中国大陆“器官移植与脑死亡立法”的策略与思考

Organ Transplantation and Brain Death Legislation in China:Strategies and Thoughts

目的通过比较发达国家器官移植和脑死亡立法前后移植量的变化,探讨立法成效,提出我国器官移植与脑死亡立法的策略与思考。方法检索美国器官移植共享网、世界捐赠与移植监测网、美国科学移植登记网;中国肝移植注册网、中国国家统计局等相关官方网站(截至2008年12月6日),收集各国器官移植及捐献数量相关统计数据,按国别和移植器官种类进行对比描述分析。结果①查找到2003～2005年英国、美国、新西兰、西班牙、法国、意大利、德国、澳大利亚8种器官移植及器官捐献数量;1988～2007年美国和西班牙尸体捐献数量;2002～2006年澳大利亚各州移植总量;1993～2006年美国器官移植数量;1988～2008年3月美国肝、肾移植数量;1993～2008年3月中国肝移植数量,2000～2004年中国部分省市肾移植数量。②美国器官移植数量占绝对优势。③合并立法代表国西班牙2003～2005年百万人口捐献率位居八国之首。④南澳大利亚州政府采用西班牙捐献模式后4年百万人口肾移植率平均值高出其它各州。⑤美国10年活体肾移植占移植总量比例明显高于肝移植量,提示唯一器官与双器官的捐献对活体供者的风险不容忽视。⑥全球保障器官移植稳步发展的可行做法包括:由国家签订国际多边或双方条约;非政府组织规范;行业自律;专家共识指导;建立病人同盟。结论全球器官移植开展得好的国家,无一不与器官移植和脑死亡法的成功制定和不断完善及措施配套、保险跟进和宣传普及有关。我国应把握与国际医学同步发展的机遇,借鉴国外在脑死亡和器官移植问题上的成功做法,发挥后发优势,进行脑死亡和器官移植立法。

Objective We investigated the effectiveness of legislation in developed countries by analyzing their legislation, and produced ideas and strategies for organ transplantation and brain death legislation in China. Methods Official websites were searched as follows： UNOS, TCE, CLTR, ANZDATA, and SRTR through December 6, 2008. We included statistical reports and data analysis of organ donations and transplants, and excluded literature about non-solid organs. The absolute transplantation numbers were standardized to per one million people. Results 1. The following data was retrieved： The number of eight kinds of organ transplants and organ donations in Britain, the United States, New Zealand, Spain, France, Italy, Germany, and Australia from 2003 to 2005; the number of deceased donors in the United States and Spain from 1988 to 2007; the total number of organ transplants in Australia from 2002 to 2006; the amount of organ transplants in the United States from 1993 to 2006; liver and kidney transplant totals in the United States from 1988 through March, 2008; liver transplants number of China from 1993 through March, 2008; and the number of kidney transplants in some provinces and cities in China. 2. Transplant totals were greatest in the United States; in Spain, after ONT was founded in 1990, the rate of donation from the deceased was the most in the world. 3. Spain had the best rate of donation with 34.5 pmp, 10.9 pmp higher than in the United States with separate legislation from 2003 to 2005. There was a rate difference of 0.98 pmp between Germany and the United Kingdom which implemented separated legislation nine years earlier. 4. Southern Australia had a maximum rate of average kidney transplant in the country from 2002 to 2006, 5. Live donor kidney transplants accounted for 31.2-44% compared to 4.3% and 4.1% for liver transplants in 2006 and 2007 respectively in the United States. 6. The following have been applied globally to regulate organ transplantation and brain death： 1） International or multilateral treaties; 2） Regulation of NGOs; 3） Self-discipline in the field of organ transplantation; 4） Expert consensus; 5） Establishment of patient＇s alliance. Conclusion Countries that have implemented organ transplantation and brain death laws have developed successful measures to improve and support insurance and follow-up information for donors and recipients, however, legislation is still urgently needed in China. As long as brain death and organ transplant laws are reasonably developed and legislators resolve to deal with the difficult issues, then the legislation and its subsequent enforcement will reflect the interests of the people and improve health quality for all.