Ethical issues in increasing living kidney donations by expanding kidney paired exchange programs.
Ethical issues in increasing living kidney donations by expanding kidney paired exchange programs.
复制标题
通过扩大肾脏配对交换计划来增加活体肾脏捐赠的道德问题。
DOI：
10.1097/00007890-200004270-00001
复制
发表时间：
2000
期刊：
影响因子：
6.2
通讯作者：
E. Woodle
中科院分区：
文献类型：
--
作者：
L. Ross;E. Woodle
介绍
1997年，Ross等人提议通过两个活体肾脏供体-受体对之间的交换安排，使用来自ABO血型不合活体供体的肾脏，以增加活体肾脏捐赠的供应。虽然许多移植中心正在探索这种选择，但只有一小部分潜在的供体-受体对有资格基于ABO不相容性进行交换。在这篇文章中，我们探讨了三种可能具有重大临床意义的变化。
方法
讨论的三种潜在变化是：（1）利他主义不平衡的活体供体-受体交换;（2）基于阳性交叉配型的间接交换（活体供体-受体对与尸体供体-受体对之间的交换）;（3）基于ABO不相容性的间接交换。
讨论
肾脏配对交换计划的目标是增加可用于伦理移植的肾脏的供应。我们承认，所有的交换都增加了胁迫的可能性，我们目前拒绝利他主义不平衡交换的提议，因为有胁迫的可能性。但是，我们认为，对于间接交换，可以实现自愿同意。间接ABO兼容交换不会对我们最初的活体配对交换计划产生新的伦理问题，我们支持其实施。间接ABO血型不合的交换确实引起了新的伦理问题，因为它可能会增加O型血受体的脆弱性。如果能制订机制，避免增加O型血配血者的轮候时间，我们会支持推行间接ABO血型不合的换血计划。
INTRODUCTION
In 1997, Ross et al. proposed to increase the supply of living kidney donations by using kidneys from living ABO-incompatible donors through an exchange arrangement between two living kidney donor-recipient pairs. Although many transplant centers are exploring this option, only a small fraction of potential donor-recipient pairs are eligible for an exchange on the basis of ABO incompatibility. In this article, we explore three variations that have potentially great clinical relevance.
METHODS
The three potential variations discussed are: (1) altruistically unbalanced living donor-recipient exchanges; (2) an indirect exchange (an exchange between a living donor-recipient pair with a cadaveric donor-recipient pair) on the basis of a positive crossmatch; and (3) an indirect exchange on the basis of ABO incompatibility.
DISCUSSION
The goal of kidney paired exchange programs is to increase the supply of kidneys available for transplantation ethically. We acknowledge that all exchanges increase the potential for coercion, and we currently reject the proposal of altruistically unbalanced exchanges because of the potential for coercion. However, we believe that voluntary consent can be achieved for indirect exchanges. The indirect ABO-compatible exchange creates no new ethical concerns to our original living paired exchange program and we support its implementation. The indirect ABO-incompatible exchange does create a new ethical concern because it may increase the vulnerability of O blood group recipients. If mechanisms can be developed to avoid increasing the waiting time for blood group O recipients, we would support the implementation of the indirect ABO-incompatible exchange.