Benjamin M
Health Prog. 1988 Mar;69(2):47-52.
Should organ transplants be available to all, regardless of ability to pay? Are organ transplants diverting funds from other, more basic medical needs? These are some of the economic questions of transplantation facing the medical profession and society in general. With the development of dialysis in the 1960s came the agonizing question of who should benefit from the limited number of kidney machines. This was resolved in 1972 when Congress extended Medicare benefits to patients with end-stage renal disease who were not federal employees or covered by VA benefits. But the economic fallout from the costs of such treatment underlies much of the reluctance to make access to heart and liver transplants available to everyone who would benefit from them. Some argue that if kidney transplants are available to all regardless of ability to pay, why should the same not be true of heart and liver transplants? The counterargument favors other uses for the funds, such as investing in basic research, education, and other preventive strategies and meeting the basic health needs of the uninsured. One argument for equal access to transplantation is that organs are donated for the good of the public as a whole, not just for those who can afford the operations, and that individuals and their families are asked to donate organs regardless of their financial status. Therefore, if organs are to be regarded as a public resource, they should be available to all, regardless of ability to pay.
器官移植应该提供给所有人，而不论其支付能力如何吗？器官移植是否正在从其他更基本的医疗需求中挪用资金？这些是医学界乃至整个社会在器官移植方面面临的一些经济问题。随着20世纪60年代透析技术的发展，出现了一个令人痛苦的问题：谁应该从数量有限的肾脏机器中受益。1972年，国会将医疗保险福利扩大到患有终末期肾病但不是联邦雇员或未享受退伍军人管理局福利的患者，这个问题得以解决。但是，这种治疗费用所带来的经济影响在很大程度上是人们不愿让每个能从心脏和肝脏移植中受益的人都能获得移植的原因。一些人认为，如果肾脏移植不论支付能力都提供给所有人，那么心脏和肝脏移植为何不应该如此呢？反对的观点则倾向于将资金用于其他用途，比如投资基础研究、教育和其他预防策略，以及满足未参保者的基本健康需求。支持平等获得移植的一个理由是，器官捐赠是为了整个公众的利益，而不仅仅是为了那些能够支付手术费用的人，而且个人及其家人被要求捐赠器官时并不考虑其经济状况。因此，如果器官要被视为一种公共资源，就应该提供给所有人，而不论其支付能力如何。
