[译文]那些本可避免的痛苦
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A Cost-Benefit Analysis of Government Compensation of Kidney Donors
政府补贴捐肾者的成本效益分析

作者：Alex Tabarrok @ 2015-11-25
译者：Eartha（@王小贰_Eartha)
校对：小册子（@昵称被抢的小册子）
来源：Marginal Revolution，http://marginalrevolution.com/marginalrevolution/2015/11/a-cost-bene%EF%AC%81t-analysis-of-government-compensation-of-kidney-donors.html

The latest issue of the American Journal of Transplantation has an excellent and comprehensive cost-benefit analysis of paying kidney donors by Held, McCormick, Ojo, and Roberts.

最新一期【译注：即2015年第十期】的《美国移植杂志》刊登了一篇由Held, McCormick, Ojo, 与 Roberts合著的文章，出色且全面地描述了关于支付捐肾者报酬的成本效益分析。

Earlier, Becker and Elias estimated that a payment of $15,000 per living donor would be sufficient to eliminate the US waiting list. The authors adopt a larger figure of $45,000 for living donors and $10,000 for deceased donors and find that even at these rates paying donors generates benefits far in excess of costs.

早些时候，Becker与 Elias就估算过，如果向每位活体捐赠者支付15,000美元，就会有足够的捐赠者来满足全美的肾脏移植需求。上述论文的作者们在分析中采用了更高的补贴数额，给予活体捐献者45,000美元，遗体捐献者10,000美元。结果显示，即使以这样的高价格补贴捐献者，其产生的效益也远超过成本。

In particular, a program of government compensation of kidney donors would provide the following benefits (quoting from the article):

具体而言，政府补贴捐肾者的计划将会带来下列好处（摘自该文章）：

  • Transplant kidneys would be readily available to all patients who had a medical need for them, which would prevent 5000 to 10 000 premature deaths each year and significantly reduce the suffering of 100 000 more receiving dialysis.
  • 所有有医疗需求的患者都能够顺利地获得肾脏移植，每年将会挽救5,000至10,000例早逝患者，并为超过100,000名依赖透析的患者极大地减缓病痛。
  • This would be particularly beneficial to patients who are poor and African American because they are considerably overrepresented on the transplant waiting list. Indeed, it would be a boon to poor kidney recipients because it would enable them to reap the great benefits of transplantation at very little expense to themselves.
  • 穷人和非裔病患将尤其从中受益，因为他们在移植等候名单中明显占据了多数。对于贫苦的肾脏移植接受者来说，这的确是一件好事，因为这将使得他们能以非常低的价格享受到肾脏移植的巨大好处。
  • Because transplant candidates would no longer have to spend almost 5 years receiving dialysis while waiting for a transplant kidney, they would be younger and healthier when they receive their transplant, increasing the chances of a successful transplantation.
  • 因为移植接受者将不必再依赖透析等待近5年，他们接受移植的时候也会更加年轻与健康，移植的成功率将会得到提高。
  • With a large number of transplant kidneys available, it would be much easier to ensure the medical compatibility of donors and recipients, which would increase the success rate of transplantation.
  • 由于有大量的肾脏可供移植，捐献者与受移植者在医学上的相容性会更容易得到保障，这也会提高移植的成功率。
  • Taxpayers would save about $12 billion each year. Dialysis is not only an inferior therapy for end-stage renal disease (ESRD), it is also almost 4 times as expensive per quality-adjusted life-year (QALY) gained as a transplant.
  • 纳锐人将因此每年节省大约120亿美元。对末期肾衰竭（ESRD）患者来说，肾透析不仅是一种次等的治疗方法，而且延长每个经质量调整寿命年（QALY）的花费，几乎是肾移植的四倍。【译注：QALY是一种经调整的期望寿命，其计算方式是将实际年数乘上该健康状态下的效用价值。如果在效用价值为5的健康状态持续3年，QALY就等于1.5，相当于保持1.5年的完美健康状态。】

（编辑：辉格@whigzhou）

*注：本译文未经原作者授权，本站对原文不持有也不主张任何权利，如果你恰好对原文拥有权益并希望我们移除相关内容，请私信联系，我们会立即作出响应。

——海德沙龙·翻译组，致力于将英文世界的好文章搬进中文世界——

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A Cost-Benefit Analysis of Government Compensation of Kidney Donors 政府补贴捐肾者的成本效益分析 作者：Alex Tabarrok @ 2015-11-25 译者：Eartha（@王小贰_Eartha) 校对：小册子（@昵称被抢的小册子） 来源：Marginal Revolution，http://marginalrevolution.com/marginalrevolution/2015/11/a-cost-bene%EF%AC%81t-analysis-of-government-compensation-of-kidney-donors.html The latest issue of the American Journal of Transplantation has an excellent and comprehensive cost-benefit analysis of paying kidney donors by Held, McCormick, Ojo, and Roberts. 最新一期【译注：即2015年第十期】的《美国移植杂志》刊登了一篇由Held, McCormick, Ojo, 与 Roberts合著的文章，出色且全面地描述了关于支付捐肾者报酬的成本效益分析。 Earlier, Becker and Elias estimated that a payment of $15,000 per living donor would be sufficient to eliminate the US waiting list. The authors adopt a larger figure of $45,000 for living donors and $10,000 for deceased donors and find that even at these rates paying donors generates benefits far in excess of costs. 早些时候，Becker与 Elias就估算过，如果向每位活体捐赠者支付15,000美元，就会有足够的捐赠者来满足全美的肾脏移植需求。上述论文的作者们在分析中采用了更高的补贴数额，给予活体捐献者45,000美元，遗体捐献者10,000美元。结果显示，即使以这样的高价格补贴捐献者，其产生的效益也远超过成本。 In particular, a program of government compensation of kidney donors would provide the following benefits (quoting from the article): 具体而言，政府补贴捐肾者的计划将会带来下列好处（摘自该文章）：
  • Transplant kidneys would be readily available to all patients who had a medical need for them, which would prevent 5000 to 10 000 premature deaths each year and significantly reduce the suffering of 100 000 more receiving dialysis.
  • 所有有医疗需求的患者都能够顺利地获得肾脏移植，每年将会挽救5,000至10,000例早逝患者，并为超过100,000名依赖透析的患者极大地减缓病痛。
  • This would be particularly beneficial to patients who are poor and African American because they are considerably overrepresented on the transplant waiting list. Indeed, it would be a boon to poor kidney recipients because it would enable them to reap the great benefits of transplantation at very little expense to themselves.
  • 穷人和非裔病患将尤其从中受益，因为他们在移植等候名单中明显占据了多数。对于贫苦的肾脏移植接受者来说，这的确是一件好事，因为这将使得他们能以非常低的价格享受到肾脏移植的巨大好处。
  • Because transplant candidates would no longer have to spend almost 5 years receiving dialysis while waiting for a transplant kidney, they would be younger and healthier when they receive their transplant, increasing the chances of a successful transplantation.
  • 因为移植接受者将不必再依赖透析等待近5年，他们接受移植的时候也会更加年轻与健康，移植的成功率将会得到提高。
  • With a large number of transplant kidneys available, it would be much easier to ensure the medical compatibility of donors and recipients, which would increase the success rate of transplantation.
  • 由于有大量的肾脏可供移植，捐献者与受移植者在医学上的相容性会更容易得到保障，这也会提高移植的成功率。
  • Taxpayers would save about $12 billion each year. Dialysis is not only an inferior therapy for end-stage renal disease (ESRD), it is also almost 4 times as expensive per quality-adjusted life-year (QALY) gained as a transplant.
  • 纳锐人将因此每年节省大约120亿美元。对末期肾衰竭（ESRD）患者来说，肾透析不仅是一种次等的治疗方法，而且延长每个经质量调整寿命年（QALY）的花费，几乎是肾移植的四倍。【译注：QALY是一种经调整的期望寿命，其计算方式是将实际年数乘上该健康状态下的效用价值。如果在效用价值为5的健康状态持续3年，QALY就等于1.5，相当于保持1.5年的完美健康状态。】
（编辑：辉格@whigzhou） *注：本译文未经原作者授权，本站对原文不持有也不主张任何权利，如果你恰好对原文拥有权益并希望我们移除相关内容，请私信联系，我们会立即作出响应。

——海德沙龙·翻译组，致力于将英文世界的好文章搬进中文世界——


已有2条评论

  1. Vivek @ 2020-09-25, 23:22 

    台灣每年八萬人洗腎，用掉高達百分之十的健保資源。
    「对末期肾衰竭（ESRD）患者来说，肾透析不仅是一种次等的治疗方法，而且延长每个经质量调整寿命年（QALY）的花费，几乎是肾移植的四倍。」

    [回复]

    Vivek 回复:
    9月 25th, 2020 at 23:28

    现实世界的信息条件不完备的，对于一件被出售的器官，人们很难判定它是否来自凶杀盗取，而后一种情况实在太可怕，共同体值得为杜绝它而走得远一点。
    捐献者不会收到一笔现金，但政府部门或者指定的慈善机构会为他们提供非现金奖励，例如：向捐献者的退休基金供款，所得税抵免或者学费代金劵，终生健康保险，向捐献者指定的慈善机构捐款，或者债务豁免。

    与此同时，法律可以规定捐献者在捐献前有至少六个月的冷静期，以确保他们不是冲动行事，而是经过周详考虑才决定同意。和现在所有捐献者一样，有偿捐献者也需要经过仔细筛选以保证身心健康。这些措施可以把那些急着等钱用的人过滤掉，他们会为了那笔钱而冲去捐献，但事后追悔莫及。
    所有有偿捐献者都将得到术后并发症的跟踪治疗，这个规定是现在没有的。
    并介绍了一种用“默示同意”规则来提高捐献率的想法。

    1）保险公司可以在销售医疗保险时，可以建议客户与该公司签署一份捐献协议，签了之后，可享受保费折扣；
    2）凡持有捐献协议的保险公司，有权将协议下的捐献器官优先使用于其保险客户；

    3）保险公司可将接受上述器官移植的优先机会，与其特定医保产品绑定。

    [回复]

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