台湾重大医疗事故 误移植艾滋器官给五人

National Taiwan University Hospital transplanted the organs of an HIV-infected donor on Wednesday without realizing it, putting five organ transplant recipients at high risk of contracting AIDS, the Department of Health said yesterday.

The department said it was the first-ever known incident of recipients being exposed to the risk of contracting AIDS because of organ transplants.

The hospital informed the -department of the incident earlier in the day, Centers for Disease Control deputy director Shih Wen-yi (施文儀) said.

Shih said the hospital had offered emergency anti-AIDS medication to the five organ transplant recipients.

The hospital has not issued a statement on why the organs were not properly screened before the transplant or when it actually discovered that the donor had HIV.

The department has demanded that the hospital present a full report on the incident in three days.

Shih said the hospital had apologized to the patients and their families as well as briefed them on the situation. He added that to the best of his knowledge, the hospital had consistently conducted HIV-testing on organ donors.

“We don’t know at the moment what went wrong in this case, which has left five innocent organ recipients facing the risk of contracting AIDS,” Shih said.

【相关报道】

台大发生重大医疗疏失，除了让五名器官受赠病患极可能感染艾滋病，包括台大、成大两家医学中心，共有47名医护人员也暴露在感染艾滋风险。换句话说，因为台大内部沟通出问题，连同病患及医护人员，共有52人身陷艾滋恐惧之中。

据联合晚报报道，事关重大，连远在美国访问的台“卫生署长”邱文达都深表遗憾。“卫生署”公关室主任王哲超转述，邱文达非常关心此事件的发展，已指示台大医院必须妥善照料这些器官受赠者，也要求“卫生署”内部检讨器捐移植流程，不要让类似悲剧再度发生。

多年前，主导撰写“台大医院器官捐赠小组标准作业程序”一书的台大外科资深教授兼急重症加护病房主任和创伤医学部主任柯文哲，上午面对记者采访时，更是无奈，连声叹气。

柯文哲指出，岛内约有10家医学中心执行器官移植手术，水准都不错，但都各做各的，其中并无整合系统。这次台大医院将小错变大错，错误已经造成，希望岛内相关医院不要再各自为政。

柯文哲说，“一个说讲错，一个说听错，不管怎样，都是台大的错”。这项重大医疗疏失，让台大、成大共有47名医护人员暴露在感染艾滋风险中。

如果“卫生署”给予最高惩处，台大医院器官移植小组恐将在一年内不得进行肝脏、肺脏、肾脏等移植手术。依照目前统计，受影响的病患恐多达1800人，这些在台大等待器官移植的病患都必须得转院。

台大医院发生有史以来最严重的致命错误，尽管院方坦承疏失，扛起责了任，但许多亟需器官捐赠来延续生命的病患，却无辜受到牵连，影响就医权益，这笔帐该向谁来算。

柯文哲无奈地说，他编撰器官捐赠移植手册，想了一堆，也写了一大堆，最后还是漏掉“艾滋感染”这一段。他曾经有想过，但最后还是没写进去。

柯文哲分析，造成这次大错，就像是一个螺丝钉松了，以致于全部螺丝钉都掉了下来。他认为，台湾器官捐赠系统各自为政的作法，应该要有所改革，不能再这样下去。