Renal Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Am Geriatr Soc. 2010 Oct;58(10):1980-6. doi: 10.1111/j.1532-5415.2010.03031.x. Epub 2010 Sep 9.
Competing visions for health reform in the United States and renewed interest in health technology assessment (HTA) have led to fierce national debates about the appropriateness of rationing. Because of a limited supply of organs, kidney transplantation has always required rationing and overt discussion of the ethics that guide it, but the field of transplantation has also contended recently with internal calls for a new rationing system. The aim of the Life Years from Transplantation (LYFT) proposal is to allocate kidneys to patients who obtain the greatest survival benefit from transplantation, which would lengthen the lives of kidney transplant recipients but restrict the ability of older Americans to obtain a transplant. The debate around the LYFT proposal reveals the ethical and policy challenges of identifying which patients should receive a treatment based on the results of cost-effectiveness and other HTA studies. This article argues that attempts to use HTA for healthcare rationing are likely to disadvantage older patients. Guiding principles to help ensure that resources such as kidneys are justly allocated across the life span are proposed.
美国医疗改革的不同愿景以及对健康技术评估（HTA）的重新关注，引发了关于配给制是否合理的激烈全国性辩论。由于器官供应有限，肾移植一直需要配给制，并且需要公开讨论指导其配给的伦理问题，但移植领域最近也对新的配给制度提出了内部要求。《移植生命年》（LYFT）提案的目的是将肾脏分配给那些从移植中获得最大生存获益的患者，这将延长肾移植受者的寿命，但限制了美国老年人获得移植的能力。围绕 LYFT 提案的辩论揭示了在确定哪些患者应根据成本效益和其他 HTA 研究的结果接受治疗时，所面临的伦理和政策挑战。本文认为，试图将 HTA 用于医疗保健配给制可能会使老年患者处于不利地位。本文提出了一些指导原则，以帮助确保在整个生命周期内公平分配肾脏等资源。
