Institute for Health Research, University of Bedfordshire, Luton, UK.
Nephrol Dial Transplant. 2013 Jun;28(6):1343-5. doi: 10.1093/ndt/gft075.
The challenge to resolve the gap between supply and demand for organs is a global phenomenon. The possible solutions can invariably involve a range of ethical and moral dilemmas. This is certainly the case when considering rewards and compensation for kidney donation. In their thought provoking study, Ghahramami et al. provide the perspectives of medical professionals on these issues. The views of nephrologists concerning rewards and compensation chime with views of the public, which have been highlighted in many previous studies. Rewards and compensation for organ donation are perceived, by some, as barriers to successful organ donation transplant programmes; whereas others view them as potential facilitators to increasing organ donation rates. It is interesting to note that two-thirds of survey respondents believe that introducing some kind of reward or offering compensation would lead to an increase in organ donation. This finding is not unique to this study and is evident in many public surveys where respondents have expressed a belief that offering some form of incentive would have a positive impact on organ donation rates. Disappointingly, the debates concerning the type of reward or compensation and its potential impact on donation rates continue to take place in a relatively 'evidence base-free' vacuum. What is abundantly clear is that many lives continue to be lost in many countries due to a lack of suitable organs for transplant. What is less clear is which forms of reward and compensation actually have an impact on donation rates and whether they positively impact the life experiences of donors, recipients and their families. This level of evidence- base is urgently required.
解决器官供需之间差距的挑战是一个全球性现象。可能的解决方案总是会涉及到一系列的伦理和道德困境。当考虑肾脏捐赠的奖励和补偿时，情况更是如此。在他们发人深省的研究中，Ghahramami 等人提供了医疗专业人员对这些问题的看法。肾病学家对奖励和补偿的看法与公众的看法一致，这在许多先前的研究中都得到了强调。一些人认为，器官捐赠的奖励和补偿是成功的器官捐赠移植项目的障碍；而另一些人则认为，它们是增加器官捐赠率的潜在促进因素。有趣的是，三分之二的调查受访者认为，引入某种形式的奖励或提供补偿将导致器官捐赠的增加。这一发现并非这项研究所独有，在许多公众调查中，受访者都表示相信提供某种形式的激励将对器官捐赠率产生积极影响。令人失望的是，关于奖励或补偿的类型及其对捐赠率的潜在影响的争论仍在相对“缺乏证据基础”的情况下进行。显而易见的是，由于缺乏适合移植的器官，许多国家仍有许多生命因此丧失。不太清楚的是，哪些形式的奖励和补偿实际上对捐赠率有影响，以及它们是否对捐赠者、接受者及其家人的生活经历产生积极影响。这种证据基础急需建立。
