Regional and racial disparities in the use of live non-directed kidney donors
Regional and racial disparities in the use of live non-directed kidney donors
复制标题
DOI：
10.1111/j.1600-6143.2008.02192.x
复制
发表时间：
2008-05-01
影响因子：
8.8
通讯作者：
Montgomery, R. A.
中科院分区：
文献类型：
--
作者：
Segev, D. L.;Montgomery, R. A.
在过去的十年中，使用活体非定向供体（LNDDs）或利他供体的情况显著增加，并引发了关于这种新的活体供体肾脏来源的伦理和分配的争论。目前使用的三种分配理念，包括以捐赠者为中心、以接受者为中心和以社会为中心的模式，我们小组也提倡在配对捐赠中使用LNDDs。然而，既没有普遍接受的分配政策，也没有国家监督。为了确定当前实践模型的分配模式，我们分析了自1998年以来在美国进行的372例LNDD肾移植。大多数LNDD移植发生在少数中心，只有5个中心的表现超过10，超过28%的LNDD患者到州外捐赠。此外，一个中心使用LNDD肾脏与该中心的器官短缺并不相关。最后，即使考虑到使用LNDD肾脏的中心等候名单的种族构成差异，非洲裔美国人在分配LNDD肾脏的受者中也明显不足。这些差异表明需要在国家一级继续监测和讨论LNDD。如果非定向捐赠继续以目前的速度增长，国家分配政策可能是合理的。
Use of live non-directed donors (LNDDs), or altruistic donors, has increased significantly over the past decade and has fueled debate regarding the ethics and allocation of this new source of live donor kidneys. Three allocation philosophies are currently in use, including donor-centric, recipient-centric and socio-centric models, and our group has also advocated the use of LNDDs in paired donation. However, no universally accepted allocation policy exists, nor does national oversight. To determine allocation patterns resulting from current practice models, we analyzed the 372 LNDD kidney transplants performed in the United States since 1998. Most LNDD transplants occurred at a minority of centers, with only five centers performing over 10, and over 28% of LNDDs traveled out-of-state to donate. Furthermore, a center's use of LNDD kidneys did not correlate with that center's organ shortage. Finally, African Americans were significantly under-represented among recipients who were allocated LNDD kidneys, even after accounting for differences in the racial makeup of the waiting list representing centers using LNDD kidneys. These disparities suggest the need for continued monitoring and discussion of LNDD at a national level. If non-directed donation continues to rise at its current rate, a national allocation policy may be reasonable.