Ghods Ahad J, Savaj Shekoufeh
Transplantation Unit, Hashemi Nejad Kidney Hospital, Iran University of Medical Sciences, Tehran, Iran.
Clin J Am Soc Nephrol. 2006 Nov;1(6):1136-45. doi: 10.2215/CJN.00700206. Epub 2006 Oct 11.
Since the 1980s, many countries have passed legislation prohibiting monetary compensation for organ donation. Organ donation for transplantation has become altruistic worldwide. During the past two decades, advances in immunosuppressive therapy has led to greater success in transplantation and to increased numbers of patients on transplant waiting lists. Unfortunately, the altruistic supply of organs has been less than adequate, and severe organ shortage has resulted in many patient deaths. A number of transplant experts have been convinced that providing financial incentives to organ sources as an alternative to altruistic organ donation needs careful reconsideration. In 1988, a compensated and regulated living-unrelated donor renal transplant program was adopted in Iran. As a result, the number of renal transplants performed substantially increased such that in 1999, the renal transplant waiting list was completely eliminated. By the end of 2005, a total of 19,609 renal transplants were performed (3421 from living related, 15,356 from living-unrelated and 823 from deceased donors). In this program, many ethical problems that are associated with paid kidney donation also were prevented. Currently, Iran has no renal transplant waiting lists, and >50% of patients with ESRD in the country are living with a functioning graft. In developed countries, the severe shortage of transplantable kidneys has forced the transplant community to adopt new strategies to expand the kidney donor pool. However, compared with the Iranian model, none of these approaches has the potential to eliminate or even alleviate steadily worsening renal transplant waiting lists.
自20世纪80年代以来，许多国家已通过立法禁止对器官捐赠进行金钱补偿。器官移植捐赠在全球范围内已成为利他行为。在过去二十年中，免疫抑制疗法的进展使移植取得了更大成功，移植等待名单上的患者数量也有所增加。不幸的是，利他性器官供应不足，严重的器官短缺导致许多患者死亡。一些移植专家确信，向器官来源提供经济激励作为利他性器官捐赠的替代方案需要仔细重新考虑。1988年，伊朗采用了一项有偿且受监管的非亲属活体供肾移植计划。结果，肾移植手术的数量大幅增加，以至于在1999年，肾移植等待名单被彻底消除。到2005年底，共进行了19609例肾移植手术（3421例来自亲属活体，15356例来自非亲属活体，823例来自已故捐赠者）。在该计划中，与有偿肾捐赠相关的许多伦理问题也得到了预防。目前，伊朗没有肾移植等待名单，该国超过50%的终末期肾病患者靠有功能的移植肾存活。在发达国家，可移植肾脏的严重短缺迫使移植界采取新策略来扩大肾脏供体库。然而，与伊朗模式相比，这些方法都没有消除甚至缓解不断恶化的肾移植等待名单的潜力。
