Better Off Living—The Ethics of the New UNOS Proposal for Allocating Kidneys for Transplantation

[摘要] In February 2011, the United Network for Organ Sharing (UNOS) issued a new policy proposal to change how deceased donor kidneys are allocated to adults in the United States (1). The proposal comes at a crucial juncture in the field of kidney transplantation. Stagnation in kidney donation rates, ever-rising waiting times, and a greater reliance on “marginal” organs reveal an area of medicine that is struggling to cope with organ shortages and concerned about a future where greater demand awaits. The main aim of the new policy is to make allocation more efficient by achieving greater survival for kidney transplant recipients. This aim would be accomplished by age matching of recipients to donors and by allocating the highest quality kidneys to recipients with the longest projected survival. To date, the main ethical objections have focused on the consequence of diminished transplant access for older patients, the challenge of accurately forecasting recipient survival after transplant, and the possible negative effect on kidney donation by living donors (2). We believe these objections are not sufficient to outweigh the powerful moral claims of saving more lives and extending patients' lives in a meaningful way. If the new proposal has an ethical failing, it is that UNOS does not go far enough to redress obvious sources of inequity in access to kidney transplants.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome