Agich George J
Department of Bioethics, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Mt Sinai J Med. 2003 May;70(3):141-7.
The concept of vital organ transplantation is critically analyzed by considering how traditional transplantation modifies the commitment to saving lives. Problems such as those associated with immunosuppression might seem to provide a compelling reason to oppose extension of transplantation to non-lifesaving situations. A closer examination, however, shows that immunosuppression does not present an intractable objection. For some organ transplants, such as the uterus, use of immunosuppression could be limited to the childbearing years. Complexities associated with assessment of quality of life are discussed using the example of hand transplantation. Assessment of success and functionality in a hand transplant is more complicated than it might appear at first. These complications suggest that monitoring and assessment should be a part of any extension of organ transplantation. Informed consent provides a limited, but important, component in justifying extended transplantation. Such justification, however, does not rest on patient autonomy, but on the reasonable prospect of benefit. Transplant programs considering an extension of traditional transplantation should develop formal protocols that include assessment of costs, benefits, quality of life, and the adequacy of informed consent.
通过思考传统移植如何改变拯救生命的承诺，对重要器官移植的概念进行了批判性分析。诸如与免疫抑制相关的问题似乎为反对将移植扩展到非挽救生命的情况提供了令人信服的理由。然而，仔细研究表明，免疫抑制并非无法克服的障碍。对于某些器官移植，如子宫移植，免疫抑制的使用可以仅限于生育年龄。以手部移植为例，讨论了与生活质量评估相关的复杂性。手部移植中成功和功能的评估比乍看起来要复杂得多。这些复杂性表明，监测和评估应成为器官移植扩展的一部分。知情同意在证明扩展移植合理性方面提供了一个有限但重要的组成部分。然而，这种合理性并非基于患者的自主性，而是基于受益的合理前景。考虑扩展传统移植的移植项目应制定正式方案，包括成本、效益、生活质量评估以及知情同意的充分性评估。
