Rhee Jason, Kern Barbara, Cooper Jeffery, Freeman Richard B
Division of Transplantation, Tufts Medical Center, Boston, Massachusetts, USA.
Semin Liver Dis. 2009 Feb;29(1):19-39. doi: 10.1055/s-0029-1192053. Epub 2009 Feb 23.
Liver transplantation expertise has expanded throughout the world to the point where liver transplants are available in most developed countries. In many cases, however, legislation and regulations have not kept pace with the advances in healthcare technology. In a few cases, these regulatory voids have lead to exploitation and profit making around transplantation activities. The growing patient demand has motivated governments to develop numerous national efforts to improve the standards by which organ donation and transplantation are practiced and programs to increase the number organ of donors, most notably in Spain. Although these efforts have helped, the worldwide demand for lifesaving transplantation exerts extreme pressures such that financial incentives, profit making, and overt exploitation have compelled the World Health Organization to issue guiding principles. Other efforts to increase the number of available organs have centered on expanding the medical criteria for acceptable organ donors and using donation after cardiac death protocols. Implicit in these efforts is the need to understand, both on the part of the practitioner and the recipient, the higher risks involved in using these donors, the circumstances in which taking such risks are justified, and that all parties-including those responsible for paying the higher healthcare costs associated with using these organs-are willing to assume these risks. Also important is recognizing that the risks of transmission of donor disease to recipients are very low but not zero, even though these events receive enormous media attention. As the demand for organs rises relentlessly, more research must be devoted to understanding how to make the marginal donor organs function better.
肝脏移植技术在全球范围内不断发展，如今大多数发达国家都能开展肝脏移植手术。然而，在许多情况下，法律法规的制定并未跟上医疗技术进步的步伐。在少数情况下，这些监管空白导致了围绕移植活动的剥削和盈利行为。患者需求的不断增长促使各国政府开展了诸多全国性行动，以提高器官捐赠和移植的实施标准，并制定增加器官捐赠者数量的计划，西班牙在这方面尤为突出。尽管这些努力取得了一定成效，但全球对挽救生命的移植手术的需求带来了巨大压力，以至于经济激励、盈利行为和公然的剥削促使世界卫生组织发布了指导原则。其他增加可用器官数量的努力主要集中在扩大可接受器官捐赠者的医学标准以及采用心脏死亡后捐赠协议。这些努力背后隐含的需求是，从业者和接受者都需要明白使用这些捐赠者所涉及的更高风险、承担这些风险的合理情形，以及包括那些承担与使用这些器官相关的更高医疗费用的各方都愿意承担这些风险。同样重要的是要认识到，尽管这些事件受到了媒体的广泛关注，但捐赠者疾病传播给接受者的风险非常低但并非零。随着对器官的需求持续飙升，必须投入更多研究来了解如何使边缘供体器官更好地发挥功能。
