從多元觀點省思器官捐贈制度的應有走向－以屍體器官捐贈為中心

Abstract

依中華民國器官捐贈協會推估，國內約有五至六千人正等待移植，惟每年捐贈器官人數不滿百人。我國器官捐贈率約3pmp，低於歐美20pmp。國內法界向來不重視器官捐贈議題，醫界雖然討論熱烈，不過通常只談增加器官來源，不討論分配。其次，醫界倫理觀偏效益主義，少見康德思維。醫界文獻多有美國UNOS介紹，卻忽略世界推行器官捐贈最優的西班牙，亦不曾討論國內骨髓、血液的成功運作經驗。本論文係透過倫理學分析、法律經濟分析、法律社會分析、他國法制的參考、法律史探討、次級資料分析及質化的深度訪談等研究方法，全面檢視器官捐贈議題。 本論文介紹了歐美器官捐贈制度，並參考國內血液、骨髓募集與分享的操作經驗，目的是要建立我國器官捐贈的適當法制。又為提高器官供給量，本論文分析學者曾提出的各種對策，包括死刑犯器官捐贈、器官市場、未來市場、補償制、推定同意制、強行抉擇制、交互保險制、異種移植、器官複製。而一般民眾對器官捐贈的看法深刻影響器官捐贈風氣，本論文除解讀學者已提出的問卷調查成果外，也親自訪談十六位相關人士，以了解民眾與專業人員的想法。本論文且充分探討這個領域最重要法律－人體器官移植條例的歷來演進。透過仔細論證，本論文建議器官捐贈制度應以西班牙模式為藍本，兼採美國、我國血液、骨髓運作經驗。短期內，我國器官捐贈量仍是杯水車薪，本論文主張應推動公平的分配原則，以免有社經地位者佔盡優勢。此外，器官捐贈法制要有效運行，人體器官移植條例就有修正必要。本論文認為修法重點在於：設立器官、組織與移植委員會、死亡概念的更新、捐贈屍體器官的配套、捐贈活體器官條件的修正、醫學倫理委員會權能的擴張、告知後同意義務的擴張、增加登錄中心協調分配的權力、強制醫護或社工人員勸募器官、增加器官捐贈誘因、器官贈與概念的釐清、將骨髓幹細胞列入輸出入管制、針對器官買賣應增訂刑罰、限制媒體散佈影響器官公平分配的訊息。單靠修正人體器官移植條例尚非足夠，仍應採取妥當法律政策，在符合人性尊嚴、效率的要求下，增加器官供給量。本論文建議：放棄死刑犯器官捐贈、酌採補償制、採納強行抉擇制、推動交互保險制、鼓勵基因科技與異種移植技術的發展、管制國人境外購買器官、檢察官相驗制度的配合。就提昇器官捐贈風氣方面，本論文則強調主管機關可責成登錄中心，開辦訓練計劃，再與慈濟基金會等優良社會團體合作。

According to Organ Procurement Association, R.O.C., 5000~6000 patients are in the waiting list of organ transplantation, but there are less than 100 donors a year in Taiwan. The organ donation rate is about 3pmp in Taiwan, less than west world 20pmp. Legal profession does not pay much attention to organ donation. Medical profession though discusses this subject a lot, they usually talk about promoting organ supply, no sharing. Medical profession puts utilitarianism in mind, not Kantianism. Many papers in medical profession talk about UNOS, but dismiss Spain the best in organ donation rate, they do not discuss the successful experience of bone marrow or blood donation in Taiwan, either. This thesis tries to examine organ donation problems through ethics, economic analysis of law, social analysis of law, comparative law, legal history, secondary material review, interview research. The purpose of this thesis is to suggest an appropriate organ donation legal system from introducing European and American organ donation system, and referring to the experience of bone marrow and blood donation in Taiwan. This thesis analyzes proposals from scholars, including organ donation from executed prisoners, organ market, future market, compensation system, presumed consent, mandated choice, mutual insurance pool, xenotransplantation, organ reproduction, for the goal of promoting organ supply. Because the public’s attitudes influence organ supply deeply, this thesis tries to find out the attitudes of public and medical profession from scholars’ survey reports, and also I interviewed 16 related persons. This thesis also discusses the legal history of Human Organ Transplant Act, the most important law in organ donation in Taiwan. This thesis suggests that organ donation system should base on Spain model, and adopt the experience of U.S. organ donation system, Taiwan’s bone marrow and blood donation system. In the near future, it will still be few of donative organs, so I think we must set up fair organ sharing principles in Taiwan. In addition, Human Organ Transplant Act needs to be reformed, in order to run organ donation legal system effectively. Of course, it is not enough just to reform Human Organ Transplant Act, we need to take suitable legal policies to promote organ supply under humanity and efficiency. This thesis proposes：giving up organ donation from executed prisoners, adopting compensation system, mandated choice, mutual insurance pool , encouraging the development of gene engineering and xenotransplantation technology , forbidding overseas organ sale , reforming the running of prosecutors’ autopsy.