Shapiro Michael E
Organ Transplantation, Hackensack University Medical Center, Surgery, New Jersey Medical School/UMDNJ, Hackensack, New Jersey, USA.
Curr Opin Nephrol Hypertens. 2007 Nov;16(6):512-5. doi: 10.1097/MNH.0b013e3282f08638.
The current system of kidney allocation in the United States has been undergoing review by the Organ Procurement and Transplantation Network. The Organ Procurement and Transplantation Network kidney committee is nearing the release of a draft proposal for sweeping changes in kidney allocation. The involvement of the renal community is critical to the successful development and implementation of these new policies.
This review describes ethical issues related to allocation of scarce resources such as kidneys, the current US kidney allocation system and problems associated with it, as well as the development of a new model for kidney allocation. The new paradigm involves the application of 'life years from transplant'--an approach that compares predicted survival of a recipient after transplant versus remaining on dialysis, adjusted for multiple factors such as cause of renal failure, age and co-morbid conditions. Alternate systems as well as criticism of the current proposals are presented.
The use of life years from transplant would increase allocation of kidneys to patients more likely to benefit from transplantation, resulting in many thousands of additional life-years saved. Such a scheme would also tend to assign these kidneys to younger patients, which has generated controversy.
美国当前的肾脏分配系统正在接受器官获取与移植网络的审查。器官获取与移植网络肾脏委员会即将发布一项关于全面改革肾脏分配的提案草案。肾脏学界的参与对于这些新政策的成功制定和实施至关重要。
本综述描述了与肾脏等稀缺资源分配相关的伦理问题、美国当前的肾脏分配系统及其相关问题，以及一种新的肾脏分配模型的发展情况。新范式涉及应用“移植后的生存年数”——一种比较移植后受者预测生存期与继续接受透析生存期的方法，并针对肾衰竭原因、年龄和合并症等多种因素进行了调整。文中还介绍了替代系统以及对当前提案的批评意见。
使用移植后的生存年数将增加将肾脏分配给更有可能从移植中受益的患者的比例，从而额外挽救数千个生命年。这样的方案也倾向于将这些肾脏分配给年轻患者，这引发了争议。
