Doig Christopher James, Rocker Graeme
Department of Critical Care Medicine and The Office of Medical Bioethics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Can J Anaesth. 2003 Dec;50(10):1069-76. doi: 10.1007/BF03018376.
The increasing gap between numbers of individuals awaiting organ replacement surgery and the supply of organs available for transplant underpins attempts to increase the number of organs available. One practice, used in other countries, is the recovery of organs from non-heart-beating organ donors (NHBD). The purpose of this review is to discuss ethical issues surrounding the use of organs from these donors.
Narrative review from selected Medline references, and other published reports.
NHBD protocols have been established in many countries including the United States. Despite numerous publications, and extensive debate in the literature, significant ethical issues remain unresolved in the retrieval of organs from donors that have died from cessation of cardiac activity. The ethical concerns primarily arise in the determination of death, the tension between the time constraints on recovering organs viable for transplantation, and procedures to enhance organ viability. Despite a concerted effort in the United States, less than half of the organ procurement organizations have NHBD protocols.
Canadian centres can learn from the difficulties encountered in other centres that have developed NHBD protocols. A moratorium on Canadian NHBD protocols should be considered until a National consensus reflecting Canadian values has been undertaken.
等待器官置换手术的人数与可用于移植的器官供应之间的差距日益增大，这促使人们努力增加可用器官的数量。在其他国家采用的一种做法是从非心脏跳动器官捐献者（NHBD）身上获取器官。本综述的目的是讨论围绕使用这些捐献者器官的伦理问题。
从选定的医学索引数据库参考文献及其他已发表报告中进行的叙述性综述。
包括美国在内的许多国家都已制定了非心脏跳动器官捐献者方案。尽管有大量出版物以及文献中的广泛辩论，但在从因心脏活动停止而死亡的捐献者身上获取器官时，重大伦理问题仍未得到解决。伦理问题主要出现在死亡判定、获取可用于移植的存活器官的时间限制以及提高器官存活率的程序之间的矛盾上。尽管美国做出了一致努力，但不到一半的器官获取组织有非心脏跳动器官捐献者方案。
加拿大的中心可以从其他制定了非心脏跳动器官捐献者方案的中心所遇到的困难中吸取教训。在达成反映加拿大价值观的全国共识之前，应考虑暂停加拿大的非心脏跳动器官捐献者方案。
