The organs crisis and the Spanish model: theoretical versus pragmatic considerations.
The organs crisis and the Spanish model: theoretical versus pragmatic considerations.
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器官危机和西班牙模式：理论与务实的考虑。
DOI：
10.1136/jme.2007.023127
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发表时间：
2008
影响因子：
4.1
通讯作者：
Quigley M
中科院分区：
文献类型：
--
作者：
Quigley M
在联合王国，关于如何最好地弥补移植器官短缺的辩论断断续续地持续了多年。人们往往认为，解决办法只是将法律改为推定同意制度。首席医疗官利亚姆·唐纳森爵士在7月发表的年度报告中，或许是基于这一假设采取行动的，他主张建立一种基于推定同意的器官捐赠制度，即所谓的“选择退出”制度。他呼吁改变英格兰和威尔士的法律，即假定同意器官捐赠，使一个人的器官在死后自动可用于移植，除非他们在活着时对此表示反对。其后，英国医学会亦支持推行这制度。[2]英国医学协会认为，“推定同意立法的实践对每百万人口中的尸体捐赠者数量产生了重大影响。”[2]人们通常想当然地认为，在推定同意立法的颁布与器官捐赠和采购的增加之间必然存在相关性。然而，这种相关性并不像看起来那么简单。也许可以在不修改2004年《人体组织法》的情况下实施其他鼓励器官捐赠的实际措施，该法生效仅一年。Abadie和Gay的一项分析表明，“推定同意立法”对
In the United Kingdom, the debate about how best to meet the shortfall of organs for transplantation has persisted on and off for many years. It is often presumed that the answer is simply to alter the law to a system of presumed consent. Acting perhaps on that presumption in his annual report launched in July, the Chief Medical Officer, Sir Liam Donaldson, advocated a system of organ donation based on presumed consent, the so-called ‘‘opt-out’’system. 1 He is calling for a change in the law in England and Wales whereby consent to organ donation is presumed, making a person’s organs automatically available for transplantation after death, unless they registered objections to this while alive. Subsequently, the British Medical Association (BMA) lent its support to the introduction of such a system. 2 The BMA contends that ‘‘the practice of presumed consent legislation has had a significant effect on the number of cadaveric donors per million population.’’2It is often taken for granted that there must be a correlation between the enactment of legislation on presumed consent and an increase in organ donation and procurement. However, the correlation is not as straightforward as it might seem. It may be that other practical measures to encourage organ donation could be implemented without changing the Human Tissue Act 2004, an Act which has been in force for barely a year. An analysis by Abadie and Gay demonstrated that ‘‘presumed consent legislation has a positive and sizeable effect on