Liver allocation: urgency of need or prospect of success? Ethical considerations
Liver allocation: urgency of need or prospect of success? Ethical considerations
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DOI：
10.1111/ctr.12154
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发表时间：
2013-07-01
影响因子：
2.1
通讯作者：
Ganten, Tom M.
中科院分区：
文献类型：
--
作者：
Bobbert, Monika;Ganten, Tom M.
在德国立法和欧洲移植组织的肝脏分配实践中，需求的紧迫性被认为是主要的分配标准。然而，在某个阶段，病人优先原则被认为是适得其反的，因为这些接受器官的患者的表现状态平均来说是危急的，肝移植后的死亡率和发病率增加。在医学移植界，成功的前景标准被高度接受。由于临床医生在决定哪些患者进入等待名单以及患者在哪个阶段被定义为不可移植方面具有一定的决策范围，并且由于移植中心追求良好的成功率，因此成功的高前景目标可能比立法和专业指南所预期的更重要。从伦理学的角度来看，它是在两个极端之间提出的所谓调解方法，即最健康者优先和最适合者优先。除此之外，还主张进一步开发肝移植术后结局的预后评分-只要牢记社会正义问题-以支持客观决策。
In German legislation and in Eurotransplant's practice of liver allocation, urgency of need is considered as the primary distribution criterion. However, at a certain stage, the sickest-first principle is regarded as counterproductive as the performance status of these patients receiving an organ is on average critical and mortality and morbidity after liver transplantation increase. Within the medical transplant community, the criterion of prospect for success is highly accepted. As clinicians having a certain scope in decision-making as gatekeepers in regard to which patient gets on the waiting list and at which stage a patient is defined as not transplantable and as transplantation centers aspire good success rates, the goal of high prospect for success might become more weighty than intended by legislation and professional guidelines. From an ethical point of view, it is submitted a so-called mediatory approach in between the two extremes sickest-first and fittest-first. Beyond that, it is argued for further development of a prognostic score for post-operative outcome after liver transplantation - as long as questions of social justice are borne in mind - to support objective decision-making.