PBS高端访谈:孩子排队等待成人肺移植享优先权

 　　GWEN IFILL:Finally tonight: The pleas of two desperate families shift the ethical¹ debate about organ transplant policies for children.

　　Ray Suarez has the story.

　　RAY SUAREZ:The cases of 10-year-old Sarah Murnaghan and 11-year-old Javier Acosta have put a national spotlight² on the issue. Both have end-stage cystic fibrosis. But they are at the bottom of a waiting list for a adult lungs because they're under 12.

　　U.S. Sen. Pat Toomey of Pennsylvania, Sarah Murnaghan's home state, says that has to change.

　　SEN. PAT TOOMEY, R-Penn.: Sarah is being treated by some of the best doctors in the world, and they are convinced that she's an excellent candidate to have a successful transplant surgery. It seems to me a policy that systemically excludes her and other children in her circumstances is a flawed policy.

　　RAY SUAREZ:Last week, federal district Judge Michael Baylson in Philadelphia ordered a change in transplant policy for both cases, and said the children must be placed higher on the waiting list. That prompted some doctors to say courts have no business deciding on medical matters.

　　DR. SCOTT HALPERN, University of Pennsylvania Hospital: I don't think we want judges making medical decisions any more than we want doctors deciding Supreme³ Court cases.

　　RAY SUAREZ:Now the Organ Procurement⁴ and Transplantation Network is setting up an appeal process for children under 12.

　　For more on the case, yesterday's decision and the issues involved, we turn to Arthur Caplan, director of the Division of Medical Ethics⁵ at New York University's Langone Medical Center.

　　Doctor, the new rules proposed in the vote last night, what would they do? How would they change things?

　　DR. ARTHUR CAPLAN, New York University’s Langone Medical Center: Well, they don't really change the, if you will, under-12 rule, that is, saying that children can't get organs from adults. What they do do is make a path for an exception, make a path for a compassionate⁶ examination of a particular case.

　　So, if you will, they create an appeals process. It will be in the hands of doctors to make an assessment⁷ case by case of whether a younger child could accept or whether organs would fit into a kid under 12 when they come from an adult. We haven't had that appeals process before. So that is a significant change.

　　RAY SUAREZ:Why were the rules written the way they were in the first place? It wasn't an outright⁸ prohibition⁹, but it was a formula that discouraged the use of adult donor¹⁰ lungs in the chests of children.

　　ARTHUR CAPLAN:The main reason is because adult donor lungs are large and kids under 12 are small, and the lungs don't fit. So you wind up having to use a piece of the lung, if you will, taking out a lobe¹¹ and putting it in.

　　Now, unlike other organs, like the liver, the lung doesn't grow back. So a lot of surgeons have felt if you are going to transplant a lobe of lung, that is riskier¹², more prone¹³ to trouble. Others disagree. But the basis of the rule was partly due to the size problem, and then some of the challenges that younger kids pose in terms of immunosuppression, the drugs you have to take after you get a transplant.

　　Both of those factors were seen as, if you will, diminishing the chance of success by many in the transplant field.

　　RAY SUAREZ:Now, understandably, in the case of the Murnaghan and Acosta families, you had families going public, heading into the court of public opinion to plead their case. Is that a good place to make medical decisions about transplantation?

　　ARTHUR CAPLAN:I don't think so.

　　It is perfectly¹⁴ understandable that a family would say, I'm going to do everything I can for my child, hire a P.R. firm, get my congressman¹⁵ or senator to pay attention. But it's not the best way to allocate¹⁶ the scarce supply of organs that we have.

　　We have a situation where if you really leave it up to who can mount the biggest publicity¹⁷ campaign, you're not necessarily going to see lungs or any other organs going to those who might benefit the most. So, to me, it's partly -- it's fully¹⁸ understandable that a parent would want to try and save their child.

　　But you don't want to have a kind of bidding war where people who can spend the most money, who are the most P.R.-savvy, who can wield¹⁹ the most influence with a congressperson are going to win the shot at getting an organ. I think it's better left more or less inside the medical community with the transplant experts to decide who is the best candidate.

　　RAY SUAREZ:In this area, do medical decisions run on a kind of different track from ethical ones? Are there things that are ethically²⁰ dodgy that would work medically or medically dodgy that are defensible ethically?

　　ARTHUR CAPLAN:That's a great question and would take more time than we have got. But the answer is yes.

　　For example, a lot of programs don't admit people who smoke marijuana. It is seen as substance abuse. On the other hand, we have got two states where it's been legalized, a lot of states where medical marijuana use is accepted. Should marijuana use be an exclusion²¹ is partly a medical question, but now it's becoming partly an ethical and legal question in terms of seeing it accepted as part of, you know, ordinary behavior in many parts of the country.

　　You have fights that break out all time about whether prisoners should have access to organs, whether someone with a severe mental disability should be considered along with others when they need a heart transplant, let's say. So the area is fraught²² about tough ethical choices.

　　But I don't mean to say that, you know, it's just up to doctors and just up to transplant surgeons. But, primarily, what you want to know is, what is going to work? What's going to succeed? And then let's argue about other behavioral, psychological, other factors that might impact who goes first.

　　RAY SUAREZ:Well, give us a thumbnail sketch²³ of how the system routinely works. There are people who need various body parts. There are donors²⁴ that become available. How does it normally work?

　　ARTHUR CAPLAN:So it's a two-step process.

　　One step is, how do you get into a particular transplant center? Each center makes decisions about the kind of patient that they think they could handle. Sometimes, it's money. If you don't have insurance, you may not be up -- accepted into a program that does a lung transplant or a liver transplant. They're costly²⁵ and people do get turned away because they can't pay.

　　Citizenship²⁶ might count. Are you an illegal alien? That might matter to different hospitals. And, as I said, issues around drug abuse, or do you have a criminal record, are you psychologically or psychiatrically very disturbed make it unlikely you could comply. That's the first cut.

　　Once you get in, all the names of the people who get into a transplant center are on a national list. And distribution from that national list is handled by the United Network for Organ Sharing, a federally chartered group that operates with these rules we keep hearing about.

　　So think of it as two steps. One, each individual transplant center makes the call. Are we going to take you or we're not? And they may be different place to place. Once on the list, the distribution of organs is handled by a national program with very clear-cut rules about who goes first.

　　RAY SUAREZ:We're just about at the end of our time. But I'm guessing all these problems are just made more difficult by a shortage of donors.

　　ARTHUR CAPLAN:They really are. And when you hear about a terrible plight²⁷ of these families looking for lungs, you have to keep in mind that people are dying every day for want of a heart, lung or liver.

　　So it's crucial to sign your donor card. It's crucial to talk about that decision with your family so they know that's what you want. Your friends and partners, they should know that's your wishes. And we might give a long hard look in this country against moving to a presumed consent system, meaning, instead of having a policy that says jump into the system, sign a card if you want to do this, let's go with what most people say they want to do, which is to be an organ donor and ask those who don't want to, to opt²⁸ out.

　　That would get us more organs, help resolve some of these tensions about who should live and who should die.

　　RAY SUAREZ:Dr. Caplan, thanks for joining us.

　　ARTHUR CAPLAN:My pleasure.

1 ethical   

adj.伦理的，道德的，合乎道德的

参考例句：

• It is necessary to get the youth to have a high ethical concept.必须使青年具有高度的道德观念。
• It was a debate which aroused fervent ethical arguments.那是一场引发强烈的伦理道德争论的辩论。

2 spotlight   

n.公众注意的中心，聚光灯，探照灯，视听，注意，醒目

参考例句：

• This week the spotlight is on the world of fashion.本周引人瞩目的是时装界。
• The spotlight followed her round the stage.聚光灯的光圈随着她在舞台上转。

3 supreme   

adj.极度的，最重要的；至高的，最高的

参考例句：

• It was the supreme moment in his life.那是他一生中最重要的时刻。
• He handed up the indictment to the supreme court.他把起诉书送交最高法院。

4 procurement   

n.采购；获得

参考例句：

• He is in charge of the procurement of materials.他负责物资的采购。
• More and more,human food procurement came to have a dominant effect on their evolution.人类获取食物愈来愈显著地影响到人类的进化。

5 ethics   

n.伦理学；伦理观，道德标准

参考例句：

• The ethics of his profession don't permit him to do that.他的职业道德不允许他那样做。
• Personal ethics and professional ethics sometimes conflict.个人道德和职业道德有时会相互抵触。

6 compassionate   

adj.有同情心的，表示同情的

参考例句：

• She is a compassionate person.她是一个有同情心的人。
• The compassionate judge gave the young offender a light sentence.慈悲的法官从轻判处了那个年轻罪犯。

7 assessment   

n.评价；评估；对财产的估价，被估定的金额

参考例句：

• This is a very perceptive assessment of the situation.这是一个对该情况的极富洞察力的评价。
• What is your assessment of the situation?你对时局的看法如何？

8 outright   

adv.坦率地；彻底地；立即；adj.无疑的；彻底的

参考例句：

• If you have a complaint you should tell me outright.如果你有不满意的事，你应该直率地对我说。
• You should persuade her to marry you outright.你应该彻底劝服她嫁给你。

9 prohibition   

n.禁止；禁令，禁律

参考例句：

• The prohibition against drunken driving will save many lives.禁止酒后开车将会减少许多死亡事故。
• They voted in favour of the prohibition of smoking in public areas.他们投票赞成禁止在公共场所吸烟。

10 donor   

n.捐献者；赠送人；(组织、器官等的)供体

参考例句：

• In these cases,the recipient usually takes care of the donor afterwards.在这类情况下，接受捐献者以后通常会照顾捐赠者。
• The Doctor transplanted the donor's heart to Mike's chest cavity.医生将捐赠者的心脏移植进麦克的胸腔。

11 lobe   

n.耳垂，（肺，肝等的）叶

参考例句：

• Tiny electrical sensors are placed on your scalp and on each ear lobe.小电器传感器放置在您的头皮和对每个耳垂。
• The frontal lobe of the brain is responsible for controlling movement.大脑前叶的功能是控制行动。

12 riskier   

冒险的，危险的( risky的比较级 )

参考例句：

• Now they are starting to demand higher returns on riskier assets. 而今他们开始在风险更高的资产上要求更高的回报。
• The problem with that: RIM's business is getting riskier every quarter. 不过问题也随之而来：RIM面临的业务风险正逐季增大。

13 prone   

adj.(to)易于…的，很可能…的；俯卧的

参考例句：

• Some people are prone to jump to hasty conclusions.有些人往往作出轻率的结论。
• He is prone to lose his temper when people disagree with him.人家一不同意他的意见,他就发脾气。

14 perfectly   

adv.完美地，无可非议地，彻底地

参考例句：

• The witnesses were each perfectly certain of what they said.证人们个个对自己所说的话十分肯定。
• Everything that we're doing is all perfectly above board.我们做的每件事情都是光明正大的。

15 Congressman   

n.（美）国会议员

参考例句：

• He related several anecdotes about his first years as a congressman.他讲述自己初任议员那几年的几则轶事。
• The congressman is meditating a reply to his critics.这位国会议员正在考虑给他的批评者一个答复。

16 allocate   

vt.分配，分派；把…拨给；把…划归

参考例句：

• You must allocate the money carefully.你们必须谨慎地分配钱。
• They will allocate fund for housing.他们将拨出经费建房。

17 publicity   

n.众所周知，闻名；宣传，广告

参考例句：

• The singer star's marriage got a lot of publicity.这位歌星的婚事引起了公众的关注。
• He dismissed the event as just a publicity gimmick.他不理会这件事，只当它是一种宣传手法。

18 fully   

adv.完全地，全部地，彻底地；充分地

参考例句：

• The doctor asked me to breathe in,then to breathe out fully.医生让我先吸气，然后全部呼出。
• They soon became fully integrated into the local community.他们很快就完全融入了当地人的圈子。

19 wield   

vt.行使，运用，支配；挥，使用(武器等)

参考例句：

• They wield enormous political power.他们行使巨大的政治权力。
• People may wield the power in a democracy.在民主国家里，人民可以行使权力。

20 ethically   

adv.在伦理上，道德上

参考例句：

• Ethically , we have nothing to be ashamed about . 从伦理上说，我们没有什么好羞愧的。
• Describe the appropriate action to take in an ethically ambiguous situation. 描述适当行为采取在一个道德地模棱两可的情况。

21 exclusion   

n.拒绝，排除，排斥，远足，远途旅行

参考例句：

• Don't revise a few topics to the exclusion of all others.不要修改少数论题以致排除所有其他的。
• He plays golf to the exclusion of all other sports.他专打高尔夫球，其他运动一概不参加。

22 fraught   

adj.充满…的，伴有(危险等)的；忧虑的

参考例句：

• The coming months will be fraught with fateful decisions.未来数月将充满重大的决定。
• There's no need to look so fraught!用不着那么愁眉苦脸的！

23 sketch   

n.草图；梗概；素描；v.素描；概述

参考例句：

• My sister often goes into the country to sketch. 我姐姐常到乡间去写生。
• I will send you a slight sketch of the house.我将给你寄去房屋的草图。

24 donors   

n.捐赠者( donor的名词复数 )；献血者；捐血者；器官捐献者

参考例句：

• Please email us to be removed from our active list of blood donors. 假如你想把自己的名字从献血联系人名单中删去，请给我们发电子邮件。
• About half this amount comes from individual donors and bequests. 这笔钱大约有一半来自个人捐赠及遗赠。 来自《简明英汉词典》

25 costly   

adj.昂贵的，价值高的，豪华的

参考例句：

• It must be very costly to keep up a house like this.维修这么一幢房子一定很昂贵。
• This dictionary is very useful,only it is a bit costly.这本词典很有用，左不过贵了些。

26 citizenship   

n.市民权，公民权，国民的义务(身份)

参考例句：

• He was born in Sweden,but he doesn't have Swedish citizenship.他在瑞典出生，但没有瑞典公民身分。
• Ten years later,she chose to take Australian citizenship.十年后，她选择了澳大利亚国籍。

27 plight   

n.困境，境况，誓约，艰难；vt.宣誓，保证，约定

参考例句：

• The leader was much concerned over the plight of the refugees.那位领袖对难民的困境很担忧。
• She was in a most helpless plight.她真不知如何是好。

28 opt   

vi.选择，决定做某事

参考例句：

• They opt for more holiday instead of more pay.他们选择了延长假期而不是增加工资。
• Will individual schools be given the right to opt out of the local school authority?各个学校可能有权选择退出地方教育局吗？