器官配給—誰來決定生死權？
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.
一個小女孩需要換肺。根據規定，她不能移植成年捐獻者的肺，只能從另一個兒童身上獲得。這意味着，她可能很難等到這一天了。
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·莫納漢和弗朗西斯·莫納漢夫婦抱怨這樣的規定對他們十歲的女兒薩拉不公平。薩拉正在費城接受囊性纖維病的治療。他們想讓醫院把薩拉的名字添加到成人肺器官捐獻的等候名單上。衛生部部長凱瑟琳·西貝柳斯已下令複查器官移植政策，但也僅止於此。一篇保守主義的社論稱她爲“一人死亡判刑委員會”。
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.
儘管器官移植的案例越來越多，可供移植的器官卻一直處於緊缺狀態（見上表）。因爲多數情況下，如果捐獻者在死亡前內部器官已受到疾病的嚴重侵損，他們本來要捐獻的器官便不能用了。即便是腎臟也很稀少，雖然人們可以捐獻一隻腎，靠另一隻仍然活得好好的。美國人說他們憎惡配給制，但他們也不支持買賣器官。於是，除了配給，他們別無選擇。配給制的具體操作過程是由醫生、病人權益維護者和生物倫理學家組成的器官獲取和移植網絡（OPTN）負責的，並受衛生部監督。OPTN的政策非常複雜，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，一位聯邦法官判決，在舉行下一次聽審之前，讓薩拉·莫納漢暫時列入成人等候名單。一天後，這位法官又幫助一個和薩拉境況相似的十一歲女孩哈維爾·阿科斯塔列入了成人等候名單。6月10日，OPTN的領導層進行了投票，決定允許那些想進入成人器官移植等候隊列的兒童向OPTN內部的審查委員會提出申請。6月12日，薩拉終於如願以償，接受了可能給予她第二次生命的肺移植。她的父母喜極而泣。很多人因此而猜想，有了薩拉的例子，將來或許有更多的人會通過打官司來插隊。
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.
國會和衛生部對於如何進行器官配給只頒佈了一些籠統的規定（比如，配給必須是“公平的”）。處理好棘手的細節則是OPTN的工作。在各種器官配給的程序中，肺配給的程序尤爲複雜，需要根據捐獻者的配型相似度、血型和一個算法來進行分配，以便在幫助患者和不浪費器官（有的患者病情過於嚴重，即使接受移植也無法康復）的需要之間取得平衡。
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.
一個更重要的問題是，器官移植是否應該偏袒青少年。去年，50歲以上的器官受贈人佔總受贈人數的比例從1988年的28%劇增到了60%。而65歲以上受贈人的比例增加比這還要戲劇：從2%到17%。隨着嬰兒潮一代步入老年，這些數字可能還會增加。
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.
本月晚些時候，OPTN將會就一項建議優先給年輕申請人移植腎臟（最常見的移植器官）的提案進行討論。提案的支持者指出，年輕人通常可以通過移植獲得更長的生命。反對者則認爲，無論老幼，所有人的生命都一樣寶貴。或許有一天，人工器官的發明將終止這場辯論。就目前而言，薩拉取得了暫時的勝利。而哈維爾的父親，以及1600多名美國人，仍在焦急地等待新的肺來拯救他們摯愛的生命。
