장기 및 인체조직 구득에 관한 공적 체계의 확립

김현철 이화여자대학교 생명의료법연구소 2014 생명윤리정책연구 Vol.8 No.2

Organs and human tissues are needed for the transplantation of organ and human tissue. However, organs or human tissues can be procured by essentially donations. Brain death and deaths donation therein is very important. And donation has ethical implications in itself because it is a manifestation of the spirit of sacrifice. So society to receive donations is responsible for honorable treatment of donors properly. For that, it is necessary to establish the public procurement system. In Korea, public procurement system has been introduced since 2003. However, in the current system “individual institutions centered procurement system” and “independent institutions centered procurement system” are mixed. In order to override this problem, it is needed to convert the paradigm of public procurement system into independent institutions centered procurement system. Then, there is a need for integration of laws to be divided into organs or human tissues for that. 장기이식과 인체조직이식을 위해서는 이식에 사용될 장기나 인체조직이 필요하다. 그런데 장기나 인체조직은 기본적으로 기증에 의해서 조달될 수 있다. 그 중에서 뇌사자와 사망자의 기증은 매우 중요하다. 그리고 기증은 그 자체로 윤리적 함의를 가지고 있고 희생정신의 발로이기 때문에, 기증을 받는 사회는 그 기증자를 적절히 예우할 책임을 진다. 그러기 위해서 필요한 것이 이른바 구득을 전담하는 공적 구득기관 제도이다. 우리나라에서는“장기등 이식에 관한 법률”에서 최초로 구득기관제도를 도입하고, 2015년부터 시행될“인체조직안전 및 관리등에 관한 법률”개정법에서 인체조직 분야에 독립적인 구득기관 제도를 도입할 예정이다. 그런데 현재 제도적으로“개별 기관 중심 구득체제”와“독립 기관 중심구득 체제”가 혼재되어 있다. 이를 기증정신과 구득의 효율성을 감안하여“독립기관 중심 구득 체제”로 제도의 패러다임을 전환해야 할 것이다. 그리고 이를 위해 장기와 인체조직으로 나뉘어 있는 법률의 통합이 필요하다.

인체조직법 개정의 의의와 법적 쟁점

김현철(Hyeon cheol KIM),윤이레(Erei Yoon) 이화여자대학교 생명의료법연구소 2015 생명윤리정책연구 Vol.9 No.2

2015년 1월부터 시행 중인「인체조직안전 및 관리 등에 관한 법률」은 국내 인체조직 기증 활성화를 위하여, 2005년 제정된 인체조직의 안전성 규제 중심의 법률에 대하여, 기증자에 대한 공적 관리를 강화하고 안전성 확보방안도 강화를하는 등 국내 인체조직 기증활성화를 위하여 큰 폭의 개정이 이루어진 법률이다. 그럼에도 여전히 규제기관의 이원화라는 점 및 기증에서부터 환자에게 전달되는 전체 프로세스의 완결성 미비라는 점에서 한계를 가지고 있으며, 이는 조직기증지원기관의 위상, 조직의 채취 및 조직의 분배구조와 환자 전달체계라는 법적· 제도적 측면에서 드러난다. 이를 위하여 인체조직 기증에서 이식에 이르는 전 과정을 구조적으로 체계화하는 입법 작업이 필요하며, 적어도 기증과정에 관한 한장기이식법과 인체조직법의 통합이 입법적으로 요청된다. The Safety and Management of Human Tissue Act, which has come into effect since January 2015, was revised for the original act focusing on regulation of human tissue safety enacted in 2005, in broad scope including to strengthen public management on donors and its guarantee of safety, in order to activate human tissue donation in Korea. Nevertheless, the act has limitations such as dual systems of regulatory agencies and incompleteness of the entire process from donation to patient, which have been seen in the legal and institutional perspectives such as appropriate role of TPO, recovery of human tissue, distribution structure of tissue, and delivery system to patients. For this, it is necessary to legislate to systematize structurally the entire process from donation of human tissue to its transplantation, and for the donation process at least, it is legislatively required to integrate both acts on organ transplantation and human tissue.

Recommendations for SARS-CoV-2 testing and organ procurement from deceased donors in the Republic of Korea

Kim Si-Ho,Wi Yu Mi,문치숙,Kang Ji-Man,Kim Minhwa,Kim Jungok,김종만,Seok Hyeri,Shi Hye Jin,Lee Su Jin,Lee Ji Yeon,Jeong Su Jin,Choe Pyoeng Gyun,Huh Kyungmin,Lee Sang-Oh,Kim Sang Il 대한이식학회 2023 Korean Journal of Transplantation Vol.37 No.3

We present a summary of the evidence on testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and organ procurement from deceased donors and provide recommendations based on current clinical data and the guidelines from major transplant organizations. Because of the limited historical experience with coronavirus disease 2019 (COVID-19), certain recommendations in this document are based on theoretical rationales rather than clinical data. The recommendations in this manuscript may be subject to revision as subsequent clinical studies provide definitive evidence regarding COVID-19 in organ procurement.

Analysis of Factors Affecting Emergency Physicians’ Attitudes toward Deceased Organ & Tissue Donation

Lee Dong Eun,Kim Hyun,Park Kwi Hwa,Park Song Yi,박승민,Jung Yong Hun,Jeong Wonjoon,Park Kyung Hye 대한의학회 2021 Journal of Korean medical science Vol.36 No.49

Background: This study aimed to investigate differences in knowledge, and attitudes toward deceased organ and tissue donation of emergency physicians. Additionally, we analyzed factors affecting the attitudes toward deceased organ and tissue donation. Methods: We conducted a survey of specialists and residents registered with the Korean Society of Emergency Medicine in December 2020. The respondents’ sex, age, position, personal registration for organ donation, experience of soliciting organ donation, participation in related education, knowledge, and attitude about brain death organ donation, and attitude toward stopping life-sustaining treatments were investigated. According to the characteristics of the respondents (specialists or residents, experience and education on organ and tissue donation), their knowledge and attitude toward deceased organ donation were compared. Stepwise hierarchical multiple regression analysis was used to investigate the factors affecting the attitudes toward deceased organ and tissue donation. Results: Of the total 428 respondents, there were 292 emergency medicine specialists and 136 medical residents. Specialists and those who registered or wished to donate organs had higher knowledge and attitude scores regarding deceased organ and tissue donation. Those who had experience recommending organ and tissue donation more than 6 times had higher knowledge scores on deceased organ and tissue donation and higher overall scores in attitude. Those who received education from the Korean Organ Donation Agency had higher knowledge scores. Specialists, and those who wished to donate or had registered as organ donors and had a higher life-sustaining treatment attitude score and knowledge about deceased organ and tissue donation, had more positive attitudes toward deceased organ and tissue donation. Conclusion: For more potential deceased organ and tissue donors to be referred for donation, there should be continuous education for emergency physicians on brain-dead organ and tissue donation-related knowledge and procedures. In addition, institutional or systematic improvements that can lead to organ donation when deciding on the withdrawal of life-sustaining treatment should be considered.

해외 주요 국가와 비교 고찰을 통한 인체조직기증 활성화 방안

현윤정(Yun-Jung Hyun),이난영(Nan Young Lee),김동자(Dong Ja Kim) 한국산학기술학회 2020 한국산학기술학회논문지 Vol.21 No.12

현대 사회는 장기 및 인체조직기증에 대한 요구도가 높아지고 있으나, 우리나라에서 인체조직기증에 대하여 인식도와 기증률이 낮아 기증 활성화를 위한 현실적인 방안에 대한 연구가 필요할 것으로 사료된다. 본 연구는 국내외 관련 문헌고찰 및 나라별 이식 등록기구 홈페이지 자료를 참조하여, 인체조직기증과 관련한 국내 법률과 운영 제도 현황을 분석하였으며, 해외 주요 국가와 비교 고찰하였다. 본 연구를 통하여 국내 인체조직기증 활성화 방안으로 법률적 측면에서 이원화된 장기와 조직이식에 관한 법체계의 통합화, 제도 운영적 측면에서 과도한 압력이 없는 국가의 장기기증에 대한 추정적 동의 방식인 Opt-out 제도의 활성화와 사회 문화적 측면에서 대국민 홍보 활성화를 제시하였다. 그러나 추정적 동의 방식은 다양한 사회적 공론화 단계가 필요하며, 거부 의사를 위한 등록체계 운영사항에 대해 국내 실정에 맞는 이해가 있어야 할 것이다. 결론적으로 외국에 비하여 낮은 장기 및 인체조직기증을 활성화하기 위한 법적 제도정비가 요구되며, 기증에 대한 긍정적 인식 전환, 대중 홍보 및 사후 기증자와 가족에 대한 지원 등이 필요할 것으로 사료된다. In modern society, there is a growing demand for human tissue donation along with organ donation. However, the awareness of tissue donation and actual donation rates remain very low in South Korea. This study was undertaken to evaluate the current status of domestic laws and systems, and to compare them with the operation systems of major foreign countries, by reviewing literature and web sites of organ donation and registration. The authors present three measures to promote human tissue donation in Korea: integration of a dual legal system in a legal aspect, vitalization of the Opt-out system in terms of system operation, and activation of public relations in terms of social and cultural aspects. The Opt-out system, in particular, is the most effective way to activate transplants in the form of presumed consent of countries without undue pressure. However, the presumed consent method requires various stages of social public debate, and the requirement is a proper domestic understanding of the registration system for rejection. In conclusion, we believe the solution towards a positive inclination for organ donation is a public policy to increase the supply for organs and human tissue transplants, and positive perception of donations, public promotion, and support for postmortem donors and their families.

응급의학과 의사의 뇌사장기조직기증 권유 대화의 경험

박송이 ( Song Yi Park ),김현 ( Hyun Kim ),박귀화 ( Kwi Hwa Park ),박승민 ( Seung Min Park ),이동언 ( Dong Eun Lee ),정용훈 ( Yong Hun Jung ),정원준 ( Won Joon Jeong ),박경혜 ( Kyung Hye Park ) 대한의료커뮤니케이션학회 2021 의료커뮤니케이션 Vol.16 No.1

Background : Emergency physicians are increasingly participating in brain-death organ tissue donation (OTD). It is difficult communication to inform family members about suspected brain-death and potential donor. This study sought to explore the experiences and communication of emergency physicians in brain-death OTD. Methods : This is a qualitative study that interviewed 10 experienced emergency physicians with brain-death OTD and analyzed the data by thematic analysis method. Results : The study revealed 20 subthemes and 5 themes; 1) Families who are invited to donate organs make decisions after long periods of consideration by the entire family, 2) It is uncomfortable to recommend organ donation, 3) Explaining and obtaining consent is ‘the hardest job’ for the attending physician, 4) The way the attending physician does ‘the hardest job’ is by explaining, 5) Passively solicit donation. Conclusion : The experienced emergency physicians with brain-death OTD were using methods of communication to understand and sympathized with the family members and had abundant experiences. The findings of this study will help inexperienced emergency physicians with brain-death OTD.

Clinical importance of congenital anomalies of the inferior vena cava in organ procurement surgery from a deceased donor

Mi-Hyeong Kim,Kang-Woong Jun,In-Sung Moon,Ji-Il Kim 대한외과학회 2016 Annals of Surgical Treatment and Research(ASRT) Vol.91 No.5

Congenital anomalies of the inferior vena cava (IVC) are rare but important problems in living donors for kidney transplantation, especially in cases of a short left renal vein and accompanying vascular and urological anatomic variations. However, the clinical impacts of IVC anomalies in deceased donors have yet to be reported. The unexpected presence of an IVC in an unusual position poses challenges to surgeons and increases the risk of bleeding during organ removal. Accompanying vascular variations can cause unexpected bleeding and injury and therefore technical complications in procurement and subsequent implantation. During cold perfusion, inadequate venous drainage or insufficient cooling can induce graft damage. Our cases highlight the need for all transplant surgeons to confirm the anatomy of the aorta, IVC, and major vessels early in the surgical procedure and, should an anomaly be detected, know how to manage the problem.

Exploring the experiences and perspectives of emergency physicians on brain death organ tissue donation after the Life-Sustaining Treatment Decision Act

박송이,김현,박귀화,박승민,이동언,Yong Hun Jung,정원준,박경혜 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.1

Background: This study explored emergency physicians’ experiences and perspectives related to brain death organ tissue donation (OTD) after the enforcement of the Life-Sustaining Treatment (LST) Decision Act in Korea. Methods: Using the Braun and Clarke thematic analysis method, this qualitative study analyzed interview data—comprising experiences and perspectives of brain death OTD since the LST Decision Act—of 10 emergency physicians who specialized in targeted temperature management (TTM) and cared for post-cardiac arrest patients. Results: Data analysis revealed 13 subthemes and 5 themes: the LST Decision Act is easier to explain to family members than brain death OTD, but it does not fit well in an emergency medical setting; many family members decide to stop LST even before physicians mention brain death or OTD; family members view stopping LST as being about comforting patients without bothering them, and decision-makers are therefore no longer willing to choose OTD; stopping LST does not always result in brain death, but cases of brain death are preceded by stopping LST; and since the LST Decision Act, the number of TTM cases and potential brain death donors has decreased. Conclusions: Unless a supplementary policy that connects stopping LST to brain death OTD is prepared, the withdrawal of LST in patients resuscitated after cardiac arrest is expected to continue, and brain death OTD is expected to decrease.

Parameters for successful pig islet isolation as determined using 68 specific-pathogen-free miniature pigs

Kim, Hyoung-Il,Lee, Song-Yi,Jin, Sang Man,Kim, Kang Seok,Yu, Jae Eun,Yeom, Su-Cheong,Yoon, Tai Wook,Kim, Jae Hyeon,Ha, Jongwon,Park, Chung-Gyu,Kim, Sang-Joon Blackwell Publishing Ltd 2009 Xenotransplantation Vol.16 No.1

<P>Abstract: Background: </P><P>Islet cell transplantation is a novel therapeutic modality for the cure of diabetes. Pig islet cells are an attractive substitute for human islet cells; however, they are known to be particularly difficult to isolate because of a weak islet capsule and a tendency to be fragmented during enzymatic digestion. Therefore, parameters favoring successful pig islet isolation were investigated using specific-pathogen-free (SPF) miniature pigs.</P><P>Methods: </P><P>Sixty-eight SPF miniature pigs were used for islet isolation. Birth weight, body weight, age, sex, pregnancy history, and the fasting blood glucose levels of each pig were determined. Each pig’s general condition was assessed with regard to feeding status and physical activity. Pancreas procurement was performed by one surgical team. Anesthesia duration, operation duration, procedure quality, and perfusate type were recorded. After pancreatectomy, a biopsy was performed for islet density analysis. Decapsulation, cannulation duration, degree of distension, and cold ischemic time were assessed. During islet isolation, pancreas weight, digestion time, and digested tissue proportion were recorded. Isolation results were evaluated by total islet equivalents (IEQ), islet equivalents per gram of pancreas (IEQ/g), isolation index, islet recovery rate, purity, and visual grade. To identify the predictors of higher islet isolation yield, we performed binary logistic regression analysis with significant (P < 0.05) variables from the univariate analysis.</P><P>Results: </P><P>The pigs were categorized into high (n = 34) and low yield (n = 34) groups according to the median IEQ/g or total IEQ values. Body weight and age were significantly different between the two groups. Being male or a positive history of pregnancy in females was factors favoring successful islet isolation. General condition assessments failed to estimate islet isolation results. Long anesthesia duration, which might have caused ischemic injury to the pancreas, negatively affected islet isolation results. Decapsulation, cannulation duration, and subsequent pancreas distension were significantly important in successful islet isolation. Inter-lot variability of Liberase was not observed because of screening processes performed before purchase. Isolation index and islet recovery rate correlated well with islet yields.</P><P>Conclusions: </P><P>Multivariate analysis using total IEQ and IEQ/g as outcome variables indicated that age older than 2, being male and moderate distension by Liberase injection are major determinants influencing successful islet isolation.</P>

간호대학생의 생존 시와 뇌사 시 장기기증 의도에 관한 구조모형

김은아(Kim, Eun A),최소은(Choi, So Eun) 한국간호과학회 2015 Journal of Korean Academy of Nursing Vol.45 No.6