Daar A S
University of Toronto Centre for Bioethics, Toronto, Ontario, Canada.
Transplant Proc. 2004 Sep;36(7):1885-7. doi: 10.1016/j.transproceed.2004.08.130.
The renewed interest in non-heart-beating donation (NHBD) in the past decade has resulted in renewed examination of the concept and meaning of death; of the nature of consent; of the propriety of interventions for the benefit of the recipient and not the donor; of potential conflicts of interest; and of defining futility. There is recognition of the need to maintain public trust. Recent experience indicates that NHBD could make a significant contribution to total renal transplant numbers. While there is graft dysfunction in the short term, the long-term results are comparable to those of transplants from heart-beating kidney donors, and in one series, even to living donors. The University of Zurich's experience indicates that waiting 10 minutes after asystole and not using in situ cooling do not adversely affect long-term outcomes. NHBD under ideal conditions could be extended to other organs such as the liver and pancreas. Ethical concerns are not insurmountable and can be minimized if cooling procedures and the use of drugs, such as heparin and phentolamine, is minimized, and if a period of 10 minutes is allowed to elapse after asystole before death is declared. We make a series of evidence-based recommendations for protocol development.
在过去十年中，人们对非心脏跳动供体（NHBD）的兴趣再度兴起，这引发了对死亡概念与意义、同意的性质、为受者而非供者进行干预的适当性、潜在利益冲突以及徒劳的定义等方面的重新审视。人们认识到有必要维护公众信任。近期经验表明，NHBD可为肾移植总数做出重大贡献。虽然短期内存在移植物功能障碍，但长期结果与心脏跳动供肾移植相当，在一个系列研究中，甚至与活体供肾移植相当。苏黎世大学的经验表明，心搏停止后等待10分钟且不采用原位降温，不会对长期结果产生不利影响。理想条件下的NHBD可扩展至肝脏和胰腺等其他器官。伦理问题并非无法克服，若将降温程序以及肝素和酚妥拉明等药物的使用降至最低限度，并在心搏停止后等待10分钟再宣布死亡，伦理问题可减至最少。我们为方案制定提出了一系列基于证据的建议。
