Segev D L
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Am J Transplant. 2009 Jul;9(7):1513-8. doi: 10.1111/j.1600-6143.2009.02667.x. Epub 2009 May 20.
Over the last 5 years, a number of utility-based allocation systems have been proposed in an effort to increase the life-prolonging potential of deceased donor kidneys in the United States. These have included various adaptations of age-matching and net benefit, including the Eurotransplant Senior Program, Life Years From Transplant, and several systems for avoiding extreme donor/recipient mismatch. However, utility-based allocation is complex and raises issues regarding choice of metric, appropriateness of certain factors for use in allocation, accuracy of prediction models, transparency and perception, and possible effects on donation rates. Changing the role of utility in kidney allocation will likely cause changes to efficiency, equity, predictability, autonomy, controversy, trust and live donation. In this manuscript, various allocation systems are discussed, and a framework is proposed for quantifying the goals of the transplant community and evaluating options for utility-based kidney allocation in this context.
在过去5年里，美国提出了一些基于效用的分配系统，旨在提高已故捐赠者肾脏延长生命的潜力。这些系统包括年龄匹配和净效益的各种调整方式，如欧洲移植高级计划、移植后生命年，以及几种避免供体/受体极端不匹配的系统。然而，基于效用的分配很复杂，会引发有关衡量标准的选择、分配中某些因素使用的适当性、预测模型的准确性、透明度和认知度，以及对捐赠率可能产生的影响等问题。改变效用在肾脏分配中的作用可能会导致效率、公平性、可预测性、自主性、争议性、信任度和活体捐赠等方面的变化。在本手稿中，讨论了各种分配系统，并提出了一个框架，用于量化移植界的目标，并在此背景下评估基于效用的肾脏分配方案。
