I.什么是移植旅游？
a. 在国外购买移植用的脏器
b. 规避器官分配政策的规则或操作进行器官交易
II.都市神话还是都市现实
a. WHO的报告显示，全球10%的器官移植是通过“移植旅游”实现的
b. 加州大学医学人类学教授Nancy-Scheper-Hughes：
i. 人体器官非法交易的大量数据
ii. 活体肾脏捐赠者
iii. 未经许可从死者身上获取心瓣膜、角膜和其他人体组织
c. 中国从囚犯身上获取器官
d. 2008年2月7日CNN报道，印度非法肾交易嫌疑人Amit Kumar医生因“诱骗500名穷人强迫‘捐肾’且不给予补偿“遭到逮捕。
III.卑劣行径的明显表现
a. 通过判处死刑获取器官的动机
b. 器官偷窃
c. 不透明
d. 未经允许
e. 未经许可移除脏器
IV. 出售器官是否合乎伦理？
a. 就买卖器官而言，审查移植旅游问题的重要性
b. 需要建立一个具备防御能力的激励机制
i. 知情同意
ii. 医疗保障
c. 商品化：很多人获得了报酬，但同时自己的健康状况也受到了威胁
i. 建筑工人
ii. NFL球员
iii. 矿工
iv. 军人
v. 以上人群的发病率和死亡率要高于正常的活体肾脏捐赠者
d. 很多个人或团体都因为器官捐赠而获益，只有捐赠者本人因“禁止收受任何钱财”而未获任何利益
i. OPO（器官获取组织）
ii. 医院/外科医生/移植医师
iii. 组织库
e. 利用
i. 医学和研究在一定程度上都涉及到利用
ii. 如果与其他的道德准则相违背，那么这种利用就是不好的
1. 同意
2. 不合适
3. 强迫
V. 购买器官是否合乎伦理？
a. 用金钱颠覆器官分配系统
b. 稀有资源的公平分配
c. 也许不能获得最佳的移植监护
VI. 美国移植协会（AST）将如何回应移植旅游的问题？
a. 目前的态度：（2007年3月2日，AST执行委员会）
i. “如何照顾好器官交易中的捐赠者是AST最关心的问题之一”；“我们会继续倡议，努力建立保护国外活体捐赠者的统一标准 ”。
ii. “AST相信，我们不应该歧视在国外接受移植手术的受体，也不能撤除对他们进行的治疗”。
b. 对是否有必要谴责移植业卑劣行径的质疑
i. 中国的囚犯问题
ii. 印度“诱摘肾脏“事件
c. 考虑建立允许器官捐赠者从捐赠行为中受益的刺激机制
d. 考虑如何解决因器官资源短缺促使绝望的患者做出卑劣行径的问题
Critically thinking about transplant tourism; issues and response
I. What is transplant tourism?
a. Purchase of a transplant organ abroad
b. Typically bypass rules or procedures for organ distribution in exchange for money
II. Urban Myth or Reality
a. WHO reports 10% of global transplant practices are “transplant tourism”
b. Nancy Scheper-Hughes from UC Berkley
i. Extensive data on organ trafficking
ii. Living Kidney Donor
iii. Unauthorized removal of heart valves, cornea and other human tissue from cadavers
c. Procurement of organs from executed prisoners in China
d. CNN report, February 7, 2008 Dr. Amit Kumar arrested in “kidney snatching ring, 500 patients forced to “give up” kidney and were not compensated.
III. Clearly despicable practices
a. Incentives to commit capital punishment to obtain donors
b. Stealing organs
c. No transparency
d. No consent
e. Removing organs without permission is assault
IV. Is it ethical to sell organs?
a. Critical to examine the issue of transplant tourism in terms of buying and selling
b. A defensible incentive system requires
i. Informed consent
ii. Quality care
c. Commodification: Many people get paid to put their bodies at risk
i. Construction workers
ii. NFL players
iii. Miners
iv. Military
v. Morbidity and mortality of these higher than living kidney donation if done properly
d. Many entities receive money as a result of organ donation; only the donor is prohibited from receiving any money for donation.
i. OPO
ii. Hospital/Surgeon/Transplant Physician
iii. Tissue bank
e. Exploitation
i. Medicine and research both involve exploitation to a degree
ii. Exploitation is bad if violates other ethical norms
1. consent
2. incompetence
3. coercion
V. Is it ethical to buy organs?
a. Subvert organ distribution systems with money
b. Fair distribution of scarce resource
c. May not be obtaining the best transplant care
VI. How should the AST respond to the problem of transplant tourism?
a. Current response: (AST executive committee, March 2, 2007)
i. “The quality of care given to paid donors is of great concern to the AST.” “We will continue to advocate for efforts that promote uniform standards for the protection of living donors abroad.”
ii. “The AST believes that optimal medical care should not be withheld from those recipients who have chosen to receive transplants as tourists from abroad.”
b. Question the need for condemnation of certain ethically despicable practices.
i. Executed prisoners in China
ii. “Kidney snatching”
c. Consider policy which leaves the door open for financial incentives for donors.
d. Consider how the problem of organ scarcity promotes despicable actions by desperate patients.
[责任编辑:刘 聪]
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