“换肝”救子手术背后的伦理审查 "In liver"Save the son behind the operation of ethical review

　　医生曾担心不符合《人体器官移植条例》，被伦理委员会叫停，最终手术获审批 The doctor had worried that do not conform to the[The human organ transplant regulations],Be ethics committee to stop,The final surgery for examination and approval

　　- 最新进展

- the latest progress

　　

两母亲已能进食两孩子已能喝水 Two mother already can eat two children has been able to drink water

　　昨日上午，“换肝”母亲罗丹和尹春林首次术后进食，并可在护工的搀扶下走路。“换肝”病童哲哲和团团仍在ICU观察，已可以适量喝一些糖水。

Yesterday morning,"In liver"Mother rodin, and for the first time YinChunLin after eating,And the care leftankle walk."In liver"Child zhe zhe and round and round still in the ICU,Already can right amount drink some sugar water.

　　9月15日，完成交换活体肝移植手术的罗丹、尹春林转入同一普通病房。由于身体虚弱，医护人员告知家属，患者排气后才能进食。昨日上午，两人的丈夫刘祥和罗开志得知妻子排气，跑到楼下买了小米粥，“这么多天没吃饭，她俩饿坏了。”

On September 15,,Complete exchange liing donor lier transplants rodin/YinChunLin into the same general ward.Due to the weak,Medical staff told family,Patients exhaust to eat.Yesterday morning,Both husband and wife LuoKaiZhi LiuXiang that exhaust,Run downstairs bought millet congee,"So many days have a meal,They hungry."

　　昨日下午4时30分，尹春林戴着口罩，一只手拄着助行器，在护工的搀扶下，在病房外的走廊里慢慢踱步。

Yesterday afternoon 4 when 30 points,YinChunLin wore masks,A hand on a walking aid,In the care of the hand,In the ward in the corridor outside slowly pace.

　　北京武警总医院副主任医师李威称，哲哲和团团仍在重症看护室内观察，可以适量喝一些糖水。主治医师岳大夫介绍，目前哲哲的抗排斥药物浓度为12.1纳克/毫升，达到目标浓度；团团的抗排斥药物浓度为5.1纳克/毫升，需医护人员根据其肝功能恢复情况加大至目标浓度。

Beijing armed police general hospital of doctor of vice director of li wei said,Zhe zhe and round and round is still in an intensive-care indoor observation,Can right amount drink some sugar water.The attending physician yue doctor is introduced,At present zhe zhe anti-rejection drug concentration is 12.1 nanogram/ml,Achieve concentration;Round and round of anti-rejection drug concentration is 5.1 nanogram/ml,Need to medical personnel according to their liver function recovery increase to target concentration.

　　两母亲“换肝”救子，全国首例交换活体肝移植手术，引起社会极大关注。

Two mother"In liver"Save the son,The country's first exchange liing donor lier transplantation surgery,Cause social attention.

　　如今手术成功，北京武警总医院副主任医师李威坦言，手术前曾面临巨大压力，并不想高调宣传。如果严格按照《人体器官移植条例》(下称“《条例》”)的相关规定，这次手术很可能被北京武警总医院伦理委员会叫停，甚至会惊动卫生部。

Now successful operation,Beijing armed police general hospital of doctor of vice director of li wei said,Before the operation have are faced with great pressure,And don't want to high-profile publicity.If in strict accordance with the[The human organ transplant regulations](said"[regulations]")The relevant provisions of the,The operation was a may be Beijing armed police general hospital ethics committee to stop,Even disturb the ministry of health.

　　

“可能违反《条例》” "A possible violation of[regulations]"

　　每周二下午，武警总医院器官移植研究所9楼会议室，都会召开病例讨论会。

Every Tuesday afternoon,Armed police general hospital organ transplant research institute and floor conference room,Will a case discussion.

　　8月底的一个周二，对于罗丹、尹春林互为对方儿子“换肝”手术方案，讨论得很激烈。

One of the end of August on Tuesday,For rodin/YinChunLin are the other son"In liver"Operation scheme,Discuss very fierce.

　　器官移植研究所副主任、主任医师陈新国回忆，当时就有医生担心，这个手术可能违反《条例》相关规定，无法通过伦理会审批。

Organ transplantation, deputy director of the institute/Chief physician ChenXinGuo memories,Then a doctor worry,The possible violation of surgery[regulations]Related regulations,Not through the ethics will for examination and approval.

　　按照《条例》规定，活体器官的接受人限于活体器官捐献人的配偶、直系血亲或者三代以内旁系血亲，或者有证据证明与活体器官捐献人存在因帮扶等形成亲情关系的人员。

According to the[regulations]provisions,Living organ to accept a person limited to living organ donors spouse/Direct blood or collateral relatives by blood up to three generations,Or there is evidence to prove and living organ donors exist for supporting formed the personnel relationship.

　　对此，陈新国解释，因帮扶等形成亲情关系的人员也仅限于养父母、继子女之类。

this,ChenXinGuo explain,For supporting formed the personnel relationship is confined to the adoptive parents/Stepchild,.

　　事实上，通过“胆道闭锁互助QQ群”联系之前，罗丹和尹春林并不相识，前者是湖北人，后者则来自云南，两家并无血亲关系。

In fact,Through the"Biliary atresia mutual QQ group"Contact before,Rodin and YinChunLin is not met,The former is hubei,The latter from yunnan,Two and no blood relationship.

　　

曾有一位母亲反悔 There have been a mother back

　　此时，罗丹儿子哲哲已在医院等待肝源近5个月。

At this time,Rodin son zhe zhe has set up a file in the hospital waiting for liver source nearly five months.

　　李威认为，哲哲病情不能再耽误了，如不进行肝移植手术，一岁左右夭折的可能性很大。

Li wei think,Zhe zhe illness can't delayed,If not for liver transplants,Age aborted possibility is very large.

　　情急之下，他甚至想过让B型血的罗丹为O型血的哲哲“捐肝”，直接进行亲体肝移植手术。

unaided,He even wanted to let type B blood rodin for type O blood zhe zhe"Donated liver",Directly parent liver transplant.

　　“我一听就不同意。”罗丹的丈夫刘祥说，这种跨血型“捐肝”的风险会比同血型的要大，他担心哲哲会有较强排异反应。

"Once I listen to not agree with."Rodin's husband LiuXiang said,This cross blood type"Donated liver"The risk of blood type than with bigger,He is worried about zhe zhe will have strong rejection reaction.

　　陈新国也表示，这样“捐肝”也会增加大笔开支，因为做手术前需要先做一些预处理。

ChenXinGuo also said,this"Donated liver"Also can increase a lot of money,Because before the operation need to do some pretreatment.

　　7月中旬，麦麦(化名)一家住进武警总医院，这个不满1岁的孩子也需要换肝治疗。

In the middle of July,McGrady(alias)A live in armed police general hospital,The less than one years old children also need to change liver treatment.

　　恰巧麦麦的血型和罗丹一致，麦麦母亲血型与哲哲一致。医生们想到了交换活体肝移植手术，但由于一些个人原因，麦麦家人又反悔了。

Happen to McGrady blood type and rodin consistent,McGrady mother blood type and zhe zhe consistent.The doctors thought about exchange liing donor lier transplantation surgery,But because of some personal reasons,Wheat a McCallister family and they go back on our word now.

　　随后，通过“胆道闭锁互助QQ群”，哲哲的生命接力棒交到尹春林手上，罗丹也可以救尹春林的儿子团团。

then,Through the"Biliary atresia mutual QQ group",Zhe zhe life baton to YinChunLin hands,Rodin can also save YinChunLin son round and round.

　　

伦理会上激烈争论 Ethical controversy at the meeting

　　虽然担心审批，但救人要紧，器官移植研究所还是决定上伦理委员会。

Although the worry about the examination and approval,But save important,Organ transplantation research institute decided to the ethics committee.

　　一名参会人员回忆，9月3日下午的伦理会讨论了3个肝脏移植手术和2例肾脏移植手术申请。尹春林和罗丹“换肝”救子手术被安排在第一个。

A memory participants,September 3, afternoon ethics will discuss the three liver transplant and 2 cases of renal transplant application.YinChunLin and rodin"In liver"Save the son surgery are arranged in the first.

　　按照《条例》规定，人体器官移植技术临床应用与伦理委员会需由医学、法学、伦理学等方面专家组成，其中从事人体器官移植的医学专家不超过委员人数的1/4。李威说，当天7名委员参会。

According to the[regulations]provisions,The human organ transplant technology clinical application and ethics committee required by medicine/law/Ethics, etc experts,The transplant of human organs engaged in medical experts are not more than a quarter of the committee members.Li wei said,The day the seven members.

　　一位参会人员称，由于委员并非都是外科专家，哲哲、团团的主管医生介绍配型结果、手术禁忌症、适应症等基本情况。

A participant researchers said,Because members are not surgical experts,Zhe zhe/Round and round the competent doctor introduction type-specific results/Operation contraindication/Indications and other basic situations.

　　罗丹、尹春林两家的身份证明材料、“不会进行器官交易”保证书等书面资料，也现场经过律师审核。

rodin/YinChunLin two proof of identity materials/"Don't carry out the organ trading"Guarantee and written material,Also field after lawyer audit.

　　“是否自愿捐肝？”“是否会做器官交易？”会议主持人向罗丹、尹春林当面提问。一些委员也向主管医生和罗丹、尹春林进行了相关询问。

"Whether voluntary donated liver?""Whether it will do organ trading?"Meeting to rodin/YinChunLin questions face to face.Some members also to the competent doctors and rodin/The YinChunLin related inquiry.

　　李威等人的担心还是出现了。据李威转述，一名参会委员起初不想签字同意。这对于实行“一票否决制”的伦理委员会，如有一人不同意，移植手术将无法进行。

Li wei and others worry or appeared.According to li wei relays,A member of the first don't want to sign agreed to.To implement the"A ticket overruled make"Ethics committee,If there is a people don't agree,Transplant will not be able to do.

　　

同时手术防后悔 At the same time prevent regret surgery

　　李威回忆，这名委员不是不同意，而是有两点担忧。

Li wei memories,The members of the committee is not don't agree,But there are two concerns.

　　首先，这样的换肝手术，如果两个孩子成功大家都高兴，万一有一个孩子不成功，“怎么跟人家妈妈交代，人家万一闹事，说我的孩子没成功，得把我的肝收回来。”

First of all,Such in liver surgery,If two children success everybody happy,One thousand have a child is not successful,"How with somebody else mother metasomatism,The somebody else one thousand riots,Said I didn't succeed in children,To put my liver back."

　　其次，一般来说，一天进行一对母子的“换肝”手术是正常。如果一个妈妈看到自己儿子前一天手术成功，第二天她就决定不捐肝了，那怎么办？“现在说得挺好，但都有可能的，你也不能把人家绑到手术台上。”

secondly,Generally speaking,One day in a pair of mother and son"In liver"Operation is normal.If a mother to see his son the day before the operation is a success,The next day she decided to donate the liver,what?"Now say well,But there are possible,You also can't take the somebody else tied to the table."

　　一名到场伦理委员会委员回忆，提出担忧的这名委员在医院从事行政管理工作，与移植科医生思考角度不同，更担心手术安全问题带来的后果。

A present ethical committee memories,Put forward the members concern in the hospital is engaged in the administrative management,And the department of transplantation doctors think from different angles,More worried about the consequences of the operation security problems.

　　随后，器官移植研究所向这名委员强调了救人要紧，并详细阐述了此前交换活体肾移植的案例，最终该委员签字同意。

then,Organ transplantation research institute to the members emphasized the urgent rescue,And elaborate the previous exchange living kidney transplantation cases,Eventually the committee agreed to sign.

　　李威说，9月14日当天交叉同时进行4台手术，也是参考这名委员的意见。

Li wei said,On September 14th cross simultaneously 4 station operation,Is this reference the opinions of the members of the committee.

　　手术总负责人沈中阳教授也在接受媒体群访时坦承，做这种手术压力很大，主要来自感情和伦理。

The total operation ShenZhongYang professor also accept media group visit admits when,Do this kind of operation under a lot of pressure,Mainly comes from feeling and ethics.

　　

是否能开创新途径？ If you can create a new way?

　　2007年5月1日，《人体器官移植条例》正式实施。

On May 1, 2007,[The human organ transplant regulations]Formal implementation.

　　2008年，一例非血缘交换肾移植手术就被广州一家医院伦理委员会叫停，之后引起卫生部门介入调查。

In 2008,,A non blood exchange renal transplant was guangzhou hospital ethics committee to stop,After investigating caused by department of health.

　　但李威记得，当时一家门户网站曾发起一个调查，参与的7000人中，只有约20人反对手术。

But li wei remember,When a web portal has launched an investigation,Of the 7000 people participate in,Only about 20 people object to surgery.

　　陈新国称，由于受封建传统观念影响，很多地区都视捐献死者器官为不孝不义之举，而利用死囚器官也涉及伦理问题。这就造成用于移植手术的肝源数量较少，“一般是1个供体有150个人在等。”陈新国说。

ChenXinGuo says,Because of the influence of the feudal traditional concept,Many areas have apparent donated the dead organ for unfilial injustice lift,And the use of death organ also involves ethical issues.This can make for transplantation surgery of liver source number less,"The general is a donor with 150 people in, etc."ChenXinGuo said.

　　据李威介绍，国外文献中曾提到,“非血缘交换肝移植”或可增加10%的肝源，“这个数据是很可观的”。

According to li wei introduced,The foreign literature in the mentioned,"The blood exchange liver transplantation"Or can increase 10% of liver source,"This data is very considerable".

　　他认为，此次“换肝”救子手术属于母子之间亲情考虑，不涉及《条例》立法初衷所要禁止的器官交易，在伦理道德上可以接受，“毕竟救人要紧”。

He thinks,the"In liver"Save the son surgery between mother and child family belongs to consider,Does not involve[regulations]The legislative purpose have to ban organs deal,In ethics can accept,"After all, save important".

　　根据卫生部门统计,国内每年约有100万至150万患者需要器官移植,但每年能实施手术的仅1.3万例。面对如此大的缺口,此次“换肝”救子手术能否给类似病例一种新的解决途径呢？

According to the health department statistics,The domestic each year about 1 million to 1.5 million patients need organ transplants,But every year to carry out the operation of 13000 cases only.In the face of such a big gap,the"In liver"Save the son surgery can you give similar cases a new way to solve it?

　　北京武警总医院主任医师陈新国接受媒体采访时称，如果以后像这种父母子女，我想这种符合国家有关法律的，不存在器官的买卖,交换我想是可以考虑的。

Beijing armed police general hospital chief physician ChenXinGuo accepted the media interview said,If later as the parents and children,I think this comply with the relevant state laws,Does not exist organ business,I want to exchange can be considered.

　　本版采写/新京报记者 许路阳 实习生 李晓波

This collection &composition/Beijing news reporter xu road male interns LiXiaoBo