arranged for patients
to arrive in an operating room within an hour after death,
and four organs are still viable at the time of harvest. Additionally,
the organs harvested would need tomatch the organs desired and
the patients’ immune profiles: patients in need of heart transplant
would not benefit from DAS donors through DCD.
Ensuring transportation and location feasibility for organ
donation raises both practical and ethical considerations. All
pre-donation testing, which can be a rigorous process, would
need to be performed before the time of death. Many patients
with terminal illness aim to die in their homes in a peaceful
setting. To disrupt this process with the arrival of an ambulance
and medical personnel could unsettle grieving families. Additionally,
this could add stressful time constraints during an already
stressful timeVimagine the patient has delayed taking his
prescription by a half hour as he is saying goodbye to his family,
then he looks out the window to see the ambulance pulling up
to prepare for his transport. If patients do not desire to die their
own home environment, then a location within hospital
grounds could serve the practical purpose of facilitating transport
to the operating room. Shortening the transport time
creates a separate ethical dilemma of temptation for anesthesia
and euthanasia, a potential slippery slope which Shaw alludes to
in his description of ‘‘organ retrieva取回；恢復l euthanasia’’. This concept,
more ethically controversial, could further maximize organ
availability, even to harvesting hearts (3).
DAS raises other potential ethical issues aside from the
usual ethics of AS. Autonomy is a principle of importance in
discussions of assisted suicide, giving patients the ability to choose
to live or die. The Oregon data shows that in 9 years, only 63% of
patients who received lethal prescriptions for assisted suicide actually
used the medication (4). Some died of their disease before
ingesting the medication, but as many as one third of patients
changed their minds. The idea of serving other persons in need by
providing organs could potentially create increased pressure in the
AS patient to complete the suicide for reasons of martyrdom and
self-sacrifice, whereas they may otherwise decide to continue with
life. On the other hand, if the AS patient changes his or hermind,
a waiting recipient might be sent home disappointed.
Multiple involved parties may face other specific ethical
dilemmas. Shaw notes that hospitals and doctors may be unwilling
to cooperate, so as not to encourage a practice they do
not support. Relevant healthcare providers include both the
harvesting and transplanting surgical teams and hospitals. Additionally,
the transplant recipient would need to be willing to
accept a donation from a planned suicide, from a patient
with known terminal illness. Organs from non-assisted
suicide cases have been used in transplantation, usually
after brain death has been established. A key difference
psychologically and ethically is that in the case of suicide

台灣的醫學倫理(Ethics)跟不上時代的先進民主國家, 怎麼談活體移植?! 只會複雜蔗公共議題.....更引起許多不必要的討論, 而沒有教育到人民!!!與誘醫師陷入法律紛爭!!!---先討論心臟死或腦死為死亡(死刑犯, Assisted-die)作為台灣國民的教育觀念!!!

請教施肇榮理事, 並從法律觀討論器官(主要是死刑犯等屍腎移植!!)應該是腦死?!或心臟死?