The Transplant Institute and Center for Transplant Outcomes and Quality Improvement at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Am J Transplant. 2011 Nov;11(11):2317-21. doi: 10.1111/j.1600-6143.2011.03726.x. Epub 2011 Sep 11.
After 6 years of deliberation, the Organ Procurement and Transplantation Network recently released a concept document proposing changes to the kidney allocation algorithm, sparking a heated debate about priority-setting of scarce health resources and discrimination. Proponents of the proposal argue that it will result in an additional 15,223 life years following transplant annually for recipients, yet the benefit will not be equally distributed and will likely benefit younger patients. Critics argue that the new model will promote age discrimination and may lead to a further decrease in live kidney donation. If true, these concerns could undermine fairness and damage public trust in the organ allocation system. We address these objections and consider their merit, highlighting both benefits and shortcomings of the proposal. We argue that, despite weaknesses of the proposal and the importance of maintaining consistency in patient and provider expectations over time, the proposal represents a needed first step in balancing equity and efficiency.
经过 6 年的审议，器官获取和移植网络最近发布了一份概念文件，提出了对肾脏分配算法的修改建议，引发了关于稀缺卫生资源优先配置和歧视的激烈辩论。该提案的支持者认为，这将使每年接受者的移植后预期寿命额外增加 15223 年，但受益不会均等分配，可能会使年轻患者受益。批评者认为，新模式将促进年龄歧视，并可能导致活体肾脏捐献进一步减少。如果这是真的，这些担忧可能会破坏公平性并损害公众对器官分配系统的信任。我们将解决这些反对意见，并考虑其优点，突出该提案的利弊。我们认为，尽管该提案存在弱点，而且随着时间的推移，在患者和提供者的期望方面保持一致性非常重要，但该提案代表了在平衡公平性和效率方面迈出的必要的第一步。
