Goyal Madhav, Mehta Ravindra L, Schneiderman Lawrence J, Sehgal Ashwini R
Department of Internal Medicine, Geisinger Health System, 200 Scenery Dr, State College, PA 16801, USA.
JAMA. 2002 Oct 2;288(13):1589-93. doi: 10.1001/jama.288.13.1589.
Many countries have a shortage of kidneys available for transplantation. Paying people to donate kidneys is often proposed or justified as a way to benefit recipients by increasing the supply of organs and to benefit donors by improving their economic status. However, whether individuals who sell their kidneys actually benefit from the sale is controversial.
To determine the economic and health effects of selling a kidney.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey conducted in February 2001 among 305 individuals who had sold a kidney in Chennai, India, an average of 6 years before the survey.
Reasons for selling kidney, amount received from sale, how money was spent, change in economic status, change in health status, advice for others contemplating selling a kidney.
Ninety-six percent of participants sold their kidneys to pay off debts. The average amount received was 1070 US dollars. Most of the money received was spent on debts, food, and clothing. Average family income declined by one third after nephrectomy (P<.001), and the number of participants living below the poverty line increased. Three fourths of participants were still in debt at the time of the survey. About 86% of participants reported a deterioration in their health status after nephrectomy. Seventy-nine percent would not recommend that others sell a kidney.
Among paid donors in India, selling a kidney does not lead to a long-term economic benefit and may be associated with a decline in health. Physicians and policy makers should reexamine the value of using financial incentives to increase the supply of organs for transplantation.
许多国家可用于移植的肾脏短缺。付钱给人们捐赠肾脏常常被提议或被视为一种既能通过增加器官供应使接受者受益，又能通过改善捐赠者经济状况使其受益的方式。然而，出售肾脏的个人是否真的能从这种交易中受益存在争议。
确定出售肾脏对经济和健康的影响。
设计、地点和参与者：2001年2月对印度金奈305名出售过肾脏的个人进行了横断面调查，这些人在调查前平均6年就已出售肾脏。
出售肾脏的原因、出售所得金额、资金使用方式、经济状况变化、健康状况变化、对其他考虑出售肾脏者的建议。
96%的参与者出售肾脏是为了偿还债务。平均所得金额为1070美元。所得的大部分资金用于偿还债务、购买食品和衣物。肾切除术后家庭平均收入下降了三分之一（P<0.001），生活在贫困线以下的参与者人数增加。四分之三的参与者在调查时仍有债务。约86%的参与者报告肾切除术后健康状况恶化。79%的人不会建议其他人出售肾脏。
在印度有偿捐赠者中，出售肾脏不会带来长期经济利益，且可能与健康状况下降有关。医生和政策制定者应重新审视利用经济激励措施增加移植器官供应的价值。
