Michielsen P
University Hospital Gasthuisberg, Leuven, Belgium.
Health Policy. 1990 Nov;16(2):117-22. doi: 10.1016/0168-8510(90)90102-j.
As there is a world-wide shortage of organs for transplantation, the selection of the patients is more defined by the availability of transplantable organs than by the medical condition of the potential recipient. This shortage of cadaveric organs is mainly responsible for the use of living donors. With HLA identical sibling donors the results are better than with cadaveric organs, but the ethical problems are usually underestimated. For the parent-to-child donation, the HLA compatibility is less than what could be achieved with well-matched cadaveric donors. The use of genetically unrelated donors is unacceptable from the ethical as well as from the medical point of view. The short- and long-term risk of donation has been insufficiently documented. The experience with the introduction of an opting-out legislation in Belgium in 1987 demonstrates that the shortage of cadaveric organs can be overcome. Harmonization of the legislation is, however, necessary so as to achieve comparable organ retrieval rates between countries participating in organ-exchange organisations.
由于全球范围内可供移植的器官短缺，患者的选择更多地取决于可移植器官的可用性，而非潜在受者的医疗状况。尸体器官的短缺是使用活体供者的主要原因。对于人类白细胞抗原（HLA）匹配的同胞供者，移植结果优于尸体器官，但伦理问题通常被低估。对于父母向子女捐赠，HLA相容性低于匹配良好的尸体供者所能达到的水平。从伦理和医学角度来看，使用基因不相关的供者都是不可接受的。捐赠的短期和长期风险记录不足。1987年比利时引入选择退出立法的经验表明，尸体器官短缺的问题是可以克服的。然而，有必要统一立法，以便在参与器官交换组织的国家之间实现可比的器官获取率。
