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\u7de8\u8f2f\uff1a\u738b\u7fe0\u9e97<\/p>\n

https:\/\/health2.mingpao.com\/ftp\/Health2\/20161024\/news\/_24YD003_.jpg\u8056\u4e09\u4e00\u5802\u4e2d\u5b78\u524d\u6821\u9577\u80e1\u6587\u660e\u56e0\u7a81\u7136\u60a3\u4e0a\u6025\u6027\u809d\u75c5\uff0c\u800c\u6025\u9700\u63db\u809d\uff0c\u5e78\u7372\u8a72\u4e2d\u5b78\u73fe\u4efb\u526f\u6821\u9577\u96f7\u5049\u8070\u7684\u592a\u592a\uff08\u5de6\uff09\u6350\u51fa\u809d\u81df\u7e8c\u547d\u3002\uff08\u8cc7\u6599\u5716\u7247\uff09;https:\/\/health2.mingpao.com\/ftp\/Health2\/20161024\/news\/_24yd101.jpg;https:\/\/health2.mingpao.com\/ftp\/Health2\/20161024\/news\/_24yd102.jpg;<\/inline><\/p>\n","protected":false},"excerpt":{"rendered":"

【明報專訊】近期接連有人急求器官捐贈續命的新聞，八月時有中大學生馬倬朗換心事件，本月前中學校長胡文明急需換肝臟，以及10歲男童鄧啟謙等候心臟移植，引來全城關注。<\/p>\n

香港器官捐贈數目一直不理想，除了目前採用的「自願捐贈」（opt-in）制度，其他捐贈方法也在研究中，如：假設全民不反對的預設默許（opt-out）機制，病人家屬之間的交叉捐贈，或採納「心臟死亡」作為器官捐贈的判斷條件之一等。以上方法，究竟可否在香港實行？<\/p>\n

聖三一堂中學前校長胡文明，後來有幸獲該校現任副校長的太太捐肝續命，男童鄧啟謙則仍在生死邊緣掙扎。然而，新聞中提到急需器官的病人，其實只是冰山一角。<\/p>\n

根據香港衛生署的資料顯示，每日有逾2000名病人急需器官或組織移植，當中不少人因得不到合適的器官而病逝。香港移植學會會長翟偉良醫生表示，引入更多外國的器官捐贈方式，是提升器官捐贈數目的方法之一。「現時器官捐贈主要有兩個途徑，一個是活體捐贈，胡文明便屬於這種；另一種是遺體捐贈，鄧啟謙所需的心臟屬於後者。而在活體捐贈中，政府有意推行『交叉捐贈』來減少病人等待器官的時間。」<\/p>\n

交叉捐贈在歐美、韓國等地已經推行一段時間，主要是透過病者提供一位家屬作為捐贈者，然後與其他需要器官的病人配對，配對成功便可互換活體器官。翟偉良解釋﹕「現時不少病人家屬因血型問題，無法捐出器官給家人，但透過『交叉捐贈』，便可更快配對到適合自己血型的器官，得以續命。香港政府想推行的交叉捐贈，主要針對腎臟移植，因為腎臟的活體捐贈數字仍然偏低。」<\/p>\n

根據醫管局數據顯示，過去九年間的換腎個案中，每年有58至87宗屬於遺體捐贈，活體捐贈只有7至16宗；另一邊廂等候換腎人數近2000人。「現時這個計劃仍然在公眾諮詢的階段，希望可在今年內或明年實行。」<\/p>\n

道德法律問題未解決 <\/p>\n

不過，要推行交叉捐贈，需要解決的問題亦不少，當中涉及道德、法律等。「器官捐贈手術與一般手術一樣，有失敗風險，如果一方成功而另一方失敗，當中會不會出現法律問題？另外，病人家屬的年紀、性別各有不同，要定下什麼規則，才能令雙方面都達至公平、透明的原則，仍需要進一步探討。還有，社會人士對『交叉捐贈』這個計劃的接受程度有幾高、病人組織又有什麼意見等，都相當重要。」如果參加人數眾多，或可參考韓國做法，建立交叉捐贈數據庫，加快配對速度之餘，亦可由電腦計分配對，增加公平性。<\/p>\n

擬改死亡定義 提升移植率<\/p>\n

除了提高活體捐贈的人數，翟偉良指出亦有部分國家採納「心臟死亡」來增加器官的數目，「現時香港定義病人死亡可捐贈器官，主要以腦幹死亡為主，但美國、澳洲等地亦會採納心臟死亡，作為另一個病人死亡的定義」。腦幹死亡是指連接大腦與脊髓的腦幹喪失功能，無法自行控制呼吸、調節血壓及體溫，需依靠機器維持生命。而作為捐贈者，必須要由兩名資深又與器官捐贈事宜無關的醫生分別測試。然而，有些垂危的病人無法測試腦幹死亡，例如腦部重創，有些國家可以心臟死亡作判斷。<\/p>\n

心臟死亡，主要是當患者心臟停頓之後，立即進行一系列測試，當證實死亡後便可移植器官。「以捐贈者心臟死亡作定義，香港政府亦在考慮中，但要克服的問題亦不少，包括心臟要停多久才列入心臟死亡，或者過程中要使用什麼儀器施救等，都要經過醫管局臨牀倫理委員會討論。」<\/p>\n

此外，心臟死亡亦可能會令器官缺氧而快速衰竭，例如移植曾缺氧的肝臟，會較腦幹死亡遺體移植更易出現併發症，接受器官病人的生存率亦由九成減至七成；但在器官捐贈不足的情况下，仍然是值得考慮的方案之一。<\/p>\n

文：勞耀全<\/p>\n

圖：資料圖片<\/p>\n

編輯：王翠麗<\/p>\n

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