Ethical Issues in Living Donor Transplantation

活体捐赠者移植的伦理问题

• 批准号: 7630439
• 负责人: Lainie Friedman Ross
• 金额: $ 7.68万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-06-01 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7630439
• 关键词: Adult; Age; Benefits and Risks; Blood; Bone Marrow; Books; Case Study; Child; Confidentiality; Ensure; Equilibrium; Ethical Analysis; Ethical Issues; Ethics; Family member; Foundations; Friends; Gender; Guidelines; Immune Tolerance; Kidney; Life; Liver; Living Donors; Lung; Marketing; Morals; Organ; Organ Donations; Organ Donor; Organ Procurements; Organ Transplantation; Outcomes Research; Pancreas; Persons; Physicians; Policies; Prisoner; Privacy; Public Health; Public Policy; Race; Recommendation; Recording of previous events; Research; Rights; Risk; Role; Scientist; Solid; Source; Spouses; Transplant Recipients; Transplantation; Vulnerable Populations; decision-making capacity; demographics; tool; trend

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.

描述（由申请人提供）： 器官供应不足是一个公共卫生危机。这项研究将探讨活体供者移植所引起的伦理和政策问题。该项目的主要目标是：1）研究从易腐器官到可再生器官的趋势，（血液和骨髓）到成对器官之一（肾脏）到器官的部分（肝、肺和胰腺）以及这在风险方面意味着什么; 2）研究活体器官捐献者的作用从遗传相关的家庭成员扩大到配偶，朋友，现在是陌生人，以及这是否以及如何影响风险效益计算; 3）研究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）研究活体捐赠者的移植受体的人口统计学变化; 5）研究弱势群体作为活体捐赠者的角色演变; 6）探讨对活体捐赠者移植进行免疫耐受研究的风险和益处; 7）提出政策建议，在保护活体捐赠者和尊重其自主权之间实现道德平衡。 这项研究的主要成果将是一本书，对现行政策进行批判性的伦理分析 以及关于活人作为器官来源参与的做法。这本书的题目是： 活体器官移植的伦理问题。在第一部分，我提供了一个器官采购问题的历史 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确认当前指南或建议修订提供了道德基础。第二部分题为“捐赠者自主权”，重点是器官交换、陌生人作为器官捐赠者以及何时（如果有的话）应该限制捐赠者自主权。我特别反对活体器官市场。第三部分题为“活体捐献者分配政策和做法”。它侧重于是否有或应该有政策，限制谁的潜在捐助者可以捐赠。 第四部分题为“移植小组的道德作用”。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些什么，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集中在移植与死者或活着的捐助者。第五部分题为“弱势群体”，审查了种族、性别和年龄在活体捐献者人口统计学中的作用，以及缺乏决策能力的囚犯、儿童和成年人是否以及何时应充当活体捐献者。第六部分提供了一个方法论的考虑，许多政策建议和修订，是提供了整个书，以促进道德参与的活人作为器官来源。

项目成果

Disclosing Health and Health Behavior Information between Living Donors and Their Recipients.

披露活体捐赠者及其接受者之间的健康和健康行为信息。

• DOI: 10.2215/cjn.02280215
• 发表时间: 2015
• 期刊: Clinical journal of the American Society of Nephrology : CJASN
• 作者: Mataya,Leslie;Meadow,Jacqueline;ThistlethwaiteJr,JRichard;Mandelbrot,DidierA;Rodrigue,JamesR;Ross,LainieFriedman
• 通讯作者: Ross,LainieFriedman

Living kidney donors and ESRD.

活体肾脏捐赠者和 ESRD。

• DOI: 10.1053/j.ajkd.2015.01.032
• 发表时间: 2015
• 期刊: American journal of kidney diseases : the official journal of the National Kidney Foundation
• 作者: Ross,LainieFriedman

Children as hematopoietic stem cell donors.

• DOI: 10.1542/peds.2009-3078
• 发表时间: 2010-02
• 期刊: Pediatrics
• 影响因子: 8
• 作者: American Academy of Pediatrics. Committee on Bioethics