Hep B核心抗体阳性器官可能为器官捐献者危机提供解决方案

StephenW

July 25, 2018
Hep B Core Antibody-Positive Organs May Provide Solutions to the Organ Donor Crisis

The current shortage of liver organs available for transplant has reached near-crisis proportions, resulting in the exploration of other viable options — in particular, livers that had been previously deemed too high risk for transplantation.                                             

In a literature review published in the Journal of Viral Hepatitis, researchers from the University of Cincinnati College of Medicine in Ohio suggest that hepatitis B core antibody (anti-HB c+) organs may be a safe and ethical transplant option in an era where increased medical knowledge has enabled greater treatment for hepatitis.

Use of anti-HB c+ donor organs creates relatively valid safety concerns, particularly among patients who may already be vulnerable to infections. However, because of the increased medical knowledge regarding viral infections, including hepatitis B, the current literature suggests anti-HB c+ donor organs may indeed be safe alternatives to healthy organs if hepatitis B immune globulin prophylaxis is used immediately following transplantation.

There are 4 ethical principles associated with the use of anti-HB c+ organs that should be considered prior to transplant: autonomy, beneficence, nonmaleficence, and justice. In summary, patients receiving organ transplants should be involved in the decision-making process and should be well-informed about their care, fulfilling the ethics aspect of autonomy.

In addition, the use of anti-HB c+ organs reduces potential morbidity and mortality. Whereas anti-HB c+ organs have the potential to cause harm, the available data suggest that the virus can remain dormant with appropriate therapy. Providing these additional options may also result in greater benefit to society at large, fulfilling the justice criteria.


“Posttransplant care has evolved to a point that these organs can be safely used and allow patients with decompensated cirrhosis to return to a state of relative health and benefit the society in general,” the authors wrote. “The next frontier in hepatitis B care is the development of drugs and treatments that provide functional cure of active replicative infection in a high proportion of cases.”
Reference

Anwar N, Sherman KE. Transplanting organs from hepatitis B positive donors: Is it safe? Is it ethical? [published online July 3, 2018] J Viral Hepat. doi:10.1111/jvh.12962

StephenW

2018年7月25日
Hep B核心抗体阳性器官可能为器官捐献者危机提供解决方案

目前可用于移植的肝脏器官短缺已达到接近危机的程度，导致探索其他可行的选择 - 特别是之前被认为具有过高移植风险的肝脏。

在发表在病毒性肝炎杂志上的一篇文献综述中，俄亥俄州辛辛那提大学医学院的研究人员表示，在医疗增加的时代，乙型肝炎核心抗体（抗HB c +）器官可能是一种安全和道德的移植选择。知识使肝炎得到更好的治疗。

抗HBc +供体器官的使用产生了相对有效的安全性问题，特别是在可能已经易受感染的患者中。然而，由于关于病毒感染（包括乙型肝炎）的医学知识的增加，目前的文献表明，如果在移植后立即使用乙型肝炎免疫球蛋白预防，则抗HBc +供体器官可能确实是健康器官的安全替代品。

在移植前应考虑使用抗HBc +器官的4个伦理原则：自主性，仁慈性，非伤害性和正义性。总之，接受器官移植的患者应参与决策过程，并应充分了解他们的护理，实现自治的道德方面。

此外，抗HBc +器官的使用降低了潜在的发病率和死亡率。虽然抗HB c +器官有可能造成伤害，但现有数据表明该病毒可以通过适当的治疗保持休眠状态。提供这些额外选择也可以为整个社会带来更大的利益，满足司法标准。


作者写道：“移植后护理已经发展到可以安全使用这些器官并使患有失代偿性肝硬化的患者恢复到相对健康状态并使整个社会受益的程度。” “乙型肝炎治疗的下一个前沿是药物和治疗方法的发展，这些药物和治疗方法可以在很大比例的情况下提供主动复制性感染的功能性治疗。”
参考

Anwar N，Sherman KE。从乙型肝炎阳性捐献者移植器官：安全吗？这是道德的吗？ [在线发表于2018年7月3日] J Viral Hepat。 DOI：10.1111 / jvh.12962