An organ for change
An organ for change
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变革的器官
DOI：
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
S. Eckstein
中科院分区：
文献类型：
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作者：
B. Farsides;S. Eckstein
当我们在未来几年回顾2007 - 2008年期间时，围绕器官捐赠问题的活动水平将是惊人的。2008年1月，器官捐献工作组发表了一份报告，其中声称，如果其14项建议得到落实，器官捐献率将在五年内提高50%。此后，政府全力支持工作队的建议，并已请国民保健服务医疗主任布鲁斯基奥爵士主持一个执行小组。与此同时，Chris Rudge先生已从英国移植公司董事总经理的职位上借调，成为负责移植问题的最新NHS Csar。工作组的工作现已进入第二阶段，因为它已被要求考虑假定同意器官捐赠的问题，因为英格兰首席医疗官利亚姆唐纳森爵士支持改变选择退出制度-英国医学协会多年来一直支持这一立场。这项工作正在进行中的杂志去印刷。该工作组已明确表示，移植需要被视为一个英国范围内的服务，所以重要的是要承认在英国各地正在发生的事情。在威尔士，卫生福利和地方政府委员会正在进行一项调查，将通过威尔士国民议会网站上主办的公共论坛讨论提供信息。在苏格兰，议员们在2006年对《人体组织（苏格兰）法案》进行投票时没有修改法律，允许推定同意，但现在通过的法案取消了亲属否决潜在捐赠者意愿的权利。与此同时，欧洲委员会也一直在处理器官捐赠问题，因此，上议院欧洲联盟特别委员会（小组委员会G）一直在听取专家的证据，说明在何种程度上欢迎欧洲关于器官安全和相关问题的指令。从这些机构的讨论中明显出现的一个问题是，提高捐赠率的障碍之一一直是，而且可能继续是从业人员的道德问题，最明显的是那些在重症监护环境中工作的人，他们通常是照顾潜在捐赠者及其家人的专业人士。正因为如此，工作组的建议之一是，应该有一个器官捐赠伦理委员会，以考虑捐赠引起的持续问题。读者将对这一建议的优点有自己的看法，但与此同时，我们希望本刊的撰稿人将参与全国性的辩论，这显然需要在许多与器官捐赠有关的问题上进行。我们非常乐意考虑临床医生及其他关注团体就更改同意捐赠器官的准则可能带来的影响所提出的意见。我们有兴趣回到定向捐赠的问题上，这在本杂志上的一个虚拟伦理委员会讨论中有所涉及，并在2008年4月通过劳拉·阿什沃思和雷切尔·泄漏的案例强调了这一点，在这个案例中，母亲不能从女儿的死后捐赠中受益。我们鼓励临床医生在本杂志的页面中排练他们可能希望被任何伦理审查机构考虑的问题和问题的介绍。作为一个国家，我们不能对我们与器官捐赠有关的统计数据感到自豪。在整个欧洲的比较中，我们似乎接近表格的底部，我们的捐赠率与欧洲器官捐赠冠军西班牙相比非常不利。如果你是少数民族的一员，情况就更严重了，因为有证据表明，在某些群体中，高水平的需求加上低水平的捐赠。简而言之，我们希望积极鼓励我们的读者和贡献者参与器官捐赠问题，以便2008年确实被视为事情真正开始改变的一年。现在来看本期，即第三卷的第二期，我们在不定期的系列文章中包括了另一篇关于各种机构和组织如何开展伦理问题工作的文章。朱利安·希瑟为我们提供了一个有趣和有用的洞察英国医学协会伦理委员会的工作，博比·法尔赛德斯自2006年夏天以来一直是布莱顿和苏塞克斯医学院的临床和生物医学伦理学教授。在此之前，她曾在伦敦国王学院医学法律和伦理中心工作了10年，后来担任医学伦理学高级讲师。她在世界各地的一些国家委员会任职，并就与她感兴趣的领域有关的伦理问题进行讲座，以及在布莱顿的临床伦理委员会任职，并担任临床伦理学的联合编辑。Bobbie Farsides是器官捐赠工作组成员，也是欧盟特别委员会G小组委员会对欧盟委员会关于器官捐赠和移植的沟通的调查的专家顾问：欧盟层面的政策行动。她在这篇社论中的评论是以私人身份发表的。Sue Eckstein是布莱顿和苏塞克斯医学院临床和生物医学伦理学讲师。她曾是伦敦国王学院医学法律与伦理中心的研究员和项目开发主任。她在多个伦理委员会任职，是《研究伦理委员会手册》（CUP，2003）的编辑。
When we look back at the period 2007–2008 in future years, the level of activity around organ donation issues will be striking. In January 2008, the Organ Donation Taskforce produced its report within which it claimed that organ donation rates could be increased by 50% within five years if its 14 recommendations were acted upon. The Government has since given its full support to the Taskforce’s recommendations and Sir Bruce Keogh, Medical Director of the NHS, has been asked to chair an implementation group. At the same time, Mr Chris Rudge has been seconded from his post as Managing Director at UK Transplant to become the newest NHS Csar with responsibility for transplant issues. The work of the Taskforce has now entered a second phase, as it has been asked to consider the issue of presumed consent to organ donation in light of Sir Liam Donaldson, Chief Medical Officer for England’s, support for a change to an opt out system – a position supported for many years by the BMA. This work is ongoing as the journal goes to press. The Taskforce has made it clear that transplantation needs to be seen as a UK-wide service, so it is important to acknowledge what is happening across the UK. In Wales, The Health Wellbeing and Local Government Committee is carrying out an enquiry which will be informed by a public forum discussion hosted on the National Assembly for Wales website. In Scotland, MPs fell short of changing the law to allow for presumed consent back in 2006 when voting on the Human Tissue (Scotland )Bill, but the Act now passed removes the right of relatives to veto the wishes of potential donors. Meanwhile, the European Commission has also been addressing organ donation and, as a result, the House of Lords’ Select Committee of the European Union (Sub Committee G) has been hearing evidence from experts on the extent to which a European Directive on organ safety and related issues would be welcome. One of the issues that has emerged clearly from the deliberations of each of these bodies is the fact that one of the impediments to increasing donation rates has been, and will possibly continue to be, the ethical concerns of the practitioners, most obviously those working within the intensive care setting who are most often the professionals caring for potential donors and their families. Because of this, one of the Taskforce’s proposals is that there should be an organ donation ethics committee to consider the ongoing issues raised by donation. Readers will have their own views on the merit of this suggestion, but in the meantime, we would hope that contributors to this journal will participate in the national debate that clearly needs to take place on many issues relating to organ donation. We are keen to consider the views among clinicians and other interested parties on the possible implications of changing the basis for consent to organ donation. We would be interested to return to the issue of directed donation as covered in a previous Virtual Ethics Committee discussion in this journal and highlighted in April 2008 by the case of Laura Ashworth and Rachel Leake, where a mother could not benefit from her daughter’s postmortem donation. We would encourage clinicians to rehearse within the pages of this journal the presentation of issues and questions they might want to be considered by any ethical review body to emerge in future. As a country we can take little pride in our statistics relating to organ donation. In cross-European comparisons we appear close to the bottom of the tables, with our donation rates comparing very unfavourably to those of Spain, the champion in Europe in terms of organ donation. If you are a member of a minority ethnic group, the situation is even more serious, as evidence suggests high levels of need coupled with low levels of donation within certain groups. In short we would like to be proactive in encouraging our readers and contributors to engage with the issue of organ donation so that 2008 will indeed be seen as the year in which things really started to change. Looking now at the current issue, the second issue of Volume Three, we include another paper in our occasional series about how work on ethical issues is carried out in various institutions and organizations. Julian Sheather gives us an interesting and useful insight into the work of the British Medical Association’s Ethics Committee, Bobbie Farsides has been Professor of Clinical and Biomedical Ethics at Brighton and Sussex Medical School since summer 2006. Prior to that she had been at the Centre of Medical Law and Ethics, King’s College London for 10 years, latterly as Senior Lecturer in Medical Ethics. She serves on a number of national committees and lectures around the world on ethical issues related to her areas of interest, as well as serving on the Clinical Ethics Committee in Brighton and being Co-editor of Clinical Ethics. Bobbie Farsides is a member of the Organ Donation Taskforce and Specialist Adviser to the Select Committee of the European Union, Sub Committee G’s Inquiry into the EU Commission’s communication on organ donation and transplantation: policy actions at EU level. Her comments in this editorial are made in a private capacity. Sue Eckstein is Lecturer in Clinical and Biomedical Ethics at Brighton and Sussex Medical School. She was previously Research Fellow and then Director of Programme Development at the Centre of Medical Law & Ethics, King’s College London. She serves on various ethics committees and is the editor of The Manual for Research Ethics Committees (CUP, 2003).