Ethical Issues in Living Donor Transplantation

描述(由申请人提供)： 器官供应不足是一种公共卫生危机。这项研究将探讨活体移植带来的伦理和政策问题。该项目的主要目标是：1)研究从可补充器官(血液和骨髓)到成对器官(肾脏)再到器官部分(肝脏、肺和胰腺)的趋势，以及这在风险方面的意义；2)研究活体器官捐赠者从血缘关系密切的家庭成员到配偶、朋友以及现在的陌生人的角色扩大，以及这是否以及如何影响风险-收益计算；3)检查允许医学上不太理想的候选人作为活体器官捐赠者的做法；4)检查活体捐赠者移植受者的不断变化的人口统计学；5)审查弱势群体作为活体捐赠者的不断演变的作用；6)探索对活体捐赠者移植进行的免疫耐受研究的风险和好处；以及7)提出在保护活体捐赠者和尊重其自主权之间实现道德平衡的政策建议。 这项研究的主要成果将是一本对当前政策进行批判性伦理分析的书 以及关于活人作为器官来源参与的做法。这本书的标题是： 活体供体移植中的伦理问题。在第一部分中，我提供了器官采购问题的历史 并描述哲学原则，这些原则为对具体案例研究和经典问题的批判性分析以及对现行指导方针的肯定或建议修订提供了道德基础。第二部分题为“器官捐赠者自主”，侧重于器官交换、陌生人作为器官捐赠者以及何时应限制捐赠者的器官捐赠权。我特别反对活体器官的市场。第三部分题为“活体捐助者分配政策和做法”。它的重点是是否有或应该有政策限制潜在捐赠者可以向谁捐赠。第四部分题为《移植团队的道德中介》。我考虑与隐私和保密有关的问题，包括当意外发现时应该做什么，以及当捐赠者食言时应该提供什么解释。我还研究了移植团队作为医生和科学家的双重角色。具体地说，我讨论了免疫耐受性研究是否应该专注于与已故或在世捐赠者的移植。第五部分题为“弱势群体”，审查了种族、性别和年龄在在世捐赠者人口结构中的作用，以及缺乏决策能力的囚犯、儿童和成年人是否以及何时应担任在世捐赠者。第六部分对全书提出的促进活人作为器官来源的道德参与的许多政策建议和修订提供了方法论上的考虑。

DESCRIPTION (provided by applicant): The inadequate supply of organs is a public health crisis. This research will explore the ethical and policy issues raised by transplantation with living donors. The broad objectives of the project are: 1) to examine the trend from replenishable organs (blood and bone marrow) to one of a paired organ (kidney) to parts of organs (liver, lung and pancreas) and what this means in terms of risk; 2) to examine the expanding role of living solid organ donors from genetically related family members to spouses, friends, and now strangers and whether and how this should impact risk-benefit calculations; 3) to examine the practice of permitting medically less ideal candidates to serve as living organ donors; 4) to examine the evolving demographics of transplant recipients from living donors; 5) to examine the evolving role of vulnerable populations as living donors; 6) to explore the risks and benefits of immune tolerance research performed on live donor transplants; and 7) to propose policy recommendations that achieve a moral balance between protecting living donors and respecting their autonomy. The main outcome of the research will be a book that offers a critical ethical analysis of current policies and practices regarding the participation of living persons as organ sources. The book will be entitled: Ethical Issues in Living Donor Transplantation. In part I, I provide a history of organ procurement issues from deceased and living donors and describe the philosophical principles that provide a moral foundation for a critical analysis of specific case studies and classic problems and for affirming current guidelines or recommending revisions. Part II is entitled "Donor Autonomy" and focuses on organ exchanges, strangers as organ donors and when, if ever, should donor autonomy be restricted. I specifically argue against a market for organs from living sources. Part III is entitled "Living Donor Allocation Policies and Practices". It focuses on whether there are or ought to be policies that restrict to whom the potential donor may donate. Part IV is entitled "The Moral Agency of the Transplant Team". I consider issues related to privacy and confidentiality including what should be done when unintended discoveries are made and what explanations should be offered when a donor reneges. I also examine the dual role of the transplant team as physicians and scientists. Specifically, I discuss whether immune tolerance research should focus on transplants with deceased or living donors. Part V is entitled "Vulnerable Populations" and examines the role of race, gender and age in living donor demographics and whether and when prisoners, children and adults who lack decision making capacity should serve as living donors. Part VI provides a methodological consideration of the numerous policy recommendations and revisions that are offered throughout the book to promote the ethical participation of living persons as organ sources.