中国明年起全面停止使用死囚器官作移植供体来源

中国人体器官捐献与移植委员会主任委员、中国 医院协会人体器官获取组织联盟（中国医院协会OPO联盟）主席黄洁夫日前在中国医院协会OPO联盟昆明研讨会上宣布：从2015年1月1日起，全面停止使 用死囚器官作为移植供体来源，公民逝世后自愿器官捐献将成为器官移植使用的唯一渠道。而如何提升民众器官捐献热情，以填补供应缺口，也成了重要课题。

将条例升格为法律，推进器官捐献

当下应及早将条例升格为法律，制定专门的《人体器官捐献法》，明确各相关部门在器官捐献联动机制中的定位与责任份额。

都知道，我国器官供求紧张，人体器官捐献率较低，是老大难问题。一方面是供需严重不匹配，一方面又是非法买卖器官现象的猖獗……这也将我国器官捐献困境映衬无遗。该怎么改变现行单一的捐献模式？说到底，得靠器官捐献制度在法治框架下的补全。

比如在人体器官移植工作方面，就应将“非移 植”医院也纳入捐赠医疗管理体系。2010年，卫生部曾公布具有人体器官移植资质的医院名单，包括全国31个省份的163家医院。但据了解，我国器官捐献 者大部分初访单位是基层医疗机构，许多潜在捐献者也都来自“非移植医院”，但它们缺乏供体维护经验，也缺乏积极性。因此，有必要对非移植医院也建立跟评级 挂钩的考核体系。而在移植程序上，器官移植临床服务过程中，还必须有专职协调员见证，不允许相关医疗机构私自开展器官捐献工作。

此外，在捐助激励机制上，进行器官捐献可减免捐赠者一些医疗费用和丧葬费，是时下的常规做法。可对器官捐献者的精神嘉勉，对其中家庭困难者的救助补偿，仍相对匮乏。在国外，对捐献者的家庭救助一般会通过商业保险解决，而国内则缺乏相应的机制。

而这些，也亟须以器官捐献管理法治化为目标， 加快器官捐献立法。2007年5月国务院曾颁布《人体器官移植条例》，使器官移植管理初步制度化。当下应及早将条例升格为法律，制定专门的《人体器官捐献 法》。就算无法升格为法律，也应尽快修改完善条例，明确各相关部门在器官捐献联动机制中的定位与责任份额。《条例》规定：“国家通过建立人体器官移植工作 体系，开展人体器官捐献的宣传、推动工作”，但并没有明确具体的工作和责任主体。

还有，根据条例规定，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。该规定在实践中易被规避、滥用，滋生 为买卖器官而假结婚，或“存在因帮扶等形成亲情关系”被无限制放大解释的现象。所以建议修改相关规定，实现“严控活体”和“激活遗体”的良好效果。

提升公众器官捐献意愿，亟须将器官捐献制度纳入法治轨道，尤其是在全面推进依法治国的背景下，这更是迫在眉睫。

□ 刘武俊（司法部《中国司法》杂志总编）
 

国外是怎么解决器官捐献问题的

对于器官移植或捐献，很多国家采取“普遍”登记制度。它们还建有独立、统一、公开的“器官获取与移植网络”，以保障器官资源分配公平。

器官捐献问题是个世界性难题。即便是在应对方式相当成熟的美国，每年仍会有几千人在等待器官移植过程中死去。不过，与国内动辄一比几十的供需比及刚刚起步的“器官捐献工程”相比，某些“它山之石”着实可资借鉴。

在不少欧美国家，政府会通过各种方式鼓励人们 签署器官移植和捐献协议，并在器官移植中心留存配型用血样。鼓励措施大体有两种：一种是社会性鼓励。协议签署者如果患病需要移植器官，将享有一定优待。另 一种是经济性鼓励。在美国，政府会给登记的志愿者减轻个人所得税。向器官移植捐献专门组织捐财物的，也会享受一定的税收减免。

对于器官移植或捐献，很多国家采取“普遍”登 记制度。在西班牙，除非其本人“生前表达过反对的意见”，否则所有公民都被视为器官捐献者。在美国，驾照的作用堪比“身份证”。公民每次申领或更新驾照 时，都会被问及是否同意死后捐献器官。如果同意，驾照背面会被标上明显的符号或印记。

那怎么保障器官资源分配公平呢？西方发达国家都建有独立、统一、公开的“器官获取与移植网络”，患者和“供体”的信息在该网络中均能获取，患者等待人体器官的排序也是公开的，且接受公众和卫生行政部门监管。

日常情况下，政府对捐后程序公平性的“增信释 疑”工作也必不可少。首先是尊重捐赠者的自愿，保证到位的全社会动员，但不以特定的人群作为游说对象。在法国，虽然法律规定“车祸死亡后无特别声明即为同 意捐献”，医疗机构也会在实际操作中与死者家人进行充分沟通。其次是分配过程透明，保证每例捐献都经过统一的分配系统，打击器官黑市，禁止系统外分配。积 极参与动员的社会组织多多益善，但供供体登记和分配的平台只能有一个。

在器官捐献问题上，一些西方发达国家的政府机 构与非政府组织在推动社会观念革新上也在合作，前者负责宏观协调，后者则重在微观动员，尤其是打破一些社会“禁忌”和“偏见”方面。例如，宣告脑死亡后立 即进行脏器摘取是不是在剥夺病人的抢救机会？老、弱、病、幼者的捐赠是不是有充分价值？专责于此的机构和组织会花大力气去消除疑虑。他们会努力举证以脑死 亡作为宣告死亡依据的科学依据，会列举各种宗教、教派视器官捐献为爱与慈善化身的证据等等。

从社会观念到制度细节到医学操作，系统化推进；从物质激励到道德感召，一样不落，这些无疑值得我们学习。

□ 史泽华（北京外国语大学副教授）
 

China will stop using executed prisoners as a source of organ transplants from next year, a former official of the Health Ministry said on Wednesday, according to a report by China Business Network.

From Jan 1, 2015, all the organs needed in transplants will come solely from voluntary donations from citizens, Huang Jiefu, former vice-minister of Health said at a seminar by China's Organ Procurement Organization (OPO) held in Kunming.

At the two CPC sessions in 2012, Huang told Beijing Times that the lack of organs caused a bottleneck in organ transplants. Because of insufficient donations, executed prisoners became the main source of organs.

"Every year, around 300,000 patients need organ transplants but only 10,000 surgeries are performed," said Huang at the seminar.

Chinese people are much less willing to donate their organs after death compared to other countries, with the ratio being only 6 out of 10,000,000, Huang said.

"The ratio in Spain is 370 out of the same amount, which is almost 62 times that of China", he added.

Speaking of the reasons behind the low participation, Huang said Chinese traditions and the fairness of organ distribution are the top two concerns, with the latter being particularly important.

For quite some time, the organ transplant situation in China has been messy, with a lot of illegal trades taking place on the black market and even in licensed hospitals, wher it is quite common for people to take advantage of organ scarcity to make profit, the report says.

"Before 2007, more than 600 medical organizations could deal with organ transplants," Huang said, "Driven by financial benefits, many illegal acts happened and nonstandard surgeries were performed."

Among the problems is the use of executed prisoners' organs, he said. In China, about 65% of transplanted organs are from the deceased, with executed prisoners the source of more than 90% of them, said an article by Huang.

According to relevant regulations issued in 1984, the prisoners' bodies can be used for organ transplant only under certain conditions, e.g. if no one collects the body, the criminal agrees or his family agrees to the medical use of the body.

However, it is questionable whether the prisoners are making the agreement out of their own will and using their organs has become an unspoken rule to ease the demand in the market, the report said.

The State Council passed the Regulations on Human Organ Transplant on March 2007, providing a legal basis to supervise transplants.

Huang said that these regulations are being amended and will be renamed as "Donations and transplant of human organs in China", in order to make voluntary donations the only source of organs.

Prisoners are still among the qualified candidates for donations, but their organs will be registered in the computerized system instead of being used for private trades, which will be the main difference in the future, Huang told reporters.

New regulations will be unveiled to clarify the legal procedures of organ donations for prisoners sentenced to death and those who violate them will be given harsh punishment, the report said.

At the same time, the Committee of Human Organ Donation and Transplant and China's Organ Procurement Organization were founded this year, with the former responsible for making policies and regulations and the OPO mainly in charge of the donation and transplant procedures, in order to make it more fair, efficient and transparent.

Data released at the seminar shows that 1500 donations have been made this year, more than the total donations from 2010 to 2013.

"I believe the situation of organ donations will get better and better in the future", Huang said.

Reportedly, 38 organ transplant centers in the country have already discontinued the use of executed prisoners' organs.