Freeman M A, Wightman A G
Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA.
Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
Pediatr Transplant. 2018 May;22(3):e13153. doi: 10.1111/petr.13153. Epub 2018 Jan 30.
Historically, living kidney donation has been justified in part by our belief that living donors face minimal risks of subsequent disease. Recent research has brought that presumption into question, particularly for younger donors including parents. In light of this finding, we re-examine many of the traditional arguments both for and against the practice of parental living kidney donation. We then propose an alternative framework in which the burden of having a child with end-stage kidney disease can be considered as an illness experienced by the potential donor parent. We believe this allows a more straightforward, as well as more accurate, assessment of the risks and benefits of donation for the potential parental donor. This assessment might then be used to best inform the decision whether or not to proceed with kidney donation using a shared decision-making model, while reflecting the appropriate ethical roles of both the potential donor and the transplantation program.
从历史上看，活体肾捐赠在一定程度上是合理的，因为我们相信活体捐赠者面临后续疾病的风险极小。最近的研究对这一假设提出了质疑，尤其是对于包括父母在内的年轻捐赠者。鉴于这一发现，我们重新审视了许多支持和反对父母活体肾捐赠做法的传统论点。然后，我们提出了一个替代框架，在这个框架中，生育患有终末期肾病孩子的负担可以被视为潜在捐赠者父母所经历的一种疾病。我们认为，这使得对潜在父母捐赠者捐赠的风险和益处进行更直接、更准确的评估成为可能。然后，这种评估可以用来通过共享决策模型，在反映潜在捐赠者和移植项目各自适当的伦理角色的同时，为是否进行肾捐赠的决定提供最佳信息。
