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In the final hours of his son’s life, Francis Moran kept a newspaper article close by for comfort.
It had been written by another Ottawa father and acquaintance, Michael Curran, and told a story heartbreakingly similar to what the Moran family was enduring in a Hamilton intensive care unit.
The two Ottawa families were devastated by their similar tragedies just a few months apart.
Both had 20-year-old sons who suffered traumatic brain injuries that would prove fatal: Emerson Curran, a University of Ottawa philosophy student, in August 2013, after being beaten at a house party in Yellowknife; and Christopher Moran, an architecture student at the University of Waterloo, who died after being struck by a car, in December 2013.
While sitting vigil at his son’s hospital bedside, Francis Moran was drawn to the article that Curran had written about his own family’s tragedy and the comfort organ donation brought them.
“When the time came for my last farewell, I can tell you the knowledge he was going into organ donation surgery gave me great strength,” wrote Curran, who is publisher of the Ottawa Business Journal. “In a time of absolute despair from the senseless killing of my son, this was a glimmer of hope.”
Moran read and re-read those words when it became clear his own son would not recover from his injuries. “It gave me strength.”
It also painted a scenario the Moran family badly hoped for — to see Christopher’s organ’s donated, fulfilling the young man’s wishes, and bringing the family some measure of comfort and helping to save lives.
It did not work out that way.
Christopher Moran’s head injury caused damage from which he would not recover, the family was told. One side of his brain was badly swollen and damaged beyond repair. The other side suffered a massive stroke. “In all meaningful respects, our son was gone,” said Moran.
The family began discussing organ donation with medical officials. But, despite the severity of his head injury, Christopher still had some measurable brain activity.
And so he was, from a medical viewpoint, in a type of limbo.
Christopher Moran
For someone’s major organs to be eligible for donation at the end of their life, one of two things must happen: The person must suffer “brain death” or “cardiac death.”
Related
Because Christopher’s brain was still showing some activity — though zero prognosis for any kind of recovery — the only other option to allow for his organs to be donated was for what is known as cardiac death to transpire, something that could happen by removing him from life-support machines and waiting for his heart to stop.
The family agreed. “We felt we needed to try.”
But even removed from life-support, Christopher Moran’s heart didn’t stop beating within the small window of time necessary to ensure organs were undamaged and viable for donation.
“It’s a hell of a thing to stand beside your son’s hospital gurney, put your hand on his chest, feel his strong, 20-year-old heart beat beneath skin that is pink and warm for the first time after more than two weeks of induced hypothermic coma, and fervently wish that that heart would stop beating some time in the next very little while,” wrote Moran, evoking the conflicting, agonizing emotions of the moment.
In the end, Christopher Moran’s corneas were donated, but no organ donations were possible.
“Compared to the immeasurable loss of our son, not being able to donate his organs was really just disappointment for us. We tried, knowing the chances were not good. We failed.”
Still, Moran was left with lingering questions that underscore one of the difficult realities of organ donation: Donations after death can only proceed when factors line up precisely. Those cases remain rare. And some wonder whether they have to be, raising delicate ethical questions about the very definitions of life and death that form the foundations of organ donations.
Only about two to three per cent of hospital deaths occur in a way that allow organs to be donated after death. Given that, the focus of organ donation campaigns is to encourage people to consent to become donors, and to discuss it with family members.
“It is incredibly rare,” said Jennifer Long, a spokeswoman for the Trillium Gift of Life Network, which is Ontario’s organ and tissue donation agency.
Trillium Gift of Life Network
In 2007, there were only 175 deceased organ donors in Ontario. That number has increased significantly in the years since — to 347 deceased donors in 2017 — largely because of the introduction of organ donation after cardiac death in the province.
Donation after cardiac death had been allowed in Ontario prior to the the concept of brain death being defined and accepted in the medical community.
Brain death, the complete, irreversible loss of brain function, is a modern concept, one that was developed by a committee at Harvard Medical School in the late 1960s when technological advances meant organ transplants were becoming more common. Brain death as a concept satisfied the need “for a living body and a dead donor,” as psychotherapist Gary Greenberg wrote in New Yorker magazine article in 2001.
Organ donations after cardiac death had stopped in Ontario after brain death became the international standard.
But such donations resumed in 2015.
That change expanded the potential pool of organ donors and contributed to a 57 per cent increase in organ donation in the province over a decade. (Transplants from living donors — especially kidney transplants — have also grown in recent years; and medically assisted death has further increased the pool of potential donors, although there have only been a handful so far under such circumstances.)
Even those increased numbers don’t come close to filling the need. There are slightly more than 1,500 people on waiting lists in Ontario for an organ from a deceased donor. People die every year while waiting.
It was, in fact, a third Ottawa family, also reeling from the sudden death of an adult child, that played a role in the expansion of organ donor criteria in Ontario to include cardiac death.
Emile Therien is best known as an outspoken advocate and past-president of the Canada Safety Council. He is also a strong advocate for organ donation.
In 2006, his 32-year-old daughter, Sarah Beth, suffered a sudden heart arrhythmia and was rushed to the hospital where she was placed on life support.
She had recently discussed being an organ donor with her family and, her father recalls, showed them her organ donor card. They knew her wishes.
When her family made the tough decision to withdraw life-support, they wanted to see those wishes fulfilled and her organs donated to help others.
Emile Therien and his wife Beth pose with a photo of their daughter Sarah Beth in this file photo.
Sarah Beth had residual brain activity, which meant she didn’t meet the criteria for brain death even though, like Christopher Moran, there was no hope of recovery. But her family was adamant that her wish to become a donor would be fulfilled. With support, they pushed for organ donation after cardiac death.
In the light of ongoing organ shortages at the time, a forum of transplant experts had developed new guidelines in 2005 paving the way for organ donation after cardiac death.
Such donations had fallen out of favour decades earlier, when brain death became an accepted criteria. Donations after cardiac death were challenging because organs had to be retrieved quickly. New technological advances are improving the ability of health professionals to keep donor organs healthy.
A year later, in 2006, Sarah Beth Therien became the first donor to do so after the new guidelines, allowing two people to receive kidney transplants.
“In death, you are allowing someone else to live,” said Therien.
Sarah Beth Therien’s donations paved the way for many more. Donations after cardiac death now make up about 30 per cent of deceased organ donations nationally, and the numbers are rising.
In donations after cardiac death, medical officials will talk to families whose loved ones don’t meet the criteria for brain death and who, given the prognosis, are going to stop life-support.
Once that decision has been made, organ donation co-ordinators will ask for consent. If the patient dies within a period of time in which organs are suitable, they will be transplanted to waiting patients.
In some cases, the organ retrieval goes ahead. In other cases it does not.
Francis Moran, a former Ottawa marketing strategist who, with his wife, now runs a bed and breakfast in South Africa, has nothing but praise for the work of health-care staff and transplant officials in his son’s case.
“These specialized health-care professionals are unbelievably dedicated to what they are doing.”
Still, four years on, he has questions, some of which he raised in an article — “The hope and heartache of organ donation” — that he wrote for a forum in which family members were invited to provide their perspectives on the organ donation process.
“The outcome was the same for us. We still lost our boy, and we feel that loss every day,” he wrote.
“Our disappointment at not being able to fulfill this final wish of his and of ours was acute. But the disappointment of the intended recipients who were so hopeful that day that their long-awaited transplant might finally happen must have been far more acute. And, in my view, not necessary.”
Moran calls it a “senseless contradiction” that his son had no viable prognosis and that the family agreed with medical officials that the only reasonable option was to withdraw life-support, and yet Christopher’s organs could not be donated to save another life because he did not meet the criteria for brain death.
“How can it be that the consensus opinion of so many medical professionals can be sufficiently unanimous and sufficiently unambiguous that withdrawing life-support was the only viable option offered to us, but insufficient to allow some small measure of hope and light to be extracted from such a horrible loss?” he asked.
Moran specifically questions why brain death can’t be defined “more broadly” to include patients such as his son, who still have some measurable brain activity.
“Our son’s brain was destroyed beyond any hope of recovery. He was brain dead. It just took the rest of his body a day or so to catch up.”
Moran and others have questioned whether the strict criteria around organ donation could be loosened — questions that tread on delicate ethical ground.
The so-called “dead-donor rule,” which states transplant organs should only be taken from persons who are dead, is the underlying ethical foundation of organ donation.
In practice, it means death cannot be caused by organ donation, even in patients who will certainly and imminently die and even if that is the only way to guarantee the viability of the organs for transplant. Brain death allows for both healthy donor organs and offers a widely agreed upon definition of death. It has detractors, though, who say both brain death and donations after cardiac death are imperfect means of defining death that leave questions and thwart some peoples’ wishes to become donors.
Patients diagnosed as brain dead would be on advanced life-support systems allowing them to breathe, but without any detectable brain function. The patient’s injuries are irreversible and would prove fatal, their brain had stopped functioning, but their organs were still being kept in good condition because of life-support machines.
Those patients make ideal candidates to become organ donors, but the circumstances are rare. The challenge for the health system is convincing enough people to make their wishes clear during their lifetimes by signing donor cards so that as many people as possible who die under those circumstances can become donors.
But should donations go beyond the current rigid criteria? Should patients who still have some measurable brain activity but who have “no prognosis” in Moran’s words, be able to be organ donors?
He is not the first to raise such questions.
In a provocative paper published in the New England Journal of Medicine in 2013, authors cited a case similar to the Moran family’s experience.
“In one recent case, the parents of a young girl wanted to donate her organs after an accident had left her with devastating brain damage. Plans were made to withdraw life-support and to procure her organs shortly after death. But the attempt to donate was aborted because the girl did not die quickly enough to allow procurement of viable organs. Her parents experienced this failure to donate as a second loss; they questioned why their daughter could not have been given an anesthetic and had the organs removed before life-support was stopped,” wrote authors, questioning why certain living patients should not be allowed to donate their organs.
Allegiance to the dead donor rule, wrote lead author Robert Truog, a professor of medical ethics and anesthesiology at Harvard Medical School, “limits procurement of transplantable organs by denying some patients the option to donate in situations in which death is imminent and donation is desired.”
Truog and his co-authors argued that the definition of brain death and criteria around donation after cardiac death are merely compromises to allow for organ donation while the organs are still viable.
“Reasonable people could hardly be faulted for viewing these compromises as little more than medical charades.”
The authors suggest people be given a choice in the circumstances of their death, including donating organs.
In short, Truog argues that, when death is very near, people should have the option of “dying to help others to live, even if that means altering the timing or manner of their death.”
That would mean abandoning the dead donor rule.
Dr. Andrew Healey, chief medical officer at Trillium, calls such arguments “purely academic,” adding that the dead donor rule — which is generally considered fundamental to maintaining public faith in the system — is not going anywhere.
“The dead donor rule means what first must occur is death and then donation. Donation cannot cause the death of the donor. We are not in a place where we could make death happen and then go on to donation.”
Some ethicists are continuing to push, but there is little sign the dead donor rule is under real attack in Canada or that anyone is pushing for organ retrieval before death.
It is disappointing when a wish to donate cannot be realized, said Healey, “but it is clear death cannot be expedited for donation.”
He says it is “an amazing thing” to watch families in crisis making a decision to give consent to have their loved one’s organs donated.
“You see these families that are devastated yet they are resilient enough in their grief to say ‘I recognize that something good can come from this.’ That consent and the discussion among the family is powerful in and of itself.”
Healy adds that is the real gift of life.
“The only power the family has is in consent. The rest will happen or will not happen,” he said. “We try to make them understand it is in their consent that the gift is … it is not whether an organ was transplanted.”
More than four years after his son’s death, Moran is helping others in ways he couldn’t have imagined.
Moran’s family’s consent and his written participation in a Canadian Blood Services patient forum about the issue, said Healey, helped build a culture of talking about organ donation and increasing understanding of families’ roles in organ donation.
Healey uses tweets that Moran posted during his son’s hospitalization to help health-care professionals better understand the progression from critical care, to prognostication, to the family making a decision to stop life support, to organ donation.
“His experience has been shared with lots of health-care professions. Every audience I show that to, they are impacted by the experience.”
Moran said he felt compelled to write about what he and other family members saw as a contradiction that meant Christopher’s organs were not donated because he feels so strongly about the importance of organ donation.
“I am not a health-care professional nor a medical ethicist,” he added.
He said he ends many conversations by encouraging others to not only sign donor cards, but to talk to their families about it.
“I cannot do anything but encourage anyone in a similar situation to do the same thing we did,” says Moran. “Even the slimmest chance that a more meaningful life could be restored to an organ recipient is worth pursuing.”
epayne@postmedia.com
查看原文...
It had been written by another Ottawa father and acquaintance, Michael Curran, and told a story heartbreakingly similar to what the Moran family was enduring in a Hamilton intensive care unit.
The two Ottawa families were devastated by their similar tragedies just a few months apart.
Both had 20-year-old sons who suffered traumatic brain injuries that would prove fatal: Emerson Curran, a University of Ottawa philosophy student, in August 2013, after being beaten at a house party in Yellowknife; and Christopher Moran, an architecture student at the University of Waterloo, who died after being struck by a car, in December 2013.
While sitting vigil at his son’s hospital bedside, Francis Moran was drawn to the article that Curran had written about his own family’s tragedy and the comfort organ donation brought them.
“When the time came for my last farewell, I can tell you the knowledge he was going into organ donation surgery gave me great strength,” wrote Curran, who is publisher of the Ottawa Business Journal. “In a time of absolute despair from the senseless killing of my son, this was a glimmer of hope.”
Moran read and re-read those words when it became clear his own son would not recover from his injuries. “It gave me strength.”
It also painted a scenario the Moran family badly hoped for — to see Christopher’s organ’s donated, fulfilling the young man’s wishes, and bringing the family some measure of comfort and helping to save lives.
It did not work out that way.
Christopher Moran’s head injury caused damage from which he would not recover, the family was told. One side of his brain was badly swollen and damaged beyond repair. The other side suffered a massive stroke. “In all meaningful respects, our son was gone,” said Moran.
The family began discussing organ donation with medical officials. But, despite the severity of his head injury, Christopher still had some measurable brain activity.
And so he was, from a medical viewpoint, in a type of limbo.
Christopher Moran
•
For someone’s major organs to be eligible for donation at the end of their life, one of two things must happen: The person must suffer “brain death” or “cardiac death.”
Related
Because Christopher’s brain was still showing some activity — though zero prognosis for any kind of recovery — the only other option to allow for his organs to be donated was for what is known as cardiac death to transpire, something that could happen by removing him from life-support machines and waiting for his heart to stop.
The family agreed. “We felt we needed to try.”
But even removed from life-support, Christopher Moran’s heart didn’t stop beating within the small window of time necessary to ensure organs were undamaged and viable for donation.
“It’s a hell of a thing to stand beside your son’s hospital gurney, put your hand on his chest, feel his strong, 20-year-old heart beat beneath skin that is pink and warm for the first time after more than two weeks of induced hypothermic coma, and fervently wish that that heart would stop beating some time in the next very little while,” wrote Moran, evoking the conflicting, agonizing emotions of the moment.
In the end, Christopher Moran’s corneas were donated, but no organ donations were possible.
“Compared to the immeasurable loss of our son, not being able to donate his organs was really just disappointment for us. We tried, knowing the chances were not good. We failed.”
Still, Moran was left with lingering questions that underscore one of the difficult realities of organ donation: Donations after death can only proceed when factors line up precisely. Those cases remain rare. And some wonder whether they have to be, raising delicate ethical questions about the very definitions of life and death that form the foundations of organ donations.
•
Only about two to three per cent of hospital deaths occur in a way that allow organs to be donated after death. Given that, the focus of organ donation campaigns is to encourage people to consent to become donors, and to discuss it with family members.
“It is incredibly rare,” said Jennifer Long, a spokeswoman for the Trillium Gift of Life Network, which is Ontario’s organ and tissue donation agency.
Trillium Gift of Life Network
In 2007, there were only 175 deceased organ donors in Ontario. That number has increased significantly in the years since — to 347 deceased donors in 2017 — largely because of the introduction of organ donation after cardiac death in the province.
Donation after cardiac death had been allowed in Ontario prior to the the concept of brain death being defined and accepted in the medical community.
Brain death, the complete, irreversible loss of brain function, is a modern concept, one that was developed by a committee at Harvard Medical School in the late 1960s when technological advances meant organ transplants were becoming more common. Brain death as a concept satisfied the need “for a living body and a dead donor,” as psychotherapist Gary Greenberg wrote in New Yorker magazine article in 2001.
Organ donations after cardiac death had stopped in Ontario after brain death became the international standard.
But such donations resumed in 2015.
That change expanded the potential pool of organ donors and contributed to a 57 per cent increase in organ donation in the province over a decade. (Transplants from living donors — especially kidney transplants — have also grown in recent years; and medically assisted death has further increased the pool of potential donors, although there have only been a handful so far under such circumstances.)
Even those increased numbers don’t come close to filling the need. There are slightly more than 1,500 people on waiting lists in Ontario for an organ from a deceased donor. People die every year while waiting.
•
It was, in fact, a third Ottawa family, also reeling from the sudden death of an adult child, that played a role in the expansion of organ donor criteria in Ontario to include cardiac death.
Emile Therien is best known as an outspoken advocate and past-president of the Canada Safety Council. He is also a strong advocate for organ donation.
In 2006, his 32-year-old daughter, Sarah Beth, suffered a sudden heart arrhythmia and was rushed to the hospital where she was placed on life support.
She had recently discussed being an organ donor with her family and, her father recalls, showed them her organ donor card. They knew her wishes.
When her family made the tough decision to withdraw life-support, they wanted to see those wishes fulfilled and her organs donated to help others.
Emile Therien and his wife Beth pose with a photo of their daughter Sarah Beth in this file photo.
Sarah Beth had residual brain activity, which meant she didn’t meet the criteria for brain death even though, like Christopher Moran, there was no hope of recovery. But her family was adamant that her wish to become a donor would be fulfilled. With support, they pushed for organ donation after cardiac death.
In the light of ongoing organ shortages at the time, a forum of transplant experts had developed new guidelines in 2005 paving the way for organ donation after cardiac death.
Such donations had fallen out of favour decades earlier, when brain death became an accepted criteria. Donations after cardiac death were challenging because organs had to be retrieved quickly. New technological advances are improving the ability of health professionals to keep donor organs healthy.
A year later, in 2006, Sarah Beth Therien became the first donor to do so after the new guidelines, allowing two people to receive kidney transplants.
“In death, you are allowing someone else to live,” said Therien.
•
Sarah Beth Therien’s donations paved the way for many more. Donations after cardiac death now make up about 30 per cent of deceased organ donations nationally, and the numbers are rising.
In donations after cardiac death, medical officials will talk to families whose loved ones don’t meet the criteria for brain death and who, given the prognosis, are going to stop life-support.
Once that decision has been made, organ donation co-ordinators will ask for consent. If the patient dies within a period of time in which organs are suitable, they will be transplanted to waiting patients.
In some cases, the organ retrieval goes ahead. In other cases it does not.
•
Francis Moran, a former Ottawa marketing strategist who, with his wife, now runs a bed and breakfast in South Africa, has nothing but praise for the work of health-care staff and transplant officials in his son’s case.
“These specialized health-care professionals are unbelievably dedicated to what they are doing.”
Still, four years on, he has questions, some of which he raised in an article — “The hope and heartache of organ donation” — that he wrote for a forum in which family members were invited to provide their perspectives on the organ donation process.
“The outcome was the same for us. We still lost our boy, and we feel that loss every day,” he wrote.
“Our disappointment at not being able to fulfill this final wish of his and of ours was acute. But the disappointment of the intended recipients who were so hopeful that day that their long-awaited transplant might finally happen must have been far more acute. And, in my view, not necessary.”
Moran calls it a “senseless contradiction” that his son had no viable prognosis and that the family agreed with medical officials that the only reasonable option was to withdraw life-support, and yet Christopher’s organs could not be donated to save another life because he did not meet the criteria for brain death.
“How can it be that the consensus opinion of so many medical professionals can be sufficiently unanimous and sufficiently unambiguous that withdrawing life-support was the only viable option offered to us, but insufficient to allow some small measure of hope and light to be extracted from such a horrible loss?” he asked.
Moran specifically questions why brain death can’t be defined “more broadly” to include patients such as his son, who still have some measurable brain activity.
“Our son’s brain was destroyed beyond any hope of recovery. He was brain dead. It just took the rest of his body a day or so to catch up.”
Moran and others have questioned whether the strict criteria around organ donation could be loosened — questions that tread on delicate ethical ground.
•
The so-called “dead-donor rule,” which states transplant organs should only be taken from persons who are dead, is the underlying ethical foundation of organ donation.
In practice, it means death cannot be caused by organ donation, even in patients who will certainly and imminently die and even if that is the only way to guarantee the viability of the organs for transplant. Brain death allows for both healthy donor organs and offers a widely agreed upon definition of death. It has detractors, though, who say both brain death and donations after cardiac death are imperfect means of defining death that leave questions and thwart some peoples’ wishes to become donors.
Patients diagnosed as brain dead would be on advanced life-support systems allowing them to breathe, but without any detectable brain function. The patient’s injuries are irreversible and would prove fatal, their brain had stopped functioning, but their organs were still being kept in good condition because of life-support machines.
Those patients make ideal candidates to become organ donors, but the circumstances are rare. The challenge for the health system is convincing enough people to make their wishes clear during their lifetimes by signing donor cards so that as many people as possible who die under those circumstances can become donors.
But should donations go beyond the current rigid criteria? Should patients who still have some measurable brain activity but who have “no prognosis” in Moran’s words, be able to be organ donors?
He is not the first to raise such questions.
In a provocative paper published in the New England Journal of Medicine in 2013, authors cited a case similar to the Moran family’s experience.
“In one recent case, the parents of a young girl wanted to donate her organs after an accident had left her with devastating brain damage. Plans were made to withdraw life-support and to procure her organs shortly after death. But the attempt to donate was aborted because the girl did not die quickly enough to allow procurement of viable organs. Her parents experienced this failure to donate as a second loss; they questioned why their daughter could not have been given an anesthetic and had the organs removed before life-support was stopped,” wrote authors, questioning why certain living patients should not be allowed to donate their organs.
Allegiance to the dead donor rule, wrote lead author Robert Truog, a professor of medical ethics and anesthesiology at Harvard Medical School, “limits procurement of transplantable organs by denying some patients the option to donate in situations in which death is imminent and donation is desired.”
Truog and his co-authors argued that the definition of brain death and criteria around donation after cardiac death are merely compromises to allow for organ donation while the organs are still viable.
“Reasonable people could hardly be faulted for viewing these compromises as little more than medical charades.”
The authors suggest people be given a choice in the circumstances of their death, including donating organs.
In short, Truog argues that, when death is very near, people should have the option of “dying to help others to live, even if that means altering the timing or manner of their death.”
That would mean abandoning the dead donor rule.
Dr. Andrew Healey, chief medical officer at Trillium, calls such arguments “purely academic,” adding that the dead donor rule — which is generally considered fundamental to maintaining public faith in the system — is not going anywhere.
“The dead donor rule means what first must occur is death and then donation. Donation cannot cause the death of the donor. We are not in a place where we could make death happen and then go on to donation.”
Some ethicists are continuing to push, but there is little sign the dead donor rule is under real attack in Canada or that anyone is pushing for organ retrieval before death.
It is disappointing when a wish to donate cannot be realized, said Healey, “but it is clear death cannot be expedited for donation.”
He says it is “an amazing thing” to watch families in crisis making a decision to give consent to have their loved one’s organs donated.
“You see these families that are devastated yet they are resilient enough in their grief to say ‘I recognize that something good can come from this.’ That consent and the discussion among the family is powerful in and of itself.”
Healy adds that is the real gift of life.
“The only power the family has is in consent. The rest will happen or will not happen,” he said. “We try to make them understand it is in their consent that the gift is … it is not whether an organ was transplanted.”
•
More than four years after his son’s death, Moran is helping others in ways he couldn’t have imagined.
Moran’s family’s consent and his written participation in a Canadian Blood Services patient forum about the issue, said Healey, helped build a culture of talking about organ donation and increasing understanding of families’ roles in organ donation.
Healey uses tweets that Moran posted during his son’s hospitalization to help health-care professionals better understand the progression from critical care, to prognostication, to the family making a decision to stop life support, to organ donation.
“His experience has been shared with lots of health-care professions. Every audience I show that to, they are impacted by the experience.”
Moran said he felt compelled to write about what he and other family members saw as a contradiction that meant Christopher’s organs were not donated because he feels so strongly about the importance of organ donation.
“I am not a health-care professional nor a medical ethicist,” he added.
He said he ends many conversations by encouraging others to not only sign donor cards, but to talk to their families about it.
“I cannot do anything but encourage anyone in a similar situation to do the same thing we did,” says Moran. “Even the slimmest chance that a more meaningful life could be restored to an organ recipient is worth pursuing.”
epayne@postmedia.com
查看原文...
