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.

신장이식 수혜자의 삶의 질 예측모형 구축

김혜숙,소향숙 한국간호과학회 2009 Journal of Korean Academy of Nursing Vol.39 No.4

Purpose: The purpose of this study was to identify factors influencing quality of life in kidney transplant recipients and to understand the concrete pathway of influence and the power of each variable, so that integrated prediction model to promote the quality of life of kidney transplant recipients could be developed. Methods: The sample was composed of 218 patients in follow-up care after a kidney transplant in one of 4 university hospitals in the Honam area. A structured questionnaire was used and the collected data were analyzed for fitness, using the LISREL program. Results: This model was concise and extensive in predicting the quality of life of kidney transplant recipients. Conclusion: The research verified the factors influencing quality of life for kidney transplant recipients and it verified that direct factors such as perception of health state, compliance, self-efficacy, stress and indirect factors such as self-efficacy and social support can be important factors to predict the quality of life for recipients. Moreover, those variables represent 87% of variance in explaining quality of life in a prediction model so that the variables can be utilized to predict quality of life for kidney transplant recipients. Purpose: The purpose of this study was to identify factors influencing quality of life in kidney transplant recipients and to understand the concrete pathway of influence and the power of each variable, so that integrated prediction model to promote the quality of life of kidney transplant recipients could be developed. Methods: The sample was composed of 218 patients in follow-up care after a kidney transplant in one of 4 university hospitals in the Honam area. A structured questionnaire was used and the collected data were analyzed for fitness, using the LISREL program. Results: This model was concise and extensive in predicting the quality of life of kidney transplant recipients. Conclusion: The research verified the factors influencing quality of life for kidney transplant recipients and it verified that direct factors such as perception of health state, compliance, self-efficacy, stress and indirect factors such as self-efficacy and social support can be important factors to predict the quality of life for recipients. Moreover, those variables represent 87% of variance in explaining quality of life in a prediction model so that the variables can be utilized to predict quality of life for kidney transplant recipients.

장기이식인의 신체활동 참여 가능성 탐색

최승권 ( Seoung-gweon Choi ),김석진 ( Seok-jin Kim ) 한국특수체육학회 2019 한국특수체육학회지 Vol.27 No.4

본 연구는 특수체육에서 그동안 다른 장애영역의 장애인들에 비해 관련 연구나 관심히 미흡했던 이식인의 소개, 이식인 신체활동의 역사, 이식인 신체활동의 효과 및 신체활동 시 주의사항에 대하여 탐색하여 특수체육분야에 이식인 신체활동연구의 적용가능성에 관련된 정보들 제공하고자 하였다. 이를 통해 도출된 결론들은 다음과 같다. 쳇째, 이식인은 장애인복지법 상 장애인의 범주에 속해 있기 때문에 이식인들에 대한 특수체육계의 관심이 요구된다. 둘째, WTGF는 이식인들이 활발한 스포츠활동 및 운동 참여를 권고하고 있으며, 규칙적으로 세계이식인대회를 개최함으로써 이식인들의 친선과 국제적인 협조를 이끌어내고, 이들의 행복한 삶을 추구할 수 있도록 도와주고 있으며, 부족한 장기 수급을 위한 범국가적인 노력을 경주하고 있다. 셋째, 국내 이식인의 올바른 신체활동참여는 아직 미흡한 실정이지만 의료계에서 설립된 기관의 노력으로 국내이식인경기대회개최 및 세계이식인경기대회 참여를 하고 있고, 대한이식인체육연맹이 설립된 후 이식인들의 신체활동참여에 대한 행정 및 재정적 기반을 마련하고 있다. 넷째, 규칙적인 신체활동 참여는 이식인들의 신체 및 정신적 건강유지 및 향상에 도움을 준다. 다섯째, 이식인의 재활을 위한 운동을 위해서는 전문의의 관찰이 필수적이다. 의료계와 체육계의 협업을 통해 이식인의 신체활동지침을 만드는 등 지속적인 연구를 통해 이식인들에게 올바른 신체활동 정보를 제공해줄 필요가 있다. The purpose of this study was to introduce transplant recipients, the history of physical activity for transplant recipients, the effects of physical activity for transplants recipients and precautions as well as to provide applicable information in the field of adapted physical activity in Korea. The results are as followings. Firstly, specialists who are involved in adapted physical activity are required to concern that transplant recipients are legally included in the category of people with disabilities. Secondly, WTGF encourages transplant recipients to participate in sport and exercise for their well-balanced living and has been hosting World Transplants Games to share friendships and to bring international cooperation among countries. Also, WTGF tried to announce a lack of organ shortage. Thirdly, some organizations have been trying to host Transplant Games in Korea and support transplant recipients to engage in World Transplants Games, even though there are lacks of participating physical activity for transplant recipients in Korea. After establishing Korea Transplant Games Federation (KTGF), the KTGF provides administrative and financial supports for encouraging transplant recipients to take part in physical activity. Fourthly, participating physical activity for transplant recipients provides to maintain and enhance physical and psychological health. Lastly, the careful observation by medical doctor must be required for rehabilitation to transplant recipients. Cross-disciplinary cooperation are needed to provide an adequate guideline by conducting continuous researches.

Technology of Decision-Making Support Regarding the Possibility of Donation and Transplantation Considering Civil Law

Hnatchuk, Yelyzaveta,Hovorushchenko, Tetiana,Drapak, Georgii,Kysil, Tetiana International Journal of Computer ScienceNetwork S 2022 International journal of computer science and netw Vol.22 No.9

The review of known decision-making support systems and technologies regarding the possibility of donation and transplantation showed that currently there are no systems and technologies of decision-making support regarding the possibility of donation and transplantation considering civil law. The paper models the decision-making support process regarding the possibility of donation and transplantation, which is a theoretical basis for the development of rules, methods and technology of decision-making support regarding the possibility of donation and transplantation considering civil law. The paper also developed the technology of decision-making support regarding the possibility of donation and transplantation considering civil law as a component of the Unified State Information System for Organ and Tissue Transplantation, which automatically and free of charge determines the possibility/impossibility of donation and transplantation. In the case of the possibility of donation, the admissible type of donation is also determined - over-life or after-life donation - and data about potential donor is entered in the relevant Donor Register. In the case of the possibility of transplantation, if the recipient needs a transplant of one of the paired organs or a part of the organ/tissue, then data about potential recipient are entered in the Transplantation List from both over-life and after-life donor, otherwise, if the recipient needs a transplant of a non-paired organ or both paired organs, then data about potential recipient are entered only in the Transplantation List from after-life donor.

돼지에 있어서 정소 생식세포의 이식 기법 개발

김병각,이용안,김방진,김기중,민관식,이장희,유재원,김인철,류범용 한국동물생명공학회(구 한국동물번식학회) 2008 Reproductive & developmental biology Vol.32 No.3

본 연구는 돼지에 있어서 정원줄기세포를 포함하는 정소세포를 recipient 돼지의 정소 내로 이식할 수 있는 기법을 개발하기 위하여 시행되었다. 공여세포는 10~14일령의 돼지로부터 채취된 정소에서 효소처리법을 이용하여 회수하였고, recipient의 정소 내로 이식하기 전 형광 마커(PHK26)로 표지하였다. 외과적 수술을 통하여 recipient 돼지부터 정소를 꺼낸 후 초음파 기기와 이식 장치를 이용하여 형광표지된 공여세포를 recipient 정소의 세정관 내로 이식하였다. 14주령의 recipient 정소에 5~7ml 의 공여 세포부유액을 주입하여 정소 내 50% 이상의 세정관 내로 새포부유액의 주입이 가능하였고, 세포부유액이 주입된 세정관 내에서 형광표지된 정소세포들이 고루 이식되어짐이 관찰되었다. 본 연구에서 개발한 이식 기법을 이용하여 효율적인 정소세포의 이식이 가능함에 따라 향후 돼지 정원줄기세포의 연구 및 활용법 개발에 획기적인 돌파구가 마련될 것으로 기대된다. The current study was designed to extend the technique of spermatogonial transplantation to economically important pig model We evaluated the efficiency of pig to pig transplantation. Donor testis cells were harvested from testes obtained at castration of 10- to 14-day-old boars and were labeled with fluorescent marker(PKH26) before transplantation. The presence of infused dye or labeled pig testicular cells was confirmed in the seminiferous tubules from recipient pig. The most effective procedure of intratubular germ cell transfer was to insert an fine needle (21~25 gauge) through the cauda epididymis and testis into the rete testis under ultrasound guidance. Infusion of 5~7ml of dye solution or cell suspension could fill the rete and up to 50% of seminiferous tubules of 14-week-old boars. Testis were examined for the presence and localization of labeled donor cells immediately after transplantation and labeled donor cells were found in numerous seminiferous tubules from recipient pig testes. These results indicate that germ cell transplantation is feasible in recipient pig testis. This study represents successful spermatogonial transplantation between individual animals in a livestock species.

Changes in socioeconomic status and patient outcomes in kidney transplantation recipients in South Korea

Park Sehoon,Park Jina,Jeong Jihoon,Jang Yunyoung,김용철,김동기,오국환,주권욱,김연수,이하정 대한이식학회 2023 Korean Journal of Transplantation Vol.37 No.1

Background: Socioeconomic status is an important factor affecting the accessibility and prognosis of kidney transplantation. We aimed to investigate changes in kidney transplant recipients’ socioeconomic status in South Korea and whether such changes were associated with patient prognosis. Methods: T his retrospective nationwide o bservational c ohort s tudy i n S outh Korea included kidney transplant recipients between 2007 and 2016. South Korea provides a single-insurer health insurance service, and information on the socioeconomic status of the recipients is identifiable through the claims database. First, a generalized linear mixed model was used to investigate changes in recipients’ socioeconomic status as an outcome. Second, the risk of graft failure was analyzed using Cox regression as another outcome to investigate whether changes in socioeconomic status were associated with patient prognosis. Results: Among the 15,215 kidney transplant recipients included in the study, economic levels (defined based on insurance fee percentiles) and employment rates declined within the first 2 years after transplantation. Beyond 2 years, the employment rate increased significantly, while no significant changes were observed in economic status. Patients whose economic status did not improve 3 years after kidney transplantation showed a higher risk of death than those whose status improved. When compared to those who remained employed after kidney transplantation, unemployment was associated with a significantly higher risk of death-censored graft failure. Conclusions: The socioeconomic status of kidney transplant recipients changed dynamically after kidney transplantation, and these changes were associated with patient prognosis.

신장이식

김찬덕 ( Chan Duck Kim ) 대한내과학회 2014 대한내과학회지 Vol.86 No.2

Kidney transplantation is the treatment of choice for end stage renal disease. Successful kidney transplantation improves the quality of life and reduces the mortality risk for most patients, when compared with maintenance dialysis. Recent advances, including immunosuppressants, desensitization treatment for highly sensitized kidney transplant candidates, and better medical care, have resulted in an increase number of transplants with improved outcomes. However, kidney transplant recipients require close follow-up after transplantation since they are on complex immunosuppressive regimens that render them susceptible to infection, malignancy, and cardiovascular disease. The additional obstacles of kidney transplantation include the lack of improvement in long term outcomes, shortage of organs, and multiple co-morbidities due to their underlying chronic kidney disease. To improve the long-term outcome of renal allograft, physicians must be aware in developing newer immunosuppressive regimens, with lower side effects, and reduction of death with functioning graft and chronic allograft dysfunction will be the greatest challenge of all physicians who care for kidney transplant recipients. This review highlights current status of kidney transplantation in Korea, brief transplant immunology, immunologic tests, donor/recipient evaluation, immunosuppressive medications, and complications of kidney transplantation involving rejection, post transplantation infections, malignancy, cardiovascular disease and recurrence of primary disease. (Korean J Med 2014;86:142-151)

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.

Recipient Management before Lung Transplantation

김형수,박성훈 대한심장혈관흉부외과학회 2022 Journal of Chest Surgery (J Chest Surg) Vol.55 No.4

Lung transplantation is considered a viable treatment option for patients with end-stage lung disease. Recent decades have seen a gradual increase in the number of lung transplantation patients worldwide, and in South Korea, the case number has increased at least 3-fold during the last decade. Furthermore, the waiting list time is becoming longer, and more elderly patients (>65 years) are undergoing lung transplantation; that is, the patients placed on the waiting list are older and sicker than in the past. Hence, proper management during the pre-transplantation period, as well as careful selection of candidates, is a key factor for transplant success and patient survival. Although referring and transplant centers should address many issues, the main areas of focus should be the timing of referral, nutrition, pulmonary rehabilitation, critical care (including mechanical ventilation and extracorporeal membrane oxygenation), psychological support, and the management of preexisting comorbid conditions (coronary artery disease, diabetes mellitus, gastroesophageal reflux disease, osteoporosis, malignancy, viral infections, and chronic infections). In this context, the present article reviews and summarizes the pre-transplantation management strategies for adult patients listed for lung transplantation.

Effect of donor–recipient size mismatch on long-term graft survival in pediatric kidney transplantation: a multicenter cohort study

박민지,백희선,송지연,최나예,안요한,강희경,조민현 대한신장학회 2023 Kidney Research and Clinical Practice Vol.42 No.6

Background: Donor–recipient size mismatching is commonly occurs in pediatric kidney transplantation (KT). However, its effect on graft survival remains unknown. This study aimed to determine the effect of donor–recipient size mismatch on the long-term survival rate of transplant kidneys in pediatric KT. Methods: A total of 241 pediatric patients who received KT were enrolled. The medical records of all patients were retrospectively reviewed, and the correlation between donor–recipient size mismatch and graft function and long-term graft outcome was analyzed according to donor–recipient size mismatch. Results: Recipients and donors’ mean body weight at the time of KT were 34.31 ± 16.85 and 56.53 ± 16.73 kg, respectively. The mean follow-up duration was 96.49 ± 52.98 months. A significant positive correlation was observed between donor–recipient body weight ratio (DRBWR) or donor–recipient body surface area ratio (DRBSR) and graft function until 1 year after KT. However, this correlation could not be confirmed at the last follow-up. The results of long-term survival analysis using Fine and Gray’s subdistribution hazard model showed no significant difference of the survival rate of the transplant kidney according to DRBWR or DRBSR. Conclusion: Donor–recipient size mismatch in pediatric KT is not an important factor in determining the long-term prognosis of transplant kidneys.