Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas.
Division of Transplantation, University of Minnesota, Minneapolis, Minnesota.
Am J Transplant. 2020 Sep;20(9):2332-2336. doi: 10.1111/ajt.15914. Epub 2020 Apr 26.
The novel coronavirus disease 2019 (COVID-19) is impacting transplant programs around the world, and, as the center of the pandemic shifts to the United States, we have to prepare to make decisions about which patients to transplant during times of constrained resources. In this paper, we discuss how to transition from the traditional justice versus utility consideration in organ allocation to a more nuanced allocation scheme based on ethical values that drive decisions in times of absolute scarcity. We recognize that many decisions are made based on the practical limitations that transplant programs face, especially at the extremes. As programs make the transition from a standard approach to a resource-constrained approach to transplantation, we utilize a framework for ethical decisions in settings of absolutely scarce resources to help guide programs in deciding which patients to transplant, which donors to accept, how to minimize risk, and how to ensure the best utilization of transplant team members.
2019 年新型冠状病毒病（COVID-19）正在影响全球的移植项目，随着大流行的中心转移到美国，我们必须准备好在资源有限的情况下做出关于移植哪些患者的决策。在本文中，我们讨论了如何将传统的正义与效用在器官分配中的考虑转变为基于道德价值观的更细致的分配方案，这些价值观在绝对稀缺的情况下驱动决策。我们认识到，许多决策是基于移植项目所面临的实际限制做出的，尤其是在极端情况下。随着项目从标准方法向资源受限的移植方法过渡，我们利用绝对稀缺资源情况下的伦理决策框架来帮助指导项目决定移植哪些患者、接受哪些供体、如何最大限度地降低风险以及如何确保移植团队成员的最佳利用。
