Miller Charles M
Liver Transplantation, Department of General Surgery, The Cleveland Clinic, Cleveland, OH 44195, USA.
Transplant Rev (Orlando). 2008 Jul;22(3):206-9. doi: 10.1016/j.trre.2008.02.001. Epub 2008 Apr 23.
Whereas distributive justice is the most important principle in most aspects of transplantation and the allocation of scarce resources, it is far less of a central principle in directed living liver donation. For living donation, the ethical principals include (1) respect for the donor's autonomy through full, voluntary, informed consent; (2) beneficence; and (3) nonmaleficence. But how do we put these principles into practice? Practical decision making in living liver donation involves 3 fundamental ethical dimensions: (1) need, (2) probability of donor safety, and (3) the chance for good short- and long-term recipient outcomes. These same dimensions exist everywhere, but the size and shape of the "triangle" can vary greatly depending on societal beliefs. Ultimately, the proper balance of ethical equipoise is affected by the dynamics of these 3 dimensions.
虽然分配正义在移植的大多数方面以及稀缺资源的分配中是最重要的原则，但在活体肝脏定向捐赠中，它远不是核心原则。对于活体捐赠，伦理原则包括：（1）通过充分、自愿、知情同意来尊重捐赠者的自主权；（2）行善；以及（3）不伤害。但我们如何将这些原则付诸实践呢？活体肝脏捐赠中的实际决策涉及三个基本伦理维度：（1）需求，（2）捐赠者安全的可能性，以及（3）受者短期和长期良好预后的机会。这些维度在任何地方都存在，但“三角形”的大小和形状会因社会观念的不同而有很大差异。最终，伦理平衡的恰当权衡受这三个维度动态变化的影响。
