Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Am J Transplant. 2014 Jan;14(1):21-6. doi: 10.1111/ajt.12557.
In the setting of organ scarcity, the ethics of multi-organ transplantation (MOT) deserve new examination. MOT offers substantial benefits to certain recipients, including avoiding serial surgeries. However, MOT candidates in the United States commonly receive priority for their nonprimary organ over many individuals who need that organ, which may undermine equity. The absence of standard criteria for MOT eligibility also enables large and unfair regional variation in MOT, such as simultaneous liver-kidney transplantation. Unfortunately, MOT may also undermine utility (optimal patient and graft survival) in circumstances where providing multiple organs to one person fails to achieve the greater collective benefit attained by providing transplants to multiple people. Policy reforms should include the adoption of minimal clinical criteria for MOT candidacy with the attendant goal of decreasing regional variation in MOT. In the future, these minimal criteria can be revised to accommodate new research about which patients derive the most benefit from MOT. Incentives to perform MOT should also be reduced, such as by including MOT outcomes in center-specific reports. These reforms run the risk that the transplant community could be perceived as abandoning MOT candidates, but offer an opportunity to align transplant practice and ethical principles.
在器官短缺的情况下，多器官移植（MOT）的伦理值得重新审视。MOT 为某些受者带来了巨大的益处，包括避免多次手术。然而，美国的 MOT 候选者通常优先获得非主要器官，而许多需要该器官的人却无法获得，这可能会损害公平性。MOT 资格的标准也不统一，导致 MOT 存在着巨大的不公平的地区差异，例如同时进行肝肾移植。不幸的是，在为一个人提供多个器官未能实现为更多人提供移植所获得的更大集体利益的情况下，MOT 也可能会损害效用（最佳患者和移植物存活率）。政策改革应包括采用 MOT 候选资格的最低临床标准，目标是减少 MOT 的地区差异。在未来，这些最低标准可以根据从 MOT 中受益最多的患者的新研究进行修订。还应减少进行 MOT 的激励措施，例如将 MOT 结果纳入特定中心的报告中。这些改革有可能使移植界被视为放弃 MOT 候选者，但这为使移植实践和伦理原则保持一致提供了机会。
