Koch T
David See-Chai Lam Centre for International Communications, Simon Fraser University (Harbour Centre), Vancouver, Canada.
Theor Med. 1996 Mar;17(1):75-93. doi: 10.1007/BF00489742.
Normative criteria adopted to assure just, equitable, and efficient allocation of donor organs to potential recipients has been widely praised as a model for the allocation of scarce medical resources. Because the organ transplantation program relies upon voluntary participation by potential donors, all such programs necessarily rely upon public confidence in allocation decision making protocols. Several well publicized cases have raised questions in North America about the efficacy of allocation procedures. An analysis of those cases, and the relevant technical literature, suggest consistent structural deficits exist in the organ allocation process as it is applied by many individual transplantation centres. These irregularities are based upon both the failure of rank waiting as a method to guarantee just treatment and a general failure to recognize the extent to which prescriptive criteria--social values--are commonly used to screen potential organ transplant candidates. Resulting idiosyncratic determinations, and a devaluation of rank waiting as a criterion, raise fundamental questions regarding justice, fairness, and equability in the application procedure at large. To correct these structural problems in organ allocation procedures, a multicriterion model defining prescriptive criteria through the Analytic Hierarchy Process (AHP) is proposed.
为确保将捐赠器官公正、公平且高效地分配给潜在受者而采用的规范标准，作为稀缺医疗资源分配的典范广受赞誉。由于器官移植项目依赖潜在捐赠者的自愿参与，所有此类项目必然依赖公众对分配决策方案的信任。北美几起广为人知的案例引发了人们对分配程序有效性的质疑。对这些案例以及相关技术文献的分析表明，许多个体移植中心实施的器官分配过程中存在一致的结构性缺陷。这些违规行为既源于排队等待作为保证公正待遇的方法失效，也源于普遍未能认识到规范性标准（社会价值观）在筛选潜在器官移植候选人时的常用程度。由此产生的特殊决定以及排队等待作为标准的贬值，引发了关于整个应用程序中的公正、公平和平等的根本问题。为纠正器官分配程序中的这些结构性问题，提出了一种通过层次分析法（AHP）定义规范性标准的多标准模型。
