在中国临床开展活体供肾肾移植的伦理学问题探讨

Ethical Problems in the Clinical Application of Living-donor Renal Transplantation in China

在中国开展活体供肾肾移植更多可能遇到的是伦理学问题。供体和受体的知情、自愿、同意是最关键的伦理学问题。其中知情的内容和限度、供体与受体智力能力的判断、自愿同意三个问题需要明确。为保障智力或精神残障和未成年人的合法权益,他们绝对不允许作为活体供肾者。还应该保护不同意作为供体的人,医务人员有责任保护他们的隐私,并给予帮助。内在和外在的压力可能影响供体做出自主同意的决定,外在压力尤其值得注意。在考虑活体肾移植利益及风险方面,应恪守生命价值原则。从亲情角度考虑,对于活体供肾者给予适当的经济补偿是合理的,也是符合中国人情感表达方式的。对活体供肾肾移植进行社会伦理的干预、法律控制和社会监督是必要的。社会伦理的干预其关键点在于提高医务人员的社会道德责任感。并且要真正发挥医院伦理委员会的作用。

Ethics - related issues are the main problems encountered in living - donor renal transplantation in China. The most important ethical problems are informed fact, voluntary decision and informed consent for donors and recipients. Three problems need to be determined including content and limitation of informed fact, judgment of intellectual ability of the donor and recipient sides, and voluntary consent. Flexible principles and countermeasures should be well employed in different and complicated clinical cases. For example, people with intellectual or mental disability and minors are not permitted to be donor in order to protect their legal rights and benefits. To draw a conclusion, its necessary to give ethical interfere, legal control and social supervision to living - donor renal transplantation. The key - point of social and ethical interfere is to enhance the sense of socio - ethical responsibility among medial staffs. Hospital ethics committee should play their expected role in clinical application.