ABSTRACT
Abstract In the past several decades, due to the severe shortage of transplantable organs, organ procurement from executed prisoners have been used to transplant organs, which goes against international ethics standards. As of January 2015, China phased out the use of executed prisoner organs and embarked on its transplant reform. Since then, many efforts have been made to meet the international ethics guidelines on organ transplants. In this study, we aim to elaborate on the status quo of organ procurement from executed prisoners from the perspective of ethics and law. Although China has made great progress in organ donation and transplantation, some Western transplant surgeons and bioethicists still hold outdated views on organ donation and transplantation in China, which will not bring any benefits to its development and will alienate it from the international transplant community. In this study, we propose that both the international transplant society and Chinese transplant community, with mutual cooperation and trust, should jointly make efforts to advance the development of organ donation and transplantation in China.
Resumen En las últimas décadas, debido a la grave escasez de órganos trasplantables, la obtención de órganos de presos ejecutados se ha utilizado para trasplantar órganos, lo que contraviene las normas éticas internacionales. A partir de enero de 2015, China eliminó gradualmente el uso de órganos de prisioneros ejecutados y se embarcó en su reforma de trasplantes. Desde entonces, se han realizado muchos esfuerzos para cumplir con las directrices éticas internacionales sobre trasplantes de órganos. En este estudio, nuestro objetivo es profundizar en el status quo de la obtención de órganos de presos ejecutados desde la perspectiva de la ética y la ley. Aunque China ha logrado un gran progreso en la donación y el trasplante de órganos, algunos cirujanos de trasplantes y bioéticos occidentales todavía tienen opiniones obsoletas sobre la donación y el trasplante de órganos en China, lo que no traerá ningún beneficio para su desarrollo y lo alejará de la comunidad internacional de trasplantes. En este estudio, proponemos que tanto la sociedad internacional de trasplantes como la comunidad china de trasplantes, con cooperación y confianza mutuas, deben hacer esfuerzos conjuntos para avanzar en el desarrollo de la donación y el trasplante de órganos en China.
Resumo Nas últimas décadas, devido à grave escassez de órgãos transplantáveis, a obtenção de órgãos de prisioneiros executados tem sido usada para o transplante de órgãos, o que vai contra padrões éticos internacionais. A partir de janeiro de 2015, a China eliminou o uso de órgãos de prisioneiros executados e lançou sua reforma em transplantes. Desde então, muitos esforços foram feitos para satisfazer diretrizes éticas internacionais sobre transplantes de órgãos. Nesse estudo, nós pretendemos estudar o status quo da obtenção de órgãos de prisioneiros executados desde uma perspectiva da ética e da lei. Embora a China tenha feito grandes progressos em doação e transplante de órgãos, alguns cirurgiões de transplantes e bioeticistas ocidentais ainda mantém visões desatualizadas sobre doação e transplante de órgãos na China, as quais não trarão quaisquer benefícios para seu desenvolvimento e irão aliená-las da comunidade de transplantes internacional. Nesse estudo, nós propomos que tanto a sociedade de transplante internacional e a comunidade de transplante chinesa, com cooperação e confiança mútuas, deveriam empreender esforços conjuntos para avançar o desenvolvimento de doação e transplante de órgãos na China.
Subject(s)
Humans , Prisoners , Tissue and Organ Procurement , Organ Transplantation , Ethics , Jurisprudence , ChinaABSTRACT
@#Objective To explore the correlation between perioperative blood transfusion and acute kidney injury (AKI) after heart transplantation. Methods A retrospective study was performed on 67 patients who underwent heart transplantation in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital from January 2016 to December 2018, and finally 63 patients were included according to the exclusion criteria. There were 53 males and 10 females with an average age of 44.3±12.9 years. Twenty patients who adopted continuous renal replacement therapy (CRRT) after heart transplantation were divided into a RT group and the other 43 patients who did not use CRRT were divided into a non-RT group. Baseline characteristics, perioperative blood transfusion data and clinical prognosis were compared between the two groups. Results The preoperative baseline characteristics of the two groups were basically the same. There were significant differences in perioperative infusion of red blood cells and plasma, postoperative 24 h bleeding and re-exploration (P<0.05) between the two groups. The area under the receiver operating characteristic (ROC) curve was 0.923 (95%CI 0.852 to 0.995, P<0.001). The ROC curve showed that perioperative infusion of red blood cells more than 18 mL/kg would increase the incidence of AKI after heart transplantation. Conclusion Perioperative blood transfusion is closely related to AKI after heart transplantation. The more blood transfusion is in clinics, the higher incidence of renal injury is and the worse prognosis is. It is suggested that various blood-saving measures can be carried out.
ABSTRACT
Objectives: In this study, we examine the ethical issues concerning living organ transplant in China. We attempt to review and analyze the ethical disputes that the living organ transplant faces in China and try to find applicable solutions to these disputes. Design: Ethical Analysis. Setting: Living organ transplant in China. Results: The ideal approaches to solving the ethical disputes involve (1) preventing disease, strengthening physical fitness, and improving the health of the national citizen; (2) encouraging the citizens to donate their organs after death; and (3) developing new technologies for organ transplant. Realistic approaches to addressing the ethical disputes over the living organ transplant include choosing the lesser of two evils, reducing the harm to the donor as much as possible and improving the transplant quality. Conclusions: The living organ transplant in China is an expedient measure instead of an ideal option and should be conducted under strict laws and regulations.
Objetivos: Neste estudo, examinamos as questões éticas relativas ao transplante de órgãos vivos na China. Vamos tentar rever e analisar os conflitos éticos que o transplante de órgãos vivos enfrenta na China e tentar encontrar soluções aplicáveis a estas disputas. Projeto: Análise ética. Configuração: Transplante de órgão vivo na China. Resultados: As abordagens ideais para resolver os conflitos éticos envolvem (1) prevenção de doenças, fortalecimento da aptidão física e melhora da saúde do cidadão nacional; (2) incentivar os cidadãos a doar seus órgãos após a morte; e (3) desenvolvimento de novas tecnologias para transplante de órgão. Abordagens realistas para enfrentar as disputas éticas sobre o transplante de órgão vivos incluem escolher o menor de dois males, reduzindo o dano ao doador o máximo possível e melhorar a qualidade do transplante. Conclusões: Transplantes de órgãos vivos na China é uma medida conveniente ao invés de uma opção ideal e deve ser conduzida sob estritas leis e regulamentos.
O artigo traz à discussão a compreensão atual do comportamento ecológico do ser humano, a partir de uma relação de dominação utilitária do ambiente em contraste com a sua compreensão do ponto de vista ecológico, a qual responde a um modelo natural que faz parte de relações de seu funcionamento no ecossistema. A este respeito, é colocado em discussão o paradigma de crise ambiental, em que tal comportamento supõe um problema grave da sociedade. Para os autores, a questão está intimamente ligada ao sistema produtivo e econômico que promove a artificialização do ser humano, criando falsas necessidades que, por meio de seu consumo, garantam a sustentabilidade do modelo econômico. É realizada uma reflexão crítica a partir da educação, no sentido de uma nova compreensão do comportamento humano, cuja perspectiva ecológica impulsiona novas relações ecossistêmicas baseadas na cooperação.
Subject(s)
Humans , Organ Transplantation/ethics , Living Donors/ethics , ChinaABSTRACT
@#Objective To analyze the surgical effect of total aortic arch replacement and stented elephant trunk (Sun’s procedure) for acute or chronic Stanford type A aortic dissection, and to investigate the optimal surgical timing for Stanford type A aortic dissection involving aortic arch. Methods We retrospectively reviewed the clinical data of 327 patients with acute or chronic Stanford type A aortic dissection treated by Sun's procedure from June 2010 to June 2014 in Guangdong Cardiovascular Institute. Patients were divided into two groups according to whether the time from onset to operation was longer than 2 weeks: an acute group with 229 patients (≤2 weeks, the average time of onset to operation 5.70±3.50 d) and a chronic group with 98 patients (>2 weeks, the average time of onset to operation 21.60±15.70 d). There were 186 males and 43 females with a mean age of 47.47±11.19 years in the acute group, and 76 males and 22 females with a mean age of 45.62±12.92 years in the chronic group. The patients discharged from hospital were followed up for one year. Results There was no significant difference between the two groups in preoperative data. The rate of coronary artery bypass grafting, cardiopulmonary bypass time, aortic cross-clamping time, intraoperative and postoperative 24 h red blood cell intake were higher or more in the acute group than those in the chronic group (P<0.05). The in-hospital morality, ICU stay, mechanical ventilation time, the incidence of neurological dysfunction, low cardiac output syndrome, acute renal failure with continuous renal replacement therapy, hepatic insufficiency, poor wound healing were higher or more in the acute group than those in the chronic group (P<0.05). During one year follow-up, the survival rate of the acute and chronic groups was 97.0% and 97.6% respectively (P>0.05). No new complications were found in the two groups. The irreversible neurological dysfunction, paraplegia and renal failure showed no significant difference between the two groups. Conclusion The short-term mortality and complications of acute Stanford A aortic dissection involving aortic arch treated by Sun’s procedure are significantly higher or more than those of chronic Stanford type A aortic dissection. The risk of surgical treatment in acute phase is high.