讀者來函

:::

1993 / 7月



文.李誠民(中華民國賢臟基金會醫事顧問/中華民國賢臟內科專科醫師)

編輯先生:

拜讀貴刊五月號談「器官移植」及「腎是怎樣壞掉的」兩篇文章,個人擬以從腎臟專科醫師立場提出拙見。

首先必須釐清的一個觀念,即是不論透析治療(俗稱洗腎)或腎臟移植,皆為尿毒患者選擇延續生命的方式,至今文獻無法比較何者為優。

由於科技的進展,血液透析十四年後才會發生慢性併發症,故數年前美國匹茲堡大學(美國移植手術最多的醫學中心),已由不鼓勵親屬移植,轉而建議延至本人長期透析治療出現慢性併發症後,再實行移植手術。

其次,長期透析治療患者超過百分之七十以上的人都能重返工作崗位,貢獻社會,並享受其家庭生活與人生,故透析治療是積極的;相對的,腎移植成功的人中有近百分之廿的人無法重回工作崗位(多數根源於移植前心理評估與輔導不足)。此外,手術後病人須終身服用抗排斥藥物,感冒傷風亦可能必須住院。手術若貿然進行,不但浪費社會資源,亦造成病人不可挽回的傷害。

國內推動器官捐贈風氣是值得肯定的,但建立完善審查監督體系,使器官來源增加後,不致造成移植手術之浮濫,也是急迫須完成的。目前國內每年約有百餘例的腎移植手術,卻有十五家醫院從事腎臟移植,應訂出一個更嚴謹的器官移植醫院資格審定制度,不但易於結合院際合作,建立受腎者組織配對資料庫,以提高存活率;並增進術前受腎者選擇,加強移植手術經驗及術後抗排斥藥物使用等臨床經驗。深願國內醫界先進能去除門戶之見,嚴守專業規範,病患才能得到真正高品質的醫療照顧。

綜括而言,透析治療不但延續尿毒患者生命,且大多數都可以重返工作崗位,故是積極的;器官捐贈風氣推動是值得肯定的,但在同時應建立完備的監督體系,才不致造成負面效果。

文.台北侯景陽

編輯先生您好:

貴刊自今年四月號報導韓國華僑的故事及五月號的「一個小留學生的故事」至六月號的「讀者來函」專欄,都使我感觸良多。

上一代的華僑是為了討生活,不得已才在異國奮鬥,而心裡仍然希望將來有一天能回故鄉。他們並沒忘記自己是中國人。但目前移民國外的人,卻是因為國外環境比國內好而移民。前後兩者的心態差異,難怪有人會懷疑華僑回國的目的是為了什麼?

再談到第二代的華僑,他們的愛國心似乎不像第一代的華僑那麼濃烈。「中國」或許只是記憶中的印象。只要能和當地人打成一片,被當地人接受,即使是被同化反而更好。至於根源於何處已不重要。而台灣是當他們在當地受挫或不被接受時的避風港。是不是這樣?我不知道。

我們沒有權利要華僑做那一國人,那是他們的自由,但是華僑回台灣而沒有中華文化和中國人的認同感,想要獲得台灣人民的認同,似乎不易。

相關文章

近期文章

EN

Letters to the Editor


Dear Editor:

I have read the articles "To Give or Not to Give" and "When Kidneys Go Bad" in your May edition and would like to offer my opinions on them from the standpoint of a medical specialist on kidneys.

First off, I would like to make one thing clear: Though hemodialysis and kidney transplants are both methods that uremia patients can take to extend their lives, up to the present there have been no studies attesting to their relative efficacy.

Because of advances in technique, chronic complications will appear now only 14 years after hemodialysis, and thus several years ago the University of Pittsburgh in the United States (the U.S. medical center that has performed the greatest number of transplant operations), turned from recommending that relatives of patients not donate kidneys to recommending that transplant procedures be taken after long-term chronic complications have appeared.

Currently more than 70 percent of long-term hemodialysis patients can all return to their jobs, making a contribution to society while enjoying the pleasures of family and life. Hence, hemodialysis patients are relatively active. Correspondingly, among kidney transplant patients, nearly 20 percent cannot go back to work (mostly stemming from insufficient pre-transplant psychological evaluation and guidance). In addition, after the procedure, the patients must use anti-rejection drugs for the rest of their lives. Even a common cold can put them in the hospital. If the procedure is taken without careful consideration, not only is it a waste of social resources, it can do irretrievable harm to the patients.

Promoting the donating of organs in the R.O.C. is worthy of our support, but establishing an excellent investigatory and supervisory system is also needed--so that once the number of donated organs has grown it does not result in excessive use of the transplant procedures. Currently there are more than 100 cases of kidney transplant each year in the R.O.C., with 15 hospitals handling the transplants. There ought to be a much stricter process under which hospitals can qualify for handling transplants. Not only would this make it easier for hospitals to cooperate by establishing data banks about receivers that would make cooperation easier and lead to increased survival rates; it would also add to the preoperation choices of kidney receivers and strengthen the clinical experience about transplant procedures and the use of anti-rejection drugs afterwards. Only if the medical establishment discards its prejudices and holds a strictly guarded attitude of professionalism can patients obtain truly top-quality medical care.

In a nutshell, hemodialysis not only extends the lives of uremia patients, but the vast majority of patients so treated can go back to their jobs as well, living active lives. While it's worth affirming efforts to promote the giving of organs, at the same time it is necessary to establish a complete supervisory system to bring about the best results.

Li Cheng-min

R.O.C. Kidney Fund Medical Consultant

R.O.C. Kidney Internist

Dear Editor:

The recent publication in your esteemed periodical of the story on overseas Chinese in Korea in April, "The Story of a Returned Child Emigrant" in May, and the letters to the editor in June have triggered many feelings in me.

The previous generation of overseas Chinese went abroad to struggle for a living because they had no choice, and in their hearts they hoped to return to their native land. They did not forget that they were Chinese. But now, many emigrants go just because the environment is better abroad than here. Given the difference in motives, is it any wonder that people have their doubts about the purpose of overseas Chinese in coming back?

Again in reference to the second generation overseas Chinese, it seems they are not as loving of their country as their predecessors. "China" is perhaps just an impression in their memories. It is of course fine that they fit in with the local people in their adopted lands, and are accepted by the local people, and in fact even better if they are completely assimilated. It doesn't matter where their roots are. But is it that Taiwan is just the place they take refuge when they are disappointed or rejected? I don't know.

We have no right to ask overseas Chinese to be from any particular country; that's their own free choice. But if overseas Chinese come back to Taiwan and have no sense of identification with Chinese culture or Chinese people, and yet want to be accepted by the people of Taiwan, that's not going to be very easy.

Hou Ching-yang

Taipei

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