Levitt Mairi
Department of Politics Philosophy & Religion, County South College, Lancaster University, Lancaster, LA1 4YD, UK,
Life Sci Soc Policy. 2015;11:6. doi: 10.1186/s40504-015-0023-1. Epub 2015 Jul 23.
The organ shortage is commonly presented as having a clear solution, increase the number of organs donated and the problem will be solved. In the light of the Northern Ireland Assembly's consultation on moving to an opt-out organ donor register this article focuses on the social factors and complexities which impact strongly on both the supply of, and demand for, transplantable organs. Judging by the experience of other countries presumed consent systems may or may not increase donations but have not met demand. Donation rates have risen considerably in all parts of the UK recently but there is also an increasing demand for organs. Looking at international donation rates and attitudes, future demand for organs and education on donation, the question is whether the organ shortage could ever be met. The increase in longevity, in rates of diabetes and obesity and in alcohol related liver disease all contribute both to increased demand for transplants, and re-transplants, and a reduction in the number of usable organs. It is unlikely that demand could ever be met, since, if supply was unlimited, the focus would move to financial resources and competing demands on the health care budget in a publicly funded health system. These factors point to the need to focus on ways of reducing, or at least stabilizing, demand where lifestyle factors contribute to the underlying disease.
器官短缺问题通常被认为有一个明确的解决方案，即增加器官捐赠数量，问题就能得到解决。鉴于北爱尔兰议会就转向选择退出式器官捐赠登记册进行的磋商，本文重点关注对可移植器官的供应和需求都有重大影响的社会因素及复杂性。从其他国家的经验来看，推定同意系统可能会增加捐赠，也可能不会，但都未能满足需求。近期英国各地的捐赠率都有显著上升，但对器官的需求也在增加。综合考虑国际捐赠率和态度、未来对器官的需求以及捐赠教育情况，问题在于器官短缺是否有可能得到解决。寿命的延长、糖尿病和肥胖症发病率的上升以及酒精性肝病的增加，都导致了对移植和再次移植的需求增加，同时可用器官数量减少。需求不太可能得到满足，因为如果供应不受限制，焦点将转向财政资源以及公共资助医疗系统中医疗保健预算的竞争性需求。这些因素表明，有必要关注在生活方式因素导致潜在疾病的情况下，如何减少或至少稳定需求。
