통합 장기등이식법의 핵심쟁점과 기본방향

주호노 한국의료법학회 2018 한국의료법학회지 Vol.26 No.2

This paper presents the legislative direction of the so - called integrated organs transplantation act, which is now focussed on the organ transplantation, tissues, the cord blood transfusion and the hematopoietic stem cell transplantation. Among them, the Diet has persistently sought to rectify the following matters. In other words, in the 2014 settlement of accounts, preparing a method that can efficiently execute the Goduk activities of organs and human organizations in collaboration, establishing an integrated management system over the medium to long term, in the National Assembly Audit of 2015 , Strengthen publicity for the provision of organs, unify public information budget execution at the organ transplant center, build long-term and human body organization integrated management system in the long term, in the 2015 settlement, the Ministry of Health and Welfare , Promoting the integration plan concerning the donation management of organs and human body organization with a specific schedule and the duty of donation of organs and human body organization is dualized in the National Assembly Audit of 2016 and donor's inconvenience and budget execution As the problem of inefficiency has occurred, it is the core issue that the National Assembly was required to remedy, integrating related laws and institutions and integrally building donation procedures. The integration Act based on the organ transplantation act is adopted as the basic direction of the legislation for the integrated organs transplantation act. For more information, please refer to the following: (1) acceptance of cardiovascular or brain death with or without organ transplantation, (2) abolition of the brain death judging committee, (3) abolition of brain death judging committee, (4) prohibition of organ donation by minors, (5) and the integration of the organs acquisition agencies(KODA). 이 논문은 현재 장기이식법, 조직이식법, 제대혈법 및 조혈모세포이식법안으로 난립하고 있는 소위 이식4법의 통합법으로서의 소위 통합 장기등이식법의 입법방향을 제시하고 있다. 그 동안 국회에서는 다음과 같은 사항들에 대하여 시정할 것을 줄기차게 요구해 왔다. 즉, 2014년 결산에서는 장기와 인체조직의 구득활동을 연계하여 효율적으로 수행할 수 있는 방법을 마련하고 중장기적으로 통합관리체계를 구축할 것, 2015년 국정감사에서는 장기기증 활성화를 위한 홍보강화 및 홍보예산 집행을 장기이식센터로 일원화하고 장기적으로 장기와 인체조직의 통합관리체계를 구축할 것, 2015년 결산에서는 보건복지부는 장기와 인체조직의 기증관리에 관한 통합계획을 구체적 일정을 마련하여 추진할 것, 2016년 국정감사에서는 장기와 인체조직의 기증절차가 이원화되어 있어 기증자의 불편과 예산집행의 비효율 문제가 발생하고 있으므로 관련법 및 기관을 통합하여 기증절차를 통합적으로 구축할 것이 국회로부터 시정요구된 핵심적 사항이다. 통합 장기등이식법에 관한 입법의 기본방향으로서 장기이식법으로 중심으로 한 통합, 심장사와 함께 장기이식과 무관한 뇌사를 판정하게 함으로써 사망판정의 이원화, 뇌사판정위원회의 폐지, 미성년자의 장기기증의 금지 및 한국장기조직기증원(KODA)에 의한 장기, 조직, 세포라는 장기등의 구득기관의 통합을 제안하고 있다.

우리나라 장기이식의 현황과 법률문제

문성제 ( Moon Seong-jea ) 한국외국어대학교 법학연구소 2006 외법논집 Vol.24 No.-

Organ transplantation, the finest example of modem medicine, is based on respect for human life in that it can deliver patients from malignant diseases incurable in past. Since the first successful operation in 1969 as followed by successful transplantation of liver extracted from a person with brain death in 1988, organ transplantation has been already one of most crucial medical arts in Korean and global medicine. Here, organ transplantation consists of 2 processes; one is transplanting organs for medical treatment of patients, and the other is extracting necessary organs from organ donor. The organ transplantation includes auto-transplantation(organ recipient = organ donor), xenograft(replacement with animal organs), insertion of mechanical organs and more. These cases don't involve any special legal issue except general issues in surgical operation such as medical adaptation for such treatments, technical criteria about such medical behaviors and patient’s agreement. But in case of xenograft that needs different organ donor from organ recipient, any one party concerned faces inevitable issues like lost organs or damaged corpse, and the other party benefits from survival or recovered health via transplantation. Because of this contradiction, the organ transplantation involves a question about how to resolve relevant legal issues. As shown here, it is also necessary to discuss extra legal considerations about different interests in organ transplantation between organ donor and recipient. Although there are issues concerned with organ transplantation in terms of organ recipient, it may be construed as general medical behaviors in regard to the nature of medical cure. However, from the standpoint of organ donor, even though the extraction of organ is indispensable for the cure of organ recipient, such extraction itself is not inherent behaviors of medical cure, so it is necessary to build up a series of legal principles to legitimate such behaviors. Here, they depend on whether certain organ is extracted from living organism or dead one. Furthermore, the extraction of organ from living or dead body involves a series of questions like whether to follow the intent of person who has a disposition authority, who the person is, which legitimate effects the expression of his/her intent may have in force, and so forth. In addition, in terms of organ transplantation from living organism for successful transplantation, conflicts concerned with brain death related to beginning and end of person as principal with capacity of enjoyment of rights have been already controversial in discussions between legal and medical circles since long decades ago. Fortunately, the latest enactment and enforcement of “Organ and Equivalent Transplantation Act” gives a clue to resolve these conflicts, but there are still little reviews and studies about potential issues concerned with human respect. It is possibly expected that there will be a series of brisk academic discussions about these issues. From this viewpoint, this paper focuses on posing questions related to organ transplantation and suggesting corresponding solutions.

뇌사자 장기기증의 윤리적 조건과 문화적 과제

문시영 한국기독교사회윤리학회 2007 기독교사회윤리 Vol.13 No.-

Organ donation would be a practice of agape for saving patient's life. It has noble and moral meaning for Christians and others also. It is an ethical alternative to dealing in human organs for organ transplants. But, in Korea, shortage of organ for transplants resulted to be cases of purchasing foreigner's organ, e. g. Chinese. Now, Korean churchs eagerly try to promote promise of organ donation from volunteers. In this context, this paper studied the moral justification and ethical conditions for organ donation. There are two ways to procure human organs for transplants: from living donor and from brain death people. This paper focused on the latter, ‘organ donation from brain death people. Now, there are some principles for donation of human organ including autonomy and informed consent. And the key concept is autonomous agree on ment. But it is difficult to certify for brain death people who agree on organ donation in form of ‘living will’. In this case, the only way to decide of organ donation is, what so called, the ‘presumed consent’ of family. Now, presumed consent has some ethical difficulties for rights of decision maker of those cases. Who can decide properly? And what's the grounds of organ donation of brain death people. Now, this paper recommends shift from presumed consent to living will. In other words, organ donation must be justified by autonomous consent and voluntary devotion for agape. Organ transplants have to do with technology and medical issues. But organ donation is an ethical issue which is morally justifiable under the condition of ethical autonomy. And this study propose a task of transformation of traditional bio-culture to biblical view of life and death for Christian of Korea.

장기이식과 자기결정권

최상회 대한변호사협회 2009 人權과 正義 : 大韓辯護士協會誌 Vol.- No.394

An Organ Transplant is a medical operation in which a part of a person’s body is replaced because it is diseased. It is stand for recovering from an Organ Transplant operation. However, the situation is that there are far more patients who wish to have transplants than those who provide organs. This situation go from bad to worse every year. Organ distribution must be fair because organ is scarce sources. It is declared the equality of transplanting the organ in Articles 12 to 13 of Organ Transplantation Act. However, arguments continue because the equality is not defined clearly. Maybe Organ Transplant of a man run into conflict with many people. It is difficult to solve that society have an effect on self-determination of organ donor. In terms of organ transplant, the ‘self-determination’ is looked at from the following two principles. One is the principle that it is necessary for the patients themselves to make their own decisions for any medical actions. The other is that based on the individual’s own decision, nobody is allowed to restrict their personal lives, namely, the way they spend their lives. This paper look into irrationality from ban of organ sales for want of organ for transplant in extremis. I will seek suggestion for an new law policy through look around an opinion of Veatch on unfair of organ distribution on limit and discriminative at self determination. 장기이식은 다른 개체의 정상적인 장기나 조직을 떼어 내어서 질병이나 외상으로 손상된 부분에 이식함으로써 그 기능을 회복시키는 일을 말한다. 그러나 여러 가지 이유들로 인하여 장기는 이식을 희망하는 환자들보다 제공하겠다는 장기기증자의 수가 훨씬 적은 것이 현실이며 해마다 이러한 현상이 가중되고 있다. 장기는 매우 희소한 자원이기 때문에 장기이식을 받아야 하는 사람들 간에 공정한 배분이 이루어져야 하는 것은 자명한 것이다. 그러나 한 사람의 장기를 다른 사람에게 이식하는 일은 잠재적 장기기증자, 장기수혜자, 그리고 의료계, 경제계 혹은 연구분야 등 다른 여러 직종에 종사하는 사람들을 갈등의 상태로 몰아넣을 수 있다. 장기를 기증해야 한다 혹은 기증해서는 안된다 등을 결정함에 있어 사회가 어떤 방법으로 그 구성원에게 영향을 미칠 수 있으며, 또한 그러한 영향을 미쳐도 되는가 하는 의문에 대한 대답은 간단하지 않다. 장기이식 수술은 기증자 및 수혜자 양측 당사자의 자율적인 결정에 의한 것이어야 하며 자기결정의 원칙은 인간의 자유와 존엄성의 존중을 기초로 하여 개인의 자율이 존중되어야 하고, 인간존재로서의 자기결정은 존중되어져야 한다. 본 논문에서는 이식을 위한 장기가 극단적으로 부족한 상황에 대응하는 방법으로서 장기매매 규제에 대해서 자기결정권의 입장에서 그 불합리성을 살펴보고, 장기분배의 제한적, 차별적인 자기결정의 부당성에 대해 비치(Veatch, Robert M)의 의견을 제시함으로써 새로운 법정책의 시사점을 찾고자 하였다.

뇌사에 대한 의사와 일반인의 태도 조사

손현균,김광일,김이영 大韓神經精神醫學會 1994 신경정신의학 Vol.33 No.1

In this attitude survey using Q-methodology, the authors attemped to identify the physician`s & public attitudes toward brain death. Thirty three statements related to attitude toward brain death were Q-sorted by 71 physicians & 71 laymen. The data were statistically analysed by Q-factor analysis. Five factors in physician group and six factors in layman group could be extracted. Characteristic features of five factors in the physicians were as follows: Factor A: Physicians of this factor positively approve of brain death by pragmatic reason. They agree to organ transplantation, but they resist donation of their own organs in organ transplantation. They are selfish and treasure their body. These people could be named as 「The egoistic brain death advocators」. Factor B: Physicians of this factor approve of brain death for organ transplantation. Most of them are religious. These people could be named as「The humanitarian brain death advocators」. Factor C: Attitude toward brain death in this group is vague. They agree to organ transplantation and also have intention of donation of their own organs and receipt of others. These people could be named as 「The transplantation devotees」. Factor D: These physicians are indifferent in attitude brain death and organ transplantation basically. These people could be named as「The bystanders」. Factor E: These physicians have no trust in phsysicians, religion and modern medicine. They agree to organ transplantation but strongly oppose to brain death. These people could be named as「The doctor mistrustees」. Characteristic features of factors in the laymen were as follows: Factor A: Subjects of this factor positively approve of brain death. They also agree to organ transplantation. They want to receive organs from others but do not intend to donate their own organs because they selfish and treasure their body. These people could be named as「The egoistic brain death advocators」. Factor B: People of this factor approve of brain death and organ transplantation. They are will to donate their own organs. They are mostly post graduated, single females. These people could be named as「The active brain transplantation advocators」. Factor C: People of this factor have somewhat negative attitude toward brain death but approve of organ transplantation. They have no intention of donation of their own organs in viewing traditional concept and attitude. They are mostly religious. These people could be named as 「The traditionals」. Factor D: These persons have no trust in physicians and religion. They have somewhat negative attitude toward brain death. They have no conspicuous opinion toward brain death and organ transplantation. These people could be named as「The doctor mistrustees」. Factor E: This factor was polarized. 「The extreme opposites to brain death」versue「The extreme brain death advocators」were named.「The extreme opposites to brain death」strongly oppsed to brain death and organ transplantation. Attitude of「The extreme opposites to brain death」are mirror image of「The extreme brain death advocators」. Discussion was carried out on the various attitude toward brain death in physicians and laymen.

장기기증 의사표시방식에 관한 각국의 최근동향

송영민(Song Young Min) 원광대학교 법학연구소(의생명과학법센터) 2018 의생명과학과 법 Vol.19 No.-

The consent method of organ donation in current Organ Transplant Law is appropriate to guarantee the self-determination right of individual and family in terms of reflecting the will of individual and family at first, but this method is not appropriate to invigorate the organ donation. For this reason, many countries have been changing from existing method of assent expression of will to presumptive consent method. The extracted organs from the deceased are social resources, and the organ transplant process connecting organ donor and recipient should regard as social activity including the person concerned beyond the category of individual medical practice of organ donor and recipient. In this sense, presumptive consent method would be paid fairly by social solidarity and appraised positively in terms of saving the life of patient in case there is no treatments except organ transplant. The revised contents on consent method of current Organ Transplant Law Article 22 Clause 3, in spite of revising Organ Transplant Law several times, amended the partial contents maintaining the frame of existing consent method. For this reason, organ donation method of current Organ Transplant Law still maintains the basic frame as it was enacted. The consent method, aiming to prevent the illegal trade when it was revised, would not be appropriate to maintain it after being revised to invigorate organ transplant regarding the whole intent of the articles. Reviewing the consent method of organ donation in Korea, I suppose that transplant medical treatment is not medical practice being admitted and supported by society but medical practice being conducted within family. Transplant medical treatment would not be achieved by the patient’s intent alone. It is impossible for transplant medical treatment unless the organ donors are formed widely in the society, in this sense, transplant medical treatment is able to be implemented only by social intent. In conclusion, it is inevitable to modify the law to establish transplant medical treatment. 현행 장기이식법상의 장기기증 동의방식은 본인과 가족의 의사를 제1차적으로 반영한다는 점에서 개인이나 가족의 자기결정권 보장이라는 측면에서는 타당하다. 그러나 이러한 방식은 장기기증의 활성화라는 측면에서는 적절하지 못한 면이 있다. 많은 국가가 기존의 승낙의사표시방식에서 추정적 동의방식으로 전환하는 이유도 여기에 있다. 사망한 자로부터 적출된 장기는 사회적 자원이며, 기증자로부터 수용자에게 연결되는 장기이식 과정은 장기기증자나 장기수혜자의 개인적인 의료행위의 범주를 넘어 이식관계자를 포함한 사회적 활동이라고 보아야 한다. 이러한 의미에서 추정적 동의방식은 국민의 사회연대에 의해 공평하게 부담되고 이식 이외에는 다른 치료법이 없는 환자의 생명을 살린다는 점에서 긍정적으로 평가할 수 있다. 현행 장기이식법 제22조 제3항은 장기이식법의 수차례 개정에도 불구하고 동의방식에 대한 개정내용은 기존의 동의방식에 대한 틀을 그대로 유지한 채 부분적인 것에 대한 내용을 손질한 것이었다. 이러한 이유로 현행 장기이식법상의 장기기증방식은 제정당시의 기본 틀을 그대로 유지하고 있다. 이러한 모습은 개정당시의 장기의 불법적인 매매를 차단하는 것에 목적을 두고 있는 형태에서 태동한 동의방식은 그 후 장기이식의 활성화를 목적으로 개정된 이후에도 그대로 유지하는 것은 조문의 전체적인 취지라는 측면에서 적절하지 않다. 우리나라의 장기기증 동의방식을 보면, 이식의료는 사회가 인정하고 지지하는 의료가 아니라 가족 내에서 이루어지는 의료에 불과하다고 해야 한다. 이식의료는 환자의 意思만으로 성립하는 의료는 아니다. 장기를 기증하는 기증자가 사회에 폭넓게 형성되지 않으면 불가능한 의료이며 이러한 의미에서도 사회의 意思에 의하여 비로소 가능한 의료이다. 이식의료를 정착시키려면 법률의 정비가 불가피하다.

장기이식업무에 있어서 사회복지사의 직무수행도

이병은 한국임상사회사업학회 2007 임상사회사업연구 Vol.4 No.1

1988년 뇌사자의 장기기증에 의한 간이식 성공 이후, 뇌사의 법적 인정 필요성, 생명윤리 논란, 장기매매행위 등 제반 문제점을 해결하기 위해 ?장기 등 이식에 관한 법률?(이하 “장기법”이라 한다)을 1999년 2월 8일 제정하여 이듬해인 2000년 2월 9일부터 시행하였다.이러한 문제점을 보완하기 위하여 장기법에서는 국립장기이식센터(Korean Network for Organ Sharing : KONOS)를 두어 장기기증에 대한 총괄적 관리를 운영토록 하여 뇌사자의 기증장기를 공정하게 분배하는 성과는 있었으나 장기기증은 활성화되지 못하였다.장기법에서 사회복지사를 참여토록 규정하고 있으나 장기이식의료기관에서 사회복지사가 어떤 직무를 수행하는지에 대하여 의료사회복지사계에서 많은 연구를 하고 있으나 현재의 객관적인 사회복지사의 직무에 대한 연구는 그리 많지 않다. 그래서 본 연구에서 장기이식의료기관으로 지정받은 의료기관중 고형장기를 이식할 수 있다고 한 의료기관중에서 52개 기관을 선정하여 2006년 3월 12일부터 3월 22일까지 설문지를 우송하여 회송받았다. 적절치 않은 설문지는 제외하고 이중 16개의 설문지만 통계처리에 사용되었으며, SPSS 12.0을 사용하여 빈도분석을 실시하였다.측정도구는 이호선(2003)이 개발한 직무수행도를 토대로 하여 수정하여 사용하였으며, 간호사를 대상으로 한 수행도로서 일부내용은 사회복지사에게 적합하지 않아 의사의 자문을 받아 수정하거나 제외하였다. 수행점수는 5점 리커트척도를 사용하였으며, 1점은 “매우 자주 한다”에서 5점은 ”매우 적게 한다“로 되어 있다. 점수가 낮을수록 업무에 참여율이 높게 나타난다. After the lung transplantation was operated successfully by the organ donation from brain-dead people in 1988, 「The Law of Organ Transplantation」(“Organ Law”) was established on Feb. 8, 1999 and became effective from Feb. 9 of the next year in order to settle the problems relative to the organ transplantation such as the necessity of legal acknowledgement on brain-death, controversy on bioethics, the behavior of organ dealings, etc. To make up for those matters, “Korean Network for Organ Sharing: KONOS” was set to have them operate the general management on organ donation, and it leads fair sharing of organs donated by brain-dead people accordingly, organ donation, however, couldn’t be revitalized. Organ law prescribes that social workers are to participate in the organ transplantation’s procedure, and medical social welfare organization is studying what kind of jobs social welfare workers perform in the medical institutions of organ transplantation. There are, however, not many objective studies on the social welfare workers’ duties at present.For the study at such current situation, 52 medical institutions which are able to transplant solid organs among the ones designated as medical organizations for organ transplantation were selected. They are surveyed by post from March 12 to 22, 2006. Improper questionnaires were excluded and only 16 ones were used to the statistics process. The frequency analysis was carried by the use of ‘SPSS 12.0’. The survey tool is ‘Job performance chart’ designed by Lee Hoseon (2003) and it is partly adjusted. It’s because the subject was nurses and some parts are not suitable to social welfare workers. For the survey, thus, we revised partly or even excluded some context with the help of doctors’ advice. ‘Likert Scales’ (5 points) was used as performance score; it ranges from one point of ‘very often’ to five points of ‘rarely’. The lower the score is, the higher they participate in their duties. The result of this study presents that the educational background of participant social welfare workers are higher than master degree. The performance of social worker’s duty in the organ transplantation operation is centered on the evaluation of pureness of organ donation. It is expected that we all should pay attention to enlarge the participation of social workers in organ transplantation hereafter.

生體臟器移植과 患者의 自己決定權

김상찬(Kim Sang-Chan) 한국법학회 2008 법학연구 Vol.29 No.-

생체간 장기이식은 뇌사판정을 둘러싼 문제를 피할 수 있고 사체이식에 비하여 착생율이나 생존율이 높다는 장점이 있으며, 특히 장기이식 희망자는 많고 사후장기제공자는 적어 주요 국가들의 동향을 보면 생체이식에 의존하는 경향이 있다. 그러나 생체장기이식은 윤리성이 중시되고, 제공자의 안전과 건강을 어떻게 보호할 것인가의 문제가 남는다. 이러한 점을 감안하여 본고는 생체간 장기이식과 환자의 자기결정권에 관하여 일본에서의 논의를 중심으로 살펴보고 있다. 우선, 생체이식의 의학적 배경과 현황을 살펴본 후 주요국가의 생체이식에 대한 윤리적ㆍ법적 규제의 내용을 개괄적으로 살펴보고, 위와 같은 생체이식의 의학적ㆍ사회적 상황에 근거하여 민사법적 입장에서 생체이식과 관련하여 환자(제공자)의 자기결정권에 대하여 검토하고 있다. 우리나라도 ‘장기 등 이식에 관한 법률’이 시행되고 있는 바, 일본과 우리나라는 모두 생체이식에 의존하는 비율이 높은 실정으로 비슷한 상황이며 그에 따른 문제점도 같다고 할 수 있다. 그러므로 일본에 있어서의 이에 대한 논의는 우리나라의 같은 문제를 해결하는데 매우 유용한 자료를 제공하게 될 것이다. Live organ transplants have the advantage of being able to avoid the issues surrounding the proclamation of cerebral death as well as the fact that it has a higher rate of survival compared to transplants from a dead donor. However, the situation is that there are far more patients who wish to have transplants than those who provide organs. When looking at the general trend of many nations, there is the tendency to rely on live organ transplants. However, live organ transplants question the morality of its actions and there is the also the issue of how to protect the donors' safety and health. Taking this fact into consideration, this paper attempts to look closely into the discussions made in Japan about live organ transplants and the autonomous decisions of patients. First of all, the background and present situation of live organ transplants are looked into. Then, the general moral and legal issues regarding live organ transplants in major countries are investigated. Finally, based upon the aforementioned cases of medical and social situations of live organ transplants, the autonomous decisions by the donors from a civil law perspective are discussed. In terms of live organ transplant, the' autonomous decision' is looked at from the following two principles. One is the principle that it is necessary for the patients themselves to make their own decisions for any medical actions. The other is that based on the individual's own decision, nobody is allowed to restrict their personal lives, namely, the way they spend their lives. Korea in particular is also carrying out the 'laws regarding organs and transplants'. Both Korea and Japan are at a position where there is higher percentage of reliance on live organ transplants, making their situations similar. Therefore, the problems that follow could be said to be similar as well. As a consequence, the discussions made in Japan will be a very useful data in solving the synonymous problems in Korea.

뇌사판정과 장기이식의 윤리적 문제

이종원 새한철학회 2012 哲學論叢 Vol.69 No.3

뇌사 판정과 장기이식과 연관된 사례들을 소개하면서, 뇌사판정과 연관된 윤리적 논점들을 검토하고, 장기이식을 위해서는 뇌사판정이 어떠한 조건들을 충족해야 하는가에 대하여 고찰하고자 한다. 전통적으로 심장과 폐의 기능을 근거로 호흡이 중단되고 맥박이 멈추게 되면 사망으로 판단하였다. 하지만 최근 첨단 의료기술의 발달로 인하여 뇌사가 심폐사를 대체하는 개념으로 제시되었다. 뇌사는 삶과 죽음의 경계를 그어야 하는 현실적인 이유에서 제기되었다. 환자가 뇌사상태에 빠져 회복 불가능한 상태로 무의미한 생명 연명 치료를 지속하고 있는 경우에, 어느 시점에서는 치료를 중단해야 할 필요성이 제기된다. 뇌사에서 심장정지까지 이르는 기간 동안 소용되는 막대한 치료비를 감당하기 어려운 환자 보호자의 경제적 정신적 고통을 고려해야 한다는 것이다. 뇌사는 뇌 기능의 상실 정도에 따라 전뇌사, 뇌간사, 대뇌사로 나뉜다. 전뇌사는 뇌 전체의 기능이 상실된 상태를 말하며, 뇌간사는 호흡, 순환, 대사기능과 체온조절 등 생명유지에 필수적인 뇌간의 기능이 상실된 상태를 말하고, 대뇌사는 대뇌의 기능이 상실되었을 경우 사망으로 인정하자는 주장이다. 뇌사는 장기의식과 직접적으로 연관된다. 수많은 사람들이 장기 이식을 기다리다가 죽어가는 현실을 직시한다면 심폐사를 대체하는 개념으로 뇌사를 받아들일 수 있게 된다. 뇌기능의 정지로 인하여 죽음이 머지않아 어차피 초래되는 것이라면 그 죽음을 예측하여 사망선고를 내리고, 그 사체의 장기를 적출하여 이식할 경우, 이식의 성공률을 높일 수 있다. 뇌사자는 자신의 장기를 필요로 하는 사람들에게 제공함으로써 불치병의 환자들에게 새로운 생명을 제공할 수 있다. 따라서 자발적 동의에 의한 장기이식은 자기희생을 통해 사랑이나 자비와 같은 인류애의 보편적 가치를 실현하는 방편이 된다. 장기이식의 긍정적 측면은 첫째, 인간의 장기와 같이 가치있는 자원을 재활용한다는 것은 도덕적으로 정당하다는 것이다. 둘째, 장기의 기증자와 수혜자가 반드시 일방적으로 구분되지는 않는다는 점이다. 그런 점에서 장기이식은 공동체 의식을 고양시키고, 사회의 연대감을 강화시키는 여건을 제공하는 효과적인 수단이 된다. 따라서 자발적인 의사를 근거로 한 뇌사자의 장기제공은 새로운 건강과 행복을 되찾게 되는 불치병의 환자에게는 생명의 자발적인 희생을 대가로 주어진 존엄한 선물로 해석될 수 있다. 뇌사판정의 정확성과 합리성을 객관적으로 확립하기 위한 전제조건은 전체 뇌 기능의 상실로 제안되어야 하며, 무엇보다 인간 생명에 대한 경외심을 갖고 뇌사 판정에 신중을 기하는 것이 바람직하다. In this paper, I will survey the ethical controversy surrounding the definition of brain death. Then, I will suggest the condition definition of brain death for the Organ Transplantation. According to the traditional understanding of death, when the heart and lungs are irreversibly stopped, death has occurred. However, recently medical technical devices are intervening in the natural process of living and dying, thus the issue of brain death has emerged. There are three kinds of brain death, that is, whole brain death, brain-stem death, and higher-brain death. These three definitions of brain death represent the degree of loss of brain function. Normally when the entire brain has died, we consider death has occurred. The key concept of brain death is the irreversible loss of the capacity for bodily integration and social interaction. Brain death directly relates to organ transplantation. The demand for organ transplants exceeds the supply, and this gap is growing. Therefore if we follow the whole brain death definition, we can procure organs from a brain dead person and transplant those organs. The organ donor gives new life to the person who receive the organ. From this viewpoint, organ transplantation with voluntary consent reveals love or mercy by practicing self-sacrifice. There are two positive dimensions of organ transplantation. First, organ transplantation is justified ethically because it can recycle valuable resource, like human organs. Second, it's difficult to differentiate between organ donors and organ beneficiaries. Organ transplantation is a useful means for promoting community spirit and social solidarity. Also it is considered a dignified gift to the organ beneficiaries. The precondition for rationally and correctly defining brain death is limited to the whole brain function loss. First of all, we must be more prudent in defining brain death to preserve the dignity of human life and to prevent its misuse.

亞細亞 諸國의 臟器移植에 關한 法律 : Ⅱ. 日 本: 角膜 및 腎臟의 移植에 關한 法律(昭和 五十四年 十二月 十八日-法律 第六十三號) Ⅱ. Japna : Cornea and Kidney Transplantation Act(Law No. 63, December 18, 1979)

이영균 최신의학사 1993 最新醫學 Vol.36 No.5