Ethical Issues in Living Donor Transplantation

描述（由申请人提供）： 器官供应不足是一场公共卫生危机。这项研究将探讨活体捐赠者移植引起的伦理和政策问题。该项目的主要目标是： 1) 研究从可补充器官（血液和骨髓）到配对器官（肾脏）再到部分器官（肝脏、肺和胰腺）的趋势，以及这对风险意味着什么； 2) 研究活体实体器官捐献者的作用不断扩大，从有遗传关系的家庭成员到配偶、朋友，现在是陌生人，以及这是否以及如何影响风险收益计算； 3）审查允许医学上不太理想的候选人作为活体器官捐献者的做法； 4) 检查活体捐赠者移植受者不断变化的人口统计数据； 5) 研究弱势群体作为活体捐赠者不断变化的角色； 6) 探索对活体供体移植进行免疫耐受研究的风险和益处； 7) 提出政策建议，以在保护活体捐赠者和尊重他们的自主权之间实现道德平衡。 该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 以及有关活人作为器官来源参与的做法。这本书的标题是： 活体捐赠者移植的伦理问题。在第一部分中，我提供了器官获取问题的历史 来自已故和活着的捐赠者，并描述了为对具体案例研究和经典问题进行批判性分析以及确认当前指南或建议修订提供道德基础的哲学原则。第二部分的标题是“捐赠者自主权”，重点讨论器官交换、陌生人作为器官捐赠者，以及何时（如果有的话）应限制捐赠者自主权。我特别反对活体器官市场。第三部分的标题是“活体捐赠者分配政策和实践”。它的重点是是否存在或应该存在限制潜在捐赠者可以捐赠的政策。 第四部分的标题是“移植团队的道德主体”。我考虑与隐私和保密相关的问题，包括当出现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。具体来说，我讨论免疫耐受研究是否应该关注已故或活体捐赠者的移植。第五部分的标题是“弱势群体”，探讨种族、性别和年龄在活体捐赠者人口统计中的作用，以及缺乏决策能力的囚犯、儿童和成人是否以及何时应成为活体捐赠者。第六部分对全书中提出的众多政策建议和修订进行了方法论考虑，以促进活人作为器官来源的道德参与。

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.