经济学人2019.4.13/Kidney transplants/part3

Preservation orders

预留订单

Beatriz Domínguez-Gil of the Spanish National Transplant Organisation says that Spain adapted earlier than other countries to the ageing of the pool of deceased donors. Its doctors learned to transplant organs from donors in their 70s and 80s (typically for older recipients). A quarter of deceased donors are people with devastating brain injuries put on organ-preservation treatment as part of their end-of-life care. In many countries they are sent instead for palliative care and lost as donors.

西班牙国家移植组织的Beatriz Dominguez-Gil说，西班牙比其他国家更早地适应了已故捐赠者的老龄化。它的医生学会了从70多岁和80多岁的捐赠者身上移植器官(通常是老年接受者)。四分之一的死者是脑部严重受伤的人，他们接受器官保存治疗，作为临终关怀的一部分。在许多国家，老年人被送去接受姑息治疗，却失去了捐献者的身份。

词汇

palliative care/姑息治疗

At what stage doctors are allowed to retrieve organs matters hugely. In less than half of European countries can the process start after the heart stops (and organ damage begins), rather than when the brain shuts down too. Across Europe, the “no-touch” time before organ retrieval can then begin varies from 5 to 20 minutes.

医生被允许在什么阶段提取器官至关重要。在不到一半的欧洲国家，这一过程可以在心脏停止(器官损伤开始)后开始，而不是在大脑也停止工作的时候。在整个欧洲，器官提取前的“心跳停止判断”时间从5分钟到20分钟不等。

Nowhere, however, are enough kidneys available from the dead. Just 1-2% of people die in ways that make their organs suitable for donation—eg, from a brain injury sustained in an accident. So the living are needed. Some countries, such as Ireland and Germany, require a living donor to have close ties to the patient. But many allow people to donate a kidney to whomever they choose. Paula King, a 49-year-old American woman, decided to donate a kidney to a stranger after seeing the trouble a relative had in finding a bone-marrow donor, when nobody in the family was a match. “I wanted to alleviate the stress on another family out there at the mercy of a stranger,” says Ms King. In Britain such socalled “non-directed” donors account for nearly 10% of living-donor transplants.

然而，无论如果我们也难做到从死者作为来源以获取足够的肾。而且，只有1% -2%的人死于适合捐赠器官的方式——例如，死于意外事故造成的脑损伤。所以活体供给者是需要的。一些国家，如爱尔兰和德国，要求活体捐赠者与患者保持密切联系。但是许多人允许人们将肾脏捐献给他们选择的任何人。49岁的美国妇女保拉金(Paula King)看到自己的亲戚苦于找不到合适的骨髓捐赠者，当时家里没有人有着合适能匹配的骨髓，于是决定把一个肾捐给一个陌生人。金女士表示:“我想在一个陌生人的协助下去减轻另外一个家庭的负担。”在英国，这种所谓的“非直接”捐赠者占活体器官移植的近10%。

词汇

Sustained/  维持（sustain的过去式和过去分词）；承受

at the mercy of/完全由…支配;任由…摆布

In the past, older people were rarely considered as potential donors. But it is clear that this is misguided, says Dorry Segev of the Johns Hopkins University in Baltimore. In fact, he says, predicting the lifetime risk of kidney failure for a 25-year-old is hard, whereas someone who has done well for 70 years will probably be fine with only one kidney. Between 2014 and 2018 in America the number of living kidney-donors aged 65 or older doubled; those aged 50-64 grew by more than a quarter.

在过去，老年人很少被认为是潜在的捐赠者。但是巴尔的摩约翰霍普金斯大学的Dorry Segev说，很明显这是一种误导。事实上，他说，预测一个25岁的人一生中肾衰竭的风险是很困难的，而一个在70年里一直表现良好的人，如果只有一个肾，可能也不会有问题。2014年至2018年，美国65岁及以上的活体肾捐赠者数量翻了一番;年龄在50-64岁之间的人增加了四分之一以上。

词汇

Misguided/被误导的

A kidney donor typically needs two days in hospital and about a month to recover. About 20% suffer some, mostly minor, complications. In many countries some would-be donors are deterred by the cost of travel and other expenses. In the Netherlands, which has the highest rate of living organ-donors in the rich world, kidney donors get three months of paid leave to recover, as well as payment for related costs—even such needs as dog-sitting. In America, by contrast, donors get only some expenses paid for, and only if they are poor.

肾脏捐赠者通常需要住院两天，大约一个月才能康复。大约20%的患者会出现一些并发症，大多是轻微的。在许多国家，一些潜在的捐助者被旅行费用和其他费用吓住了。在荷兰，活体器官捐赠者的比例是世界上最高的，肾脏捐赠者有三个月的带薪假期来恢复，同时还要支付相关的费用，甚至像养狗这样的需要。相比之下，在美国，捐赠人只能得到一些支付的费用，而且只有在他们很穷的时候。

Almost half of would-be kidney donors are not biological matches for the person they want to help. So kidney-exchange schemes have evolved. In these a patient gets a kidney from a suitable living donor only if someone donates one on his behalf for another patient. Pioneered by South Korea in 1991, national kidney-for-kidney schemes have been adopted by Australia, Canada and many European countries. In America some transplant centres and several non-profit groups run their own.

几乎一半的肾脏捐赠者都不是他们想要帮助的人的生理匹配对象。因此有了肾脏交换计划的发展。在这种情况下，唯有当有人代表另一个病人捐献肾脏时，病人才能从合适的活体捐赠者那里得到一个肾脏。由韩国于1991年率先推行的全国肾脏换肾计划，已被澳大利亚、加拿大和许多欧洲国家采纳。在美国，一些移植中心和一些非盈利组织经营着自己的移植中心。

Britain’s exchange scheme conducts an algorithmic search for matches quarterly. Non-directed donors are precious, because they can be used where they are most needed, depending on the mix of blood groups and other criteria, and so initiate a chain of other matches—greatly boosting the number of transplants. Donors in a kidney-forkidney swap have surgeries scheduled as close as possible in time—not because some may renege (that is rare) but because “life happens to people”, says Lisa Burnapp of the nhs. In a long gap, a recipient might become too ill for the operation, for example, or something unexpected might happen to prevent a donor from going ahead. Such schemes are particularly beneficial for people who have had a blood transfusion or are waiting for a second transplant, because donors who suit their mix of antibodies may be extremely rare. If all living donors in America were allocated through a nationwide exchange, kidney transplants from such volunteers could double, says Jayme Locke of the University of Alabama at Birmingham.

英国的交换计划每季度进行一次算法搜索来挖掘匹配者。非定向捐献者是很宝贵的，因为他们可以在最需要的时候出现，这取决于血型和其他标准的组合，因此启动一系列其他匹配——极大地增加了移植的数量。国家医疗服务系统的Lisa Burnapp说，肾-肾交换计划的捐赠者会在最短的时间内安排手术，不是因为有些人可能会违约(这很少见)，而是因为“生命发生在人身上”。比如，在很长一段时间内，受者可能会因为病得太重而无法进行手术，或者可能会发生一些意想不到的事情来阻止捐赠者进行手术。这类方案对已经输血或正在等待第二次移植的人特别有益，因为适合他们的抗体组合的献血者可能极其罕见。阿拉巴马大学伯明翰分校的Jayme Locke说，如果美国所有的活体捐赠者都通过全国范围内的交换来分配，那么来自这些志愿者的肾脏移植将会翻倍。

词汇

Algorithmic/算法的；规则系统的