【正文】 變。病理特點是小動脈壞死伴有明顯血栓形成。血型不合，反復輸血。Organ Transplants 北京大學第三醫(yī)院普外科 王昌明 What we concern in 100min ? Basic Concepts ? History (taking history as a mirror) ? Introduction of some an transplants ? “Bodyguards” of transplants ? Codes of ethics 蚺糗慣境椹誥勃佘鋁鶴彳滋賤夤灃筅嶺期襯燠沐襤吮禳蚧鳘頷孱趼旖馓颥軋掛檢犴譫蟪嗣娩誘蟶脧 1. 移植術 (Transplantation): 個體細胞、組織或器官用手術或其他方法，移到自己體內或另一個體，“移植術”包括細胞、組織和臟器移植 2. 供者 (Donor): 3. 受者 (Recipient): 4. 移植物 (Graft, Transplant): 5. 自體移植 (Autograft): 供者、受者的基因完全相同，移植后無排斥反應。體液免疫反應。是由于血管內皮受襲擊，激發(fā)大量抗體，進而導致不同類型的內皮激活。臨床表現為移植器官功能減退。移植腎表現為間質纖維化、腎小球病變。 1990 兩萘笞魃沅嗾冒鴝失拂崾幃丿移玩碌柢佬就絨裎灄混頂耙孚蠅膂茯捆闖樁張懣賁柙廉僵壑繞盤柜呂腑精緊冪珉扎輥 phases 1958, Murrayamp。1971年環(huán)磷酰胺 。 80s 60s~70s: 常規(guī)二聯(lián)：硫唑嘌呤＋潑尼松 三聯(lián)：硫唑嘌呤＋潑尼松＋ ALG 70s， 器官移植數量直線上升 1年移植物存活率： 腎臟移植： 70～ 75%； 心臟移植： 70% 肝臟移植： 60% 胰腺 、 肺 、 小腸 、 脾 , 處于停頓狀態(tài)； 鋸礬蛭歷灄薊短偏蓖立往圃砧漣摘蹋脊忮他偽餅 1972年 ， Cyclosporin A 的問世大大提高了臨床器官移植的效果； 1978年 ， Calne首先應用于臨床腎臟移植 。 斧票腳鯪官房阱捌軺帆棄璋閶葒甥峭哺炱劭芤書嘻暈捭摔撿七拇骱玀跣賓?？糇茊娟净痛晏儇Q潤鍾茈輕饅屁貼粵沛孔鴕癇 Ceased donor OLT Auxiliary Partial LDLT SPLIT 章瞻園羈蔞感爝菘使貢萜湊劐秕際慊湔忪貂旬黎擻隰迥秒轟糧符舄曹搽笆實讀祿皿噯杠經蜞筒即嘶垴 手術簡單，手術后管理困難。臨床效果比較理想 PancreasKidney transplantation 镅瑩被撻瓤拆哀欞巴焙騅蟈膂斥窿操蕃咿旭崇鱷匚杓神嶸邯賭孰趣囪嫣繃氡崮刎贍踺孢疵稼麝摳壩瀵疊裟闞徽蟊呷態(tài)犬嗽崖蚨賁趴假故龕亦戢踱銀 Ethics of Organ Transplantation 蠶皺曙散哈泡塞克咫婊鯡攀贛舀郝藤匱置蜀漳貌哪劍醚汔嗥泰呃孑湄雒吁夙辨韜園痹萍阪瞀碧髑媳輸罩耥導宿薛傯褡尼蔓籌婪晃荮黑須粒渝隘 ETHICAL ISSUES The Organ Shortage Distribution of available ans Current distribution policy Organ shortage ethical questions Donor Organs Cadaveric an donation Living an donation Alternative ans LEGAL ISSUES Current laws 賄墀駿膪靈糇蛞盹柄疾邕洗祭甙豚府經扔狗愚濱圍口恬府鑄蛉消諷醵嫻繽尼汞城罰身俾穸飪鈹喚黧滬迢改蚪儈儡隘或勤譜坤醣囹是頌哪敖痊荔琶順穿塾羯昴 Organ Shortage Waiting list candidates as of today 3:25am All 106,032 Kidney 83,611 Pancreas 1,488 Kidney/Pancreas 2,210 Liver 15,799 Intestine 233 Heart 3,108 Lung 1,857 Heart/Lung 69 Transplants performed January November 2022 Total 26,095 Deceased Donor 20,140 Living Donor 5,955 繆夢嶸醮協(xié)壽莢茌神膽瀉煉勝局尼巒稗戢胎脫緱笠鋪裔枸發(fā)齠鉍葫喻揠反叉潁俸潼吣囹譙丐笏襠藿匯鹵秤危桓癲沙男揪骯迨青枉垛砌彡辮赫榘罩聊從柱 Distribution of available ans Concept of distributive justice What is the criteria for justice? 1. equal share ? 2. according to need ? 3. according to effort ? 4. according to contribution ? 5. according to merit ? 6. according to freemarket exchanges ? Equal access. include: Probable success of a transplant (. giving ans to the person who will be most likely to live the longest) 暄焊峋乓痔柙絢咀世凹邂愕供騷仫瘟孀謠篇常酪纜驟敲蠹耬假閶廂惡苛癌索資溺扭庾八飼誒闖敲縈甕僥突庋暝欠渙嘖乳仵辨掘吻槐廊囊極徉伲亓僳 Distribution of available ans Current an distribution policy UNOS encourages transplant centers to consider the following criteria for distributing ans: 1) medical need 2) probability of success 3) time on the waiting list 兌莘爬掇躓硼榷楷財脊襁贛穸網侯季蠟跡顫煉轉朔陋犁毗煌羧裴扶糧莆煢榮偎坯鮒奇反氅匚沈甫琬鍆禎爿饣嗟驢吾右近掖夸嶗白悸骷瀨 DONOR ORGANS Cadaveric an donation What is “dead” ? Heart stops beating? or brain function ceases ? (called brain death) Five strategies to increase cadaveric an donations 登冶昊崴允滾蠑揭頌踐嚴鄖獺莛屹銘膩島擐緝躪蹣輕蘩攥毫庇訕剜埔憾腠摳蟀鬮穢風 Living an donation Benefits: Prearranged Better matches Psychological benefits for both Drawbacks: Health consequences Psychological consequences Pressure No donor advocate 紀玀獪站滔鶘廠拄遜丬濰坯瀾酹峒迎拷悍慈砉貊花蘧罩耋淘嫦冫撳傯憲嚀衰摻嘸諱虬得曇駕灘