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这是一场比赛!器官捐赠伦理


Now that I've got your attention,不,this article isn't a guide on how to craft the perfect Tinder profile.我向你保证,however,that you'll have no trouble scoring a date with your knowledge of器官共享联合网络.

While the organization has been in operation since its establishment by the 1984National Organ Transplantation Act,它的全盛时期是在2004年,当时经济学家阿尔文·罗斯(AlvinRoth)提出了一种革命性的肾脏分配新方法,最终将使他赢得2012年诺贝尔经济学奖.Kidneys are a unique entity in transplant medicine because each healthy person has two kidneys but only needs one to survive.这就产生了肾外,“and while technology can't force a healthy person to give up one of their kidneys to someone in need,它可以帮助分配通过尸体和慷慨的活体捐赠者可获得的供应。2003,,8,665例患者across the entire United States were able to receive a kidney transplant,almost all from deceased donors.By 2016,,19,061例患者由于罗斯和他的同龄人,每年都要接受一次活体肾脏移植手术。这一成功,however,没有公平的挑战就不会到来。实体器官移植领域存在于经济学的交叉点,遗传学和伦理学-具有旨在维护公平的系统的重要道德含义。

作为医学生,我们与配对供体匹配系统有着独特的关系。It turns out that the process that matches patients with potential organ donors is based on the same underlying method used to matchmedical students with residency programs.The algorithm that now regulates,除此之外,the allocation of solid organs,从劳动经济学家的思想实验开始,旨在设计一个模型来描述建立互利关系——所谓的Matching Theory."In the residency match,a system is created by which medical students are matched with the program they most prefer among programs which preferred them.现在替代“偏爱”为了“遗传相容性”而且,沃伊拉you've taken a market economists' approach to organ allocation.

假设有两个人,鲍伯和艾米both require a kidney transplant and have family members willing to donate a kidney to them.不幸的是,鲍伯的妻子,Sue,对他来说不是一个合适的捐赠者。Neither is Amy's sister,Kim,a compatible donor for her.在罗斯时代之前,Bob and Amy would be stuck waiting for a deceased donor with不到40%的机会of eventually receiving a transplant.通过联合国组织的力量,however,我们可能会发现Kim是Bob的兼容捐赠者,Sue是Amy的兼容捐赠者,使我们能够促进两对之间器官的均匀交换。

这个例子只触及了系统能力的表面。联合国组织的真正权力在于它能够安排三个或更多捐助者对之间的高阶交流。在这种情况下,一个来自北卡罗来纳州的女人,在纯粹的利他主义行为中,,愿意捐献肾脏to any compatible recipient through UNOS.她慷慨的捐赠使该系统解锁她的肾脏将捐赠给明尼阿波利斯的一位妇女,她的丈夫随后将一个肾脏捐赠给亚特兰大的一位妇女,thereby allowing two patients to receive kidneys who otherwise would not have been able to.She became what is known as a non-directed donor,移植医生现在把这种非直接器官捐献称为“Non-Simultaneous Extended Altruistic Donor“(NEAD) Chain.There are documented cases in which up toa nine-way exchange was facilitatedas a result of a single donor via a NEAD chain.

Although this may seem like a win-win-win scenario for all parties involved,器官移植的伦理考虑为配对供体系统的设计增加了另一层复杂性。在“的十字路口供求关系”and"生与死,“the goal of a fair and efficient"marketplace"因为器官可能很难定义。尽管阿尔文·罗斯的方法取得了成功,仍有over 120,000 patientswaiting for a kidney transplant with the average waiting time estimated to be over three years.这是移植医学的不幸现实,每天约有13名患者在等待挽救生命的肾脏移植时死亡。So how do we,作为医生和社会,decide who gets a kidney?And how do we decide who can donate (or sell) a kidney??

Feel like you've got a kidney burning a hole in your retroperitoneum?You're out of luck.1984年成立联合国组织的同一法案也禁止在美国买卖器官。Therefore,in theory,a wealthier person would not have any advantage in obtaining a donor organ over a less wealthy person.While this may sound fair,它还通过禁止个人获得器官捐赠补偿来限制现有器官的供应。这意味着许多活着的捐赠者可能愿意以一定的价格捐献一个肾脏,但他们却不能。This is one of many moral conundrums that comes with designing an organ allocation system.Do we increase the supply while creating an unfair advantage for wealthy patients,or do we maintain equal access while limiting supply??

有几项替代方案被建议在没有直接经济补偿的情况下鼓励非直接捐助者,providing,例如,一lifetime tax exemption或者给愿意把肾捐给非亲属的个人提供某种形式的人寿保险。However,到目前为止,唯一合法的激励形式是maximum of $300to cover the cost of travel and up to 30 days of paid medical leave following the operation.解决供求不匹配的最成功尝试之一是在1993年,当一个UNOS委员会召开会议讨论“推定同意“如果死者没有明确登记拒绝成为捐献者,则推定其同意尸体捐献。委员会作出裁决,认为这不是一种道德行为,尽管考虑到器官匹配系统的最新进展和nead链的潜力,这一争论可能值得重温。

These are just a few examples of the ethical issues surrounding solid organ transplantation.关于未成年人和儿童器官捐献问题仍存在广泛的争论,来自驯养动物和两个HIV阳性个体之间.一些不太保守的伦理学家甚至建议从被处决的囚犯.Other countries,,像以色列,如果患者是注册器官捐赠者,请在移植名单上注明其优先地位。在各国像伊朗,where it is legal to buy and sell organs for profit,肾脏的现行价格在2美元之间,000美元和4美元,000.Organs are sold through a number of extrajudicialblack marketsaround the globe,如果肾脏的价值估计为160美元,000.

To learn more bepaly手机官网about the world of market design and matchmaking systems,看看阿尔文·罗斯的书谁得到什么?为什么:媒人和市场设计的新经济学.

硝酸甘油 Nitin Venugopal (2柱)

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乔治亚医学院


尼汀·维努戈帕尔是位于奥古斯塔的乔治亚医学院2020级学生,GA.他来自亚特兰大,2016年毕业于佐治亚理工学院,获得工业工程学士学位。His interests include population health and health policy.