The husband and wife remarried and donated livers were moved by two ethical examinations.

Recently, this newspaper reported successively to the 32-year-old Sudan to save the lives of their loved ones and decided to remarry their husbands to donate livers. Today, both the liver donation and liver transplant surgery have been successfully completed on October 31, and the two patients recovered well after surgery. Behind the remarriage and donation of the liver, there is such a special organization, the Clinical Application and Ethics Committee of the Human Organ Transplantation Technology (hereinafter referred to as the Ethics Committee), and only after the committee has passed the examination can the transplant operation be carried out. The Sudan’s remarriage and donation of the liver made some ethical committee experts skeptical until the second review.

Behind this, it is the Ethics Committee's review of medical, legal, and ethical issues, the necessity and possibility of the implementation of the surgery, and whether it is suspected of organ sales and other behavioral assessments.

Regulations

The Human Organ Transplant Ordinance provides:

Hospitals qualified for human organ transplantation must establish a clinical application ethics committee composed of experts in medicine, law, ethics, etc. The number of medical experts engaged in human organ transplantation must not exceed 1/4 of the number of members of the committee. .

Before taking live organs, the practicing physician responsible for the transplantation of human organs shall submit an application for review to the ethics committee of the medical institution. It must not be taken without the consent of the ethics committee.

After receiving the application, the ethics committee should examine whether the donor’s wishes are true, whether there are sales or disguised purchases and sales of human organs, and whether the matching of human organs and the recipient’s indications are in compliance with the ethical principles and the specifications of organ transplant technology management.

After obtaining a written opinion that agrees, the medical institution engaged in living organ transplantation should report the relevant materials to the provincial health administrative department and implement it in accordance with the reply.

Ministry of Health "Regulations on Regulating Living Organ Transplantation":

After the unanimous approval and signature confirmation of all members, the ethics committee may issue written opinions that agree to be removed.

After confirming the successful match between her husband and her husband in Sudan, she had undergone two review by the ethics committee before he was allowed to undergo surgery. For the first time, 12 experts who participated in the ethics committee were not approved, and only 8 people agreed. The ethics committee implements a one-vote veto system.

Does remarrying involve transactions?

According to the "Regulations on the Regulation of Living Organ Transplantation" promulgated by the Ministry of Health, the relationship between donors and recipients who can perform living organ donation can only be a spouse, a direct lineage or a third-generation relative, a relative, or adoptive parent. Raising children, stepparents and stepchildren. The spouse also requires marriage for more than three years or having children after marriage.

According to Shi Bingyi, director of the Army General Organ Transplant Research Institute of the General Hospital of the General Staff of the Sudan who sponsored the Ethical Review of Liver Donation, although Sudan and Tian Xincui have children, the two men divorced and remarried two months later. Experts need to consider the matter behind the remarriage. Whether it involves money transactions.

"We donate organ transplants to see the relationship between the two sides." Shi Bingyi pointed out that preventing organ sales is one of the important missions of the ethics committee. The current phenomenon of forgery of relatives' status as an organ buyer and seller still exists. Many mediators will find matches. The donor performs an organ transplant pairing and then designs the relationship between the donor and the patient based on their age.

Some doctors admitted that it was difficult to identify ID cards before. However, it is now a second-generation ID card, and 164 medical institutions with the qualifications for organ transplantation in China are all required to be equipped with ID card readers. The police station will also help check the gates.

After that, a segregated review will be conducted, asking questions such as where the aunt’s aunt’s child will go, and where the school’s identity will be true or false.

Sudan’s willingness to donate to committee members

According to the Regulations on Human Organ Transplantation, human organ donation requires the principle of voluntary and unpaid.

For ethical committees, judging whether donors donate voluntarily is also an important task.

There was a case in which Shi Bingyi was very upset after hearing this. A mother made a decision to donate kidneys for her son under social and family pressure. But before the surgery, she left. As a result, under the criticism of the media, she returned to donate her kidney but failed to restore her son's feelings.

"This is in our ethics committee, it must be not ethical, and it will not pass the review." Shi Bingyi pointed out that during the review process, members can use many means to learn whether the donor is making contributions in a stressful way, such as in isolation. During the review process, experts can find problems through questioning and observation without other relatives and friends.

The willingness of the Sudan to donate livers to Tian Xinc was strongly enough for the judges to move.

Shi Bingyi revealed that after the first review of the ethics committee failed, the Sudan did not give up. She wrote to the health bureau and hospital leadership and expressed her strong intention to donate the liver, requesting that the review be conducted again. The second ethics committee conducted a more detailed investigation. “They lived in the hospital for two months. The relationship between husband and wife is what the doctors and nurses are all witnessing.”

Surgery to be harmless to donors

The first ethical committee review of Sudan’s liver donation was not passed. There are other reasons. The experts believe that the Sudan is still young and the risk of liver transplant is greater than that of kidney transplant. They need to think twice about the risks.

Shi Bingyi pointed out that from the point of view of medical ethics, surgery should not be performed on healthy people, but the act of donating organs is also saving people. Even if medical experts believe that donors are very suitable for donating surgery, the ethics committee also Will be very careful. From a medical point of view, it mainly involves the recipient's surgical indications and contraindications, as well as individualized surgical risks. From an ethical point of view, it is necessary to limit the interests of the donors in a limited manner and to be innocuous to the donors. After all, there have been cases of death of donors after donation.

Another important responsibility of the ethics committee is to measure whether the donation meets ethical requirements outside of medicine.

In the ethics committee, experts come from many aspects such as medicine, law, ethics, pharmacy, and nursing, but medical experts engaged in human organ transplantation must not exceed one fourth of the total number of members. Shi Bingyi explained that the reason for such a provision is that organ transplant medical experts are always positive about organ transplants, and many people may influence the conclusions of the ethics committee. Therefore, experts from other disciplines need to be evaluated from various angles.

A 20-year-old son wants to give kidneys to his 60-year-old father. Shi Bingyi said that in this case, some experts would agree with the son's filial affection, and some experts would disagree that the father is old enough to pass. The method of dialysis continues life, not through the destruction of the young son's health.

The People's Armed Police General Hospital had also encountered a similar situation. Chen Xinguo, deputy director of the hospital's transplant surgery, stated that the sacrifice of the interests of a healthy person cannot bring about a long-term survival. It is obviously not in conformity with the social medical ethics and the ethics committee will not pass.

Ethical judgment is difficult to judge by law

For the experts of the ethics committee, the boundaries of the law are judged well, but the judgment of ethics is the controversial place, but also the core. "The so-called ethic means whether or not it conforms to the basic principles of society. How to grasp the boundaries of ethical issues is actually very difficult to answer. It is different from the law and has no clear boundaries."

Some time ago, the parents of the two families donated livers to each other's children and received widespread media attention through media coverage.

Shi Bingyi pointed out that in such cases, the relationship between the donor and the recipient does not comply with the relevant regulations. Is this correct? Not conclusive. But if he is a member of the judging panel, he will agree. The reason for agreeing is because it really solves the problems of the two families. Parents of both families are sincere to give donations to their children, but they cannot be implemented because of different blood types. Now they can use the method of donating to each other. He thinks it is okay.

However, in view of the current environment, Shi Bingyi believes that such cases should not be encouraged and that the restrictions on the relationship between the donors and the recipients cannot be cancelled. It is still necessary to strengthen management.

Chen Xinguo who has had personal experience also believes that there are no organ sales in both cases and they are all voluntary. Although they don’t give donations to their children, they generally meet the requirements of social ethics but can’t be promoted as routine situations. Otherwise, it will have an impact on the law and it will also make it easier for organ trading.

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