盡管腎臟供體短缺，美國還是丟棄了數(shù)千個(gè)腎臟

研究表明，盡管腎臟供體短缺，美國還是丟棄了數(shù)千個(gè)腎臟

Despite the 93,000 patients in the US seeking a kidney transplant, a new report reveals that some 3,500 donated kidneys go unused and even thrown away every year.

盡管美國有9.3萬名患者尋求腎移植，但一份新的報(bào)告顯示，每年約有3500名捐獻(xiàn)的腎臟被閑置，甚至被扔掉。

A study published in JAMA Internal Medicine this week found that 17% of donated kidneys in the US were discarded during a 10-year period. By comparison, in France, only about 9% of donated kidneys went unused during the study period.

本周發(fā)表在《美國醫(yī)學(xué)會內(nèi)科學(xué)雜志》上的一項(xiàng)研究發(fā)現(xiàn)，美國17%的捐贈腎臟在10年內(nèi)被丟棄。相比之下，在法國，只有約9%的捐贈腎臟在研究期間未被使用。

Why the waste? According to the report, doctors here in the US are less inclined to risk using lower-quality kidneys, even though previous studies have shown that even less desirable kidneys, such as older kidneys and those with abnormalities, are still better than dialysis.

為什么浪費(fèi)?根據(jù)報(bào)告，美國的醫(yī)生不太傾向于冒險(xiǎn)使用低質(zhì)量的腎臟，盡管先前的研究表明，即使是不太理想的腎臟，如老年腎臟和異常腎臟，仍然比透析更好。

In France, doctors are more willing to use kidneys from deceased patients who suffered from illnesses such as diabetes or hypertension.

在法國，醫(yī)生更愿意使用死于糖尿病或高血壓等疾病的病人的腎臟。

Cost may also be a factor in US doctors’ reticence to use affected kidneys, since these transplants may also result in extended hospital stays.

成本可能也是美國醫(yī)生不愿使用受影響腎臟的一個(gè)因素，因?yàn)檫@些移植也可能導(dǎo)致住院時(shí)間延長。

And, without a consistent set of guidelines in the US, some regions discard more kidneys than others based on their own opinions about whether a kidney is viable, according to a 2016 study by the National Kidney Foundation. That study found that as many as 50% of discarded kidneys could have been transplanted.

而且，根據(jù)美國國家腎臟基金會(National kidney Foundation) 2016年的一項(xiàng)研究，在美國沒有一套統(tǒng)一的指導(dǎo)方針的情況下，一些地區(qū)會根據(jù)自己對腎臟是否可行的看法，丟棄更多的腎臟。該研究發(fā)現(xiàn)，多達(dá)50%的廢棄腎臟可以被移植。

The United Network for Organ Sharing (UNOS) — the US’ transplant governing body — attempted to improve the discard rate by creating a kidney donor profile index in 2012, which rates how long it predicts a kidney will hold up. The network even lowered its standards in 2014 so that lesser kidneys would be considered.

美國器官共享聯(lián)合網(wǎng)絡(luò)(UNOS)——美國的移植管理機(jī)構(gòu)——試圖通過在2012年建立一個(gè)腎臟捐贈者概況指數(shù)來提高棄置率，該指數(shù)對預(yù)測一個(gè)腎臟將維持多久進(jìn)行評估。該網(wǎng)絡(luò)甚至在2014年降低了標(biāo)準(zhǔn)，以便考慮使用更小的腎臟。

The problem is wide-reaching: More than 37 million Americans suffer from chronic kidney disease, with roughly 5,000 of these patients dying each year on the transplant waiting list.

這個(gè)問題影響深遠(yuǎn)：超過3700萬美國人患有慢性腎病，每年大約有5000名患者在移植候診名單上死亡。

Still, the number of wasted kidneys continues to rise, up to 30% in some regions, according to a study published in January 2019.

然而，根據(jù)2019年1月公布的一項(xiàng)研究，一些地區(qū)的腎臟浪費(fèi)數(shù)量仍在繼續(xù)增加，高達(dá)30%。

In the end, “risk-averse” policies in US transplant programs hit patients hardest, write Dr. Ryoichi Maenosono and Dr. Stefan G. Tullius of Brigham and Women’s Hospital, in a commentary article attached to the JAMA study.

最后，美國布萊根婦女醫(yī)院的Ryoichi Maenosono博士和Stefan G. Tullius博士在《美國醫(yī)學(xué)會雜志》研究的一篇評論文章中寫道，美國移植項(xiàng)目中的“風(fēng)險(xiǎn)規(guī)避”政策對患者的打擊最大。

“Hospital administrators and patients alike are attracted by superficial five-star ranking approaches that are easy to read but not necessarily reflective of the approach of individual programs aiming to provide their patients on waiting lists with the best opportunities.”

“醫(yī)院管理者和患者都被表面的五星級排名方法所吸引，這些方法易于閱讀，但不一定反映出個(gè)人項(xiàng)目的方法，其目的是為候診名單上的患者提供最佳機(jī)會。”