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USA: Budú legalizované kompenzácie za darovanie orgánu?


 | 25.9.2014 | komentárov: 640

V Spojených Štátoch Amerických je v zozname čakateľov na transplantáciu niektorého z orgánov zapísaných viac ako 123 000 ľudí, čo je veľmi vysoký počet vzhľadom na to, že za rok 2013 sa konalo iba 29 000 transplantácií, a to najmä z dôvodu nedostatku dobrovoľných (živých) darcov orgánov.

Obrazok

Z tohto dôvodu sa viacerí zdravotnícki pracovníci a komentátori v oblasti zdravotnej starostlivosti domnievajú, že by bolo na mieste uvažovať o zavedení určitej kompenzácie pre žijúcich darcov orgánov, čo prichádza do úvahy v troch prípadoch transplantácie – obličiek, časti pečene a kostnej drene. Sally Satel z American Entrerprise Institute (nezisková organizácia zameriavajúca sa na výskum a vzdelávanie v oblasti politiky, ekonomiky a sociálneho zabezpečenia) je presvedčená, že určitá forma kompenzácie za darovanie orgánu je jedinou cestou ako možno riešiť nedostatok dobrovoľných darcov. V článku pre New York Times sa vyjadrila takto: „Altruizmus ako stratégia jednoducho neprodukuje dostatočný počet orgánov. Je potrebné podporiť darcovstvo určitou kompenzáciou.“

Podľa Satel by sa mal spustiť test na vyskúšanie systému, v ktorom by štátna alebo federálna vláda ponúkla darcovi určité výhody ako kompenzáciu za darovanie orgánu cudzincovi (nie príbuznej osobe). Ako kompenzácia by mohli byť zavedené napríklad úľava na dani, príspevok na starobný dôchodok alebo rýchly prístup do Medicare (program zdravotnej starostlivosti v USA zabezpečujúci zdravotné poistenie pre určité skupiny ľudí). Z etického hľadiska by systém zabezpečoval, že darcovia budú riadne a dostatočne informovaní o všetkých podmienkach, rizikách a následkoch transplantácie, bude sa v každom prípade chrániť ich zdravie a život, budú viac než dostačujúco odmenení a preukáže sa im dostatočná vďačnosť.

Proces darcovstva by pre darcu teda znamenal viacero výhod, ktoré momentálne pri transplantáciách zavedené nie sú. Proces by sa začal šesťmesačnou „čakacou dobou“, ktorej účelom je na jednej strane zabrániť impulzívnemu konaniu zo strany darcu, teda táto doba je dobou, v ktorej si darca môže svoje rozhodnutie dobrovoľne darovať orgán rozmyslieť. Na druhej strane táto doba bude slúžiť na dostatočné vzdelanie darcu o všetkých podmienkach, rizikách a následkoch transplantácie. Proces darovania sa však nekončí transplantáciou, ale darcovi sa v rámci nového systému zaručuje pravidelný lekársky dohľad minimálne 5 rokov po samotnej transplantácii. A nakoniec, programy zdravotnej starostlivosti v USA zabezpečujúce zdravotné poistenie (pre ľudí, ktorí si ho nemôžu dovoliť platiť sami alebo pre ľudí starších ako 65 rokov, pre ľudí so zdravotným poistením a pod.) – Medicare a Medicaid by finančne pokryli 40 000 alebo 50 000 dolárov zo sumy, ktorá by sa vyplácala darcom ako finančná odmena.

Niektorí sa obávajú, že zavedenie tohto systému by znamenalo len to, že o dobrovoľné darovanie orgánu za finančnú kompenzáciu sa budú uchádzať len ľudia s nízkymi alebo žiadnymi zárobkami. Satel sa ale v článku pre New York Times ďalej vyjadrila, že je to veľmi málo pravdepodobné, pretože demografia čakateľskej listiny ukazuje, že pacienti čakajúci na orgány sú väčšinou práve ľudia s nižšími zárobkami. Po ďalšie sa domnieva, že priťahovaní touto finančnou odmenou budú najmä mladí ľudia síce s dostatočnými príjmami, ale táto kompenzácia pre nich bude lákavá, pretože za záchranu ľudského života im táto suma pomôže splatiť pôžičku alebo uložiť si nejaké peniaze bokom.

Satel ďalej vysvetľuje, že dôvod, prečo skúšobný proces neprebieha už v tejto dobe je, že spoločenstvo transplantácií je príliš samoľúbe a príliš oddané predstave, že nezištné darovanie orgánov v prospech iných je jediným legitímnym dôvodom darovania. Avšak prvé kroky zavedenia nového systému sa už začali tým, že Americká spoločnosť transplantačných chirurgov (American Society of Transplant Surgeons) a Americká transplantačná spoločnosť (American Transplantation Society) začali spolupracovať na prípravnom dokumente, ktorým by bol zavedený skúšobný systém týchto kompenzácií.

Alan Langas, vedúci transplantácií na Nebraskej univerzite a Daniel R. Solomon zo Scripps Center for Organ Transplantation a Scripps Research Institute (neziskové inštitúcie zameriavajúce sa na medicínsky výskum) sa v inom článku pre New York Times vyjadrili podobne ako Satel: „Tak ako je súčasný systém darcovstva nastavený, je nefunkčný, pretože neprodukuje dostatok orgánov pre transplantáciu.“ Hlavným dôvodom nedostatku dobrovoľných darcov podľa nich je, že darcovia orgánov, najmä žijúci darcovia obličiek, si musia sami zaplatiť väčšinu nákladov potrebných na transplantáciu. Je teda pochopiteľné, že tieto finančné náklady predstavujú významnú prekážku pre darcovstvo orgánov. Tieto chyby v systéme musia byť odstránené a je potrebné zaviesť kompenzáciu, ako napríklad preplatenie cestovných nákladov, náhrady ušlej mzdy a zabezpečenie dlhodobého zdravotného poistenia. Zároveň, sekundárnym dôvodom pre zavedenie tejto kompenzácie, by malo byť určité odškodnenie bolesti a utrpenia.

Spracovala: Anna PEKAROVIČOVÁ

Zdroje:

  • http://www.bioedge.org/index.php/bioethics/bioethics_article/11115
  • http://www.nytimes.com/roomfordebate/2014/08/21/how-much-for-a-kidney/test-incentives-for-organ-donations-theres-no-reason-not-to
  • http://www.nytimes.com/roomfordebate/2014/08/21/how-much-for-a-kidney/remove-disincentives-to-organ-donation

 

Obrázok: freedigitalphotos.net




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