Ethic analysis of the role of incentive system in the organ donation after citizen’s death
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摘要: 器官移植在重建健康、挽救生命的卓越成效表明了其重大价值所在，其中器官捐献是促进我国器官移植事业发展的重要组成部分。近年来，我国器官移植取得了重大进展，器官捐献率也逐年上升。尽管如此，我国依然面临捐献器官数量不足的严峻事实，破解这个难题需要医学科学技术和公共卫生政策进一步完善。根据国际经验，实施一定的激励制度可以有效地提高捐献率，但是激励制度本身隐藏的伦理特性似乎与器官捐献事业中的利他精神有着根本性的冲突。因此，本文从激励的性质、器官捐献与激励制度以及激励制度的伦理论证进行综述，以期为我国官捐献和移植事业的进一步发展提供参考。Abstract: Organ transplantation has demonstrated its significant values by its excellent effectiveness in health reconstruction and life survival, where organ donation is a major component in promoting the development of organ transplantation in China. In recent years, an important progress has been made in organ transplantation in China with an annually increased organ donation rate. In spite of this, there is a serious fact confronted by us that the donated organ quantity is insufficient, which may be solved by further improvement of medical science and public health policy. According to the international experience, an incentive system may improve the organ donation rate effectively although the hidden ethic property of the incentive system itself may have an essentially conflict with the altruism contained in the organ donation. Therefore, in this article, the property of the incentive system, the interaction between organ donation and incentive system and the ethic justification of the system was reviewed, aiming to provide a reference for the further development of the organ donation and transplantation business in China.
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[1] 人体器官捐献和移植条例[EB/OL]. [2023-12-19].https://www.gov.cn/zhengce/zhengceku/202312/content_6920196.htm. [2] 全球首例!中日友好医院为54岁患者开展流程简化版“无缺血”肝移植手术[EB/OL2023-10-20]. https://www.zryhyy.com.cn/zryh/c100022/202209/ebe4377d870a462a8aade220ee66f1f8.shtml. [3] 冯龙飞, 王继超, 臧建成, 等. 论公民逝世后人体器官捐献的核心伦理原则[J]. 自然辩证法研究, 2021, 37(11): 69-75. DOI: 10.19484/j.cnki.1000-8934.2021.11.012.FENG LF, WANG JC, ZANG JC, et al. On core moral principles of organ donation from the decreased[J]. Stud Dialect Nat, 2021, 37(11): 69-75. DOI: 10.19484/j.cnki.1000-8934.2021.11.012. [4] 湖北省第十二届人民代表大会常务委员会. 湖北省人体器官捐献条例[EB/OL]. [2023-10-20]. https://www.wcbyg.com/index.php?c=show&id=267. [5] 天津市第十五届人民代表大会. 天津市人体器官捐献条例[EB/OL]. [2023-10-20]. https://www.tjrd.gov.cn/flfg/system/2013/04/08/010013487.shtml. [6] 中国器官移植基金会. 中国器官移植发展报告(2021)[M]. 北京: 人民卫生出版社, 2022: 5-8. [7] AU CH, HO KKW, CHIU DKW. Stopping healthcare misinformation: the effect of financial incentives and legislation[J]. Health Policy, 2021, 125(5): 627-633. DOI: 10.1016/j.healthpol.2021.02.010. [8] BASTANI B. The present and future of transplant organ shortage: some potential remedies[J]. J Nephrol, 2020, 33(2): 277-288. DOI: 10.1007/s40620-019-00634-x. [9] 柏拉图. 理想国[M]. 郭斌, 张竹明, 译. 北京: 商务印书馆, 2014: 46. [10] Nuffifield Council on Bioethics. Human Bodies: Donation for Medicine and Research[R/OL]. [2023-10-20].https://www.nuffieldbioethics.org/publications/human-bodies-donation-for-medicine-and-research. [11] CHOW KM, AHN C, DITTMER I, et al. Introducing incentives and reducing disincentives in enhancing deceased organ donation and transplantation[J]. Semin Nephrol, 2022, 42(4): 151268. DOI: 10.1016/j.semnephrol.2022.07.002. [12] SOYLU D, SOYLU A, ŞEN S. Two significant concepts in organ donation: empathic tendency and altruism[J]. Transpl Immunol, 2022, 75: 101731. DOI: 10.1016/j.trim.2022.101731. [13] ŁUKÓW P. Pure altruistic gift and the ethics of transplant medicine[J]. J Bioeth Inq, 2020, 17(1): 95-107. DOI: 10.1007/s11673-019-09951-z. [14] JENKIN RA, GARRETT SA, KEAY KA. Altruism in death: attitudes to body and organ donation in Australian students[J]. Anat Sci Educ, 2023, 16(1): 27-46. DOI: 10.1002/ase.2180. [15] YU L, ZHAI X. Ethical and policy considerations for organ trafficking and transplant tourism: based on the UK's first international case of human trafficking for the purpose of organ removal[J]. Health Care Sci, 2023, 2(5): 339-344. DOI: 10.1002/hcs2.70. [16] ALBERTSEN A. Efficiency and the futures market in organs[J]. Monash Bioeth Rev, 2023, DOI: 10.1007/s40592-023-00180-0[Epub ahead of print [17] LEVY M. State incentives to promote organ donation: honoring the principles of reciprocity and solidarity inherent in the gift relationship[J]. J Law Biosci, 2018, 5(2): 398-435. DOI: 10.1093/jlb/lsy009. [18] DANOVITCH GM, CAPRON AM, DELMONICO FL. The true meaning of financial neutrality in organ donation[J]. Am J Kidney Dis, 2021, 77(6): 967-968. DOI: 10.1053/j.ajkd.2020.11.006. [19] ARNOLD R, BARTLETT S, BERNAT J, et al. Financial incentives for cadaver organ donation: an ethical reappraisal[J]. Transplantation, 2002, 73(8): 1361-1367. DOI: 10.1097/00007890-200204270-00034. [20] RASIAH R, NAGHAVI N, MUBARIK MS, et al. Can financial rewards complement altruism to raise deceased organ donation rates?[J]. Nurs Ethics, 2020, 27(6): 1436-1449. DOI: 10.1177/0969733020918927. [21] LEWIS A, KOUKOURA A, TSIANOS GI, et al. Organ donation in the US and Europe: the supply vs demand imbalance[J]. Transplant Rev (Orlando), 2021, 35(2): 100585. DOI: 10.1016/j.trre.2020.100585. [22] 周帆, 王蒲生. 身体、死亡与利他主义: 从中国传统生命伦理观看器官捐献之困[J]. 医学与哲学, 2022, 43(12): 31-36. DOI: 10.12014/j.issn.1002-0772.2022.12.07.ZHOU F, WANG PS. Body, death and altruism: reviewing the dilemma of organ donation from traditional Chinese bioethical views[J]. Med Philos, 2022, 43(12): 31-36. DOI: 10.12014/j.issn.1002-0772.2022.12.07. [23] 张悦, 韩优莉. 医疗服务提供者激励要素和激励机制的实验研究综述[J]. 中国卫生政策研究, 2021, 14(2): 56-63. DOI: 10.3969/j.issn.1674-2982.2021.02.009.ZHANG Y, HAN YL. Review on experimental study of incentive factors and mechanism of medical service providers[J]. Chin J Health Policy, 2021, 14(2): 56-63. DOI: 10.3969/j.issn.1674-2982.2021.02.009. [24] 赵金萍, 武菊芳, 刘云章. 我国人体器官捐献的激励机制研究[J]. 中国医学伦理学, 2009, 22(5): 93-94. DOI: 10.3969/j.issn.1001-8565.2009.05.040.ZHAO JP, WU JF, LIU YZ. Research on the incentive mechanism of human organ donation[J]. Chin Med Ethics, 2009, 22(5): 93-94. DOI: 10.3969/j.issn.1001-8565.2009.05.040. [25] ROBITAILLE N, MAZAR N, TSAI CI, et al. Increasing organ donor registrations with behavioral interventions: a field experiment[J]. J Mark, 2021, 85(3): 168-183. DOI: 10.1177/0022242921990070. [26] DOPELT K, SITON L, HARRISON T, et al. Revisiting the relationship between altruism and organ donation: insights from Israel[J]. Int J Environ Res Public Health, 2022, 19(12): 7404. DOI: 10.3390/ijerph19127404. [27] 国家卫健委关于印发中国人体器官分配与共享基本原则和核心政策的通知[A/OL]. [2023-10-20]. https://www.codac.org.cn/contentdon/policy/20180803/173102105.html. [28] SIRAJ MS. Ethical analysis of appropriate incentive measures promoting organ donation in Bangladesh[J]. Asian Bioeth Rev, 2022, 14(3): 237-257. DOI: 10.1007/s41649-022-00208-3. [29] NAZZAL M, ENGELHARDT A, HALLCOX T, et al. The effect of a merit point incentive system on the willingness to donate organs[J]. Transplant Proc, 2023, 55(10): 2326-2332. DOI: 10.1016/j.transproceed.2023.09.023. [30] World Health Organization. WHO guiding principles on human cell, tissue and organ transplantation[J]. Transplantation, 2010, 90(3): 229-233. DOI: 10.1097/TP.0b013e3181ec29f0. [31] 于兰亦, 邱仁宗, 翟晓梅. 公民逝世后器官捐献激励的伦理学思考[J]. 医学与哲学, 2019, 40(10): 14-18,31. DOI: 10.12014/j.issn.1002-0772.2019.10.04.YU LY, QU RZ, ZHAI XM. Ethical considerations on incentives for organ donation after citizen's death[J]. Med Philos, 2019, 40(10): 14-18,31. DOI: 10.12014/j.issn.1002-0772.2019.10.04. [32] LUO A, HE H, XU Z, et al. A qualitative study in family units on organ donation: attitude, influencing factors and communication patterns[J]. Transpl Int, 2022, 35: 10411. DOI: 10.3389/ti.2022.10411. [33] DANOVITCH GM, DELMONICO FL. The prohibition of kidney sales and organ markets should remain[J]. Curr Opin Organ Transplant, 2008, 13(4): 386-394. DOI: 10.1097/MOT.0b013e3283097476. [34] 李德新, 黄敏. 人体挑战试验的伦理治理探究[J]. 医学与哲学, 2023, 44(10): 1-5. DOI: 10.12014/j.issn.1002-0772.2023.10.01.LI DX, HUANG M. Research on ethical governance of human challenge trials[J]. Med Philos, 2023, 44(10): 1-5. DOI: 10.12014/j.issn.1002-0772.2023.10.01. [35] BRYCE CL, SIMINOFF LA, UBEL PA, et al. Do incentives matter? providing benefits to families of organ donors[J]. Am J Transplant, 2005, 5(12): 2999-3008. DOI: 10.1111/j.1600-6143.2005.01106.x. [36] BARNIEH L, KLARENBACH S, GILL JS, et al. Attitudes toward strategies to increase organ donation: views of the general public and health professionals[J]. Clin J Am Soc Nephrol, 2012, 7(12): 1956-1963. DOI: 10.2215/CJN.04100412. [37] 广西壮族自治区人民政府. 南宁市免除城乡困难对象基本殡葬服务费用实施方案的通知[A/OL]. [2023-10-20]. http://nnxn.zwfw.gxzf.gov.cn/art/2022/10/8/art_26557_2051.html?dept=undefined. [38] 齐齐哈尔市人民政府. 齐齐哈尔市免除殡葬基本服务费用实施办法[EB/OL]. [2023-10-20]. http://www.qqhr.gov.cn/Newsgk_showGkmlNews.action?messagekey=220709. [39] 郭林. 中国殡葬服务:核心问题与发展思路[J]. 社会保障评论, 2020, 4(3): 90-106.GUO L. Funeral services in China: core issues and development strategies[J]. Chin Soc Secur Rev, 2020, 4(3): 90-106. [40] 李纪恒. 坚持在发展中保障和改善民生[J]. 中国民政, 2021(19): 8-11.LI JH. Persist in ensuring and improving people's livelihoods in development[J]. China Civil Affairs, 2021(19): 8-11. [41] CHEN WL. Body donation registration in Taiwan: reasons and associated psychological factors[J]. Healthcare (Basel), 2023, 11(7): 969. DOI: 10.3390/healthcare11070969. [42] 闫威, 王波. 内外在激励间的挤出效应与互补效应研究[J]. 统计与决策, 2011(6): 52-55. DOI: 10.13546/j.cnki.tjyjc.2011.06.049.YAN W, WANG B. A study on the crowding out effect and complementary effect between internal and external incentives[J]. Stats Decision, 2011(6): 52-55. DOI: 10.13546/j.cnki.tjyjc.2011.06.049. [43] 刘灿辉, 安立仁. 经济奖励对个体内生激励的挤出效应研究——激励偏好与工作复杂度的调节作用[J]. 西北大学学报(哲学社会科学版), 2016, 46(5): 63-69. DOI: 10.16152/j.cnki.xdxbsk.2016-05-010.LIU CH, AN LR. A study on the crowding out effect of economic rewards on individual endogenous incentives: the moderating effect of incentive preference and work complexity[J]. J Northwest Univ (Philos Soc Sci Edit), 2016, 46(5): 63-69. DOI: 10.16152/j.cnki.xdxbsk.2016-05-010. [44] MARTÍNEZ-LÓPEZ MV, DÍAZ-COBACHO G, LIEDO B, et al. Beyond the altruistic donor: embedding solidarity in organ procurement policies[J]. Philosophies, 2022, 7(5): 107. DOI: 10.3390/philosophies7050107. [45] DELMONICO FL, MARTIN D, DOMÍNGUEZ-GIL B, et al. Living and deceased organ donation should be financially neutral acts[J]. Am J Transplant, 2015, 15(5): 1187-1191. DOI: 10.1111/ajt.13232. -
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