Mount Sinai Medical Center, New York, NY.
University of British Columbia, St. Paul's Hospital, Vancouver, Canada.
Am J Transplant. 2010 Apr;10(4):747-750. doi: 10.1111/j.1600-6143.2009.02994.x. Epub 2010 Jan 29.
The health insurance system for living donors is derived from insurance policies designed to cover accidental death or dismemberment. The system covers only the direct consequences of organ removal, and recoups the costs of related medical services from the transplant recipient's health insurance provider. The system forces transplant programs to differentiate between health services that are, or are not directly attributable to donation and may compromise the pretransplant evaluation, postoperative care and long-term care of living donors. The system is particularly problematic in the United States, where a significant proportion of donors do not have medical insurance. The requirement to assign donor costs to a particular recipient is poorly suited to facilitate advances in living donation such as the use of nondirected donors and living-donor paired exchange programs. We argue that given the current understanding regarding the long-term risks of living donation, the provision of basic medical insurance is a necessity for living donation and that the system of attributing donor costs to the recipient's insurance is inefficient, has the potential to undermine the care of living donors and is a disincentive to the expansion of living donation.
活体捐献者的医疗保险制度源自于旨在涵盖意外死亡或残疾的保险政策。该制度仅涵盖器官移除的直接后果，并从移植受者的医疗保险提供者处收回相关医疗服务的费用。该制度迫使移植项目区分与捐赠直接相关或不直接相关的医疗服务，可能会影响到活体捐献者的移植前评估、术后护理和长期护理。该制度在美国尤其成问题，因为相当一部分捐献者没有医疗保险。将捐赠者的费用分配给特定受者的要求不利于促进活体捐献的发展，例如使用非定向捐献者和活体捐献者配对交换计划。我们认为，鉴于目前对活体捐献长期风险的理解，提供基本医疗保险是活体捐献的必要条件，而将捐赠者的费用归因于受者保险的制度效率低下，有可能破坏活体捐献者的护理，并且不利于活体捐献的扩大。
