问答题
Mike and Adam Hurewitz grew up together on Long Island, in the
suburbs of New York City. They were very close, even for brothers. So when
Adam's liver started failing, Mike offered to give him half of his. The
operation saved Adam's life. But Mike, who went into the hospital in seemingly
excellent health, developed a complication—perhaps a blood colt—and died
last week. He was 57. Mike Hurewitz's death has prompted a lot of soul searching
in the transplant community. Was it a tragic fluke or a sign that transplant
surgery has reached some kind of ethical limit? The Mount Sinai Medical Center,
the New York City hospital where the complex double operation was performed, has
put on hold its adult living donor liver transplant program, pending a review of
Hurewitz's death. Mount Sinai has performed about 100 such operations in the
past three years. A 1-in-100 risk of dying may not seem like
bad odds, but there's more to this ethical dilemma than a simple ratio. The
first and most sacred rule of medicine is to do no harm. "For a normal healthy
person a mortality rate 1% is hard to justify," says Dr. John Fung, chief of
transplantation at the University of Pittsburgh Medical Center. "If the rate
stays at 1%, it's just not going to be accepted." On the other hand, there's an
acute shortage of traditional donor organs from people who have died in
accidents or suffered fatal heart attacks. If family members fully understand
the risks and are willing to proceed, is there any reason to stand in their way?
Indeed, a recent survey showed that most people will accept a mortality rate for
living organ donors as high as 20%. The odds, thankfully, aren't nearly that
bad. For kidney donors, for example, the risk ranges from 1 in 2,500 to 1 in
4,000 for a healthy volunteer. That helps explain why nearly 40% of kidney
transplants in the U. S. come from living donors. The operation
to transplant a liver, however, is a lot trickier than one to transplant a
kidney. Not only is the liver packed with blood vessels, but it also makes lots
of proteins that need to be produced in the right ratios for the body to
survive. When organs from the recently deceased are used, the surgeon gets to
pick which part of the donated liver looks the best and to take as much of it as
needed. Assuming all goes well, a healthy liver can grow back whatever portion
of the organ is missing, sometimes within a month. A
living-donor transplant works particularly well when an adult donates a modest
portion of the liver to a child. Usually only the left lobe of the organ is
required, leading to a mortality rate for living-donors in the neighborhood of 1
in 500 to 1 in 1, 000. But when the recipient is another adult, as much as 60%
of the donor's liver has to be removed. "There really is very little margin for
error," says Dr. Fung. By way of analogy, he suggests, think of a tree. "An
adult-to-child living-donor transplant is like cutting off a limb. With an
adult-to-adult transplant, you're splitting the trunk in half and trying to keep
both halves alive. " Even if a potential donor understand and
accepts these risks, that doesn't necessarily mean the operation should proceed.
All sorts of subtle pressures can be brought to bear on such a decision, says
Dr. Mark Siegler, director of the MacLean for Clinical Medical Ethics at the
University of Chicago. "Sometimes the sicker the patient, the greater the
pressure and the more willing the donor will be to accept risks. " If you feel
you can't say no, is your decision truly voluntary? And if not, is it the
medical community's responsibility to save you from your own best
intentions? Transplant centers have developed screening
programs to ensure that living donors fully understand the nature of their
decision. But unexamined, for the most part, is the larger issue of just how
much a volunteer should be allowed to sacrifice to save another human being. So
far, we seem to be saying some risk is acceptable, although we're still vaguer
about where the cutoff should be. There will always be family members like Mike
Hurewitz who are heroically prepared to make the ultimate sacrifice for a loved
one. What the medical profession and society must decide is if it's appropriate
to let them do so.
问答题
Describe in your own words the liver transplant between the two brothers Mike and Adam.
【正确答案】Mike and Adam are brothers, and when Adam's liver is "failing", Mike donated half of his liver. Even though Adam survived, Mike, the healthy brother, due to the "complication" developed in the operation, died after the successful transplant.
问答题
What is the major issue raised in the article?
【正确答案】There is a risk of donors' dying from organ transplant between family members. Therefore, it is necessary to let the donor have a full understanding of the risk of donating organs. The medical profession and society is responsible for telling the donors whether it is appropriate to do so.