Sackner-Bernstein Jonathan D, Godin Seth
Division of Cardiology, North Shore University Hospital, Manhasset, NY 11030, USA.
Transplantation. 2004 Jan 15;77(1):157-9. doi: 10.1097/01.TP.0000103741.63011.B8.
Ten to 30 times as many people die as a result of end-organ failure than are fortunate enough to undergo transplantation. To date, efforts to increase the donor pool or establish an alternative to transplant have failed. The authors' goal was to define a revision to the transplant system that can use innate human motivators to lead to an increase in organ donation. People are motivated more by self-interest than by altruism. To increase organ donation, the incentive needs to be aligned with self-interests. Therefore, the authors propose that the priority to receive a transplant should be based on prior willingness to be a donor: to get, you have to be willing to give. This would replace the "time on list" as a key variable in determining priority and waiting time. The commitment to the system of transplant--being a willing donor--is the fairest way to prioritize recipient status. Such a system will encourage more donation as people on the donor list start to receive transplants themselves, especially when the transplant takes place quickly, before risk becomes excessive.
因终末期器官衰竭而死亡的人数是有幸接受移植手术人数的10至30倍。迄今为止，增加供体库或建立移植替代方案的努力均告失败。作者的目标是定义一种对移植系统的修订方案，该方案能够利用人类与生俱来的动机来增加器官捐献。相比利他主义，人们更多地受到自身利益的驱使。为了增加器官捐献，激励措施需要与自身利益保持一致。因此，作者提议接受移植的优先权应基于之前成为供体的意愿：要得到，你必须愿意给予。这将取代“排队时间”，成为决定优先权和等待时间的关键变量。对移植系统的承诺——成为一名自愿供体——是确定受者地位优先权的最公平方式。这样的系统将鼓励更多的捐献，因为在供体名单上的人自己开始接受移植时，尤其是当移植手术迅速进行，在风险变得过高之前，情况更是如此。
