Ross Lainie Friedman, Thistlethwaite J Richard
Department of Medicine and the MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois 60637, USA.
Semin Dial. 2012 Nov-Dec;25(6):675-81. doi: 10.1111/sdi.12016. Epub 2012 Oct 19.
In this manuscript, we examine what role age can morally play in the allocation of deceased donor kidneys for transplantation into adult candidates. Our focus is on the equity concerns raised by recent proposals that give younger adults in end-stage renal disease priority to more and better deceased donor kidneys. We begin with a description of four models: the current allocation method ("baseline proposal"), the two models offered by the Kidney Transplant Committee in February 2011: a pure ±15 years age-matching model and a 20/80 proposal (http://optn.transplant.hrsa.gov/SharedContentDocuments/KidneyConceptDocument.PDF), and a new model entitled Equal Opportunity supplemented by Fair Innings (EOFI) described by Ross et al. earlier this year. We then consider the requirement of the National Organ Transplantation Act (NOTA) of 1984 that allocation policies balance efficiency and equity. The models all define efficiency as promoting graft and patient survival but use various conceptions of equity. We discuss the various conceptions of equity employed in the various models. We show that only the new proposal, EOFI, can meet the NOTA requirements using a multiprincipled equity approach to kidney allocation.
在本论文中，我们探讨年龄在已故捐赠者肾脏分配给成年候选移植受者的过程中，在道德层面上能起到什么作用。我们关注的是近期提议引发的公平性问题，这些提议给予终末期肾病的年轻成年人优先获得更多、更好的已故捐赠者肾脏的机会。我们首先描述四种模式：当前的分配方法（“基线提议”）、肾脏移植委员会于2011年2月提出的两种模式：一种纯粹的±15岁年龄匹配模式和一种20/80提议（http://optn.transplant.hrsa.gov/SharedContentDocuments/KidneyConceptDocument.PDF），以及罗斯等人在今年早些时候描述的一种名为“公平机会辅以公平寿限”（EOFI）的新模式。然后，我们考虑1984年《国家器官移植法》（NOTA）的要求，即分配政策要平衡效率与公平。这些模式都将效率定义为促进移植物和患者的存活，但使用了不同的公平概念。我们讨论了各种模式中所采用的不同公平概念。我们表明，只有新提议EOFI能够通过采用多原则公平方法进行肾脏分配来满足NOTA的要求。
