器官配给—谁来决定生死权？

A young girl wanted some new lungs. The rules said she could not have lungs from an adult donor, only from another child. That meant she would probably die.

一个小女孩需要换肺。根据规定，她不能移植成年捐献者的肺，只能从另一个儿童身上获得。这意味着，她可能很难等到这一天了。

Janet and Francis Murnaghan complained that the rules discriminated against their daughter Sarah, a ten-year-old being treated for cystic fibrosis in Philadelphia. So they sued to put her on the waiting list for adult lungs. Kathleen Sebelius, the health secretary, ordered a review of the policy but was hesitant to meddle further. A conservative editorial called her “a death panel of one”.

珍妮特·莫纳汉和弗朗西斯·莫纳汉夫妇抱怨这样的规定对他们十岁的女儿萨拉不公平。萨拉正在费城接受囊性纤维病的治疗。他们想让医院把萨拉的名字添加到成人肺器官捐献的等候名单上。卫生部部长凯瑟琳·西贝柳斯已下令复查器官移植政策，但也仅止于此。一篇保守主义的社论称她为“一人死亡判刑委员会”。

Although the number of transplants is rising, there are never enough organs (see chart). Most donations require someone to die before an ailment has ravaged his insides. Even kidneys are scarce, though you can donate one and still get by with the other. Americans say they abhor rationing. But they also hate the idea of letting people sell an organ, so rationing is what they are left with. The process is handled by the Organ Procurement and Transplantation Network (OPTN), which includes doctors, patient advocates and bioethicists, overseen by the health department. Its policies are complex and, inevitably, imperfect.

尽管器官移植的案例越来越多，可供移植的器官却一直处于紧缺状态（见上表）。因为多数情况下，如果捐献者在死亡前内部器官已受到疾病的严重侵损，他们本来要捐献的器官便不能用了。即便是肾脏也很稀少，虽然人们可以捐献一只肾，靠另一只仍然活得好好的。美国人说他们憎恶配给制，但他们也不支持买卖器官。于是，除了配给，他们别无选择。配给制的具体操作过程是由医生、病人权益维护者和生物伦理学家组成的器官获取和移植网络（OPTN）负责的，并受卫生部监督。OPTN的政策非常复杂，而且也不可避免地存在缺陷。

On June 5th a federal judge ordered Miss Murnaghan to be placed temporarily on the adult waiting list, pending further hearings. A day later the judge ordered similar relief for Javier Acosta, an 11-year-old in the same situation. The OPTN’s leaders voted on June 10th to let children seeking a spot in the adult queue appeal to an internal review board. On June 12th Miss Murnaghan finally received a potentially life-saving lung-transplant. Her parents were ecstatic. Others wondered if this would prompt more people to sue to be moved to the front of the queue.

6月5日，一位联邦法官判决，在举行下一次听审之前，让萨拉·莫纳汉暂时列入成人等候名单。一天后，这位法官又帮助一个和萨拉境况相似的十一岁女孩哈维尔·阿科斯塔列入了成人等候名单。6月10日，OPTN的领导层进行了投票，决定允许那些想进入成人器官移植等候队列的儿童向OPTN内部的审查委员会提出申请。6月12日，萨拉终于如愿以偿，接受了可能给予她第二次生命的肺移植。她的父母喜极而泣。很多人因此而猜想，有了萨拉的例子，将来或许有更多的人会通过打官司来插队。

Congress and the health department issue broad rules for how to distribute organs (allocation must be “equitable”, for example). The OPTN must sort out the thorny details. The procedure for lungs is particularly elaborate. They are allotted according to a donor’s proximity, blood type and an algorithm to balance the desire to help the afflicted with the desire not to waste organs on those too ill to recover.

国会和卫生部对于如何进行器官配给只颁布了一些笼统的规定（比如，配给必须是“公平的”）。处理好棘手的细节则是OPTN的工作。在各种器官配给的程序中，肺配给的程序尤为复杂，需要根据捐献者的配型相似度、血型和一个算法来进行分配，以便在帮助患者和不浪费器官（有的患者病情过于严重，即使接受移植也无法康复）的需要之间取得平衡。

A broader question is whether organ donations should favour the young. The share of total organ recipients aged 50 and older has jumped from 28% in 1988 to 60% last year. The rise has been even more dramatic for those 65 and older—the share jumped from 2% to 17%. These figures may rise further as the baby-boomers age.

一个更重要的问题是，器官移植是否应该偏袒青少年。去年，50岁以上的器官受赠人占总受赠人数的比例从1988年的28%剧增到了60%。而65岁以上受赠人的比例增加比这还要戏剧：从2%到17%。随着婴儿潮一代步入老年，这些数字可能还会增加。

Later this month the OPTN will consider a proposal to place young candidates higher in the queue for kidneys, the most commonly transplanted organ. Supporters point out that the young stand to gain more years of life from a transplant. Opponents retort that all human lives are equally valuable. One day, artificial organs may render this debate irrelevant. For now, Miss Murnaghan has won a reprieve. Mr Acosta and more than 1,600 other Americans are still waiting for new lungs.

本月晚些时候，OPTN将会就一项建议优先给年轻申请人移植肾脏（最常见的移植器官）的提案进行讨论。提案的支持者指出，年轻人通常可以通过移植获得更长的生命。反对者则认为，无论老幼，所有人的生命都一样宝贵。或许有一天，人工器官的发明将终止这场辩论。就目前而言，萨拉取得了暂时的胜利。而哈维尔的父亲，以及1600多名美国人，仍在焦急地等待新的肺来拯救他们挚爱的生命。