Preservation orders

預(yù)留訂單

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.

西班牙國家移植組織的Beatriz Dominguez-Gil說，西班牙比其他國家更早地適應(yīng)了已故捐贈(zèng)者的老齡化。它的醫(yī)生學(xué)會(huì)了從70多歲和80多歲的捐贈(zèng)者身上移植器官(通常是老年接受者)。四分之一的死者是腦部嚴(yán)重受傷的人，他們接受器官保存治療，作為臨終關(guān)懷的一部分。在許多國家，老年人被送去接受姑息治療，卻失去了捐獻(xiàn)者的身份。

詞匯

palliative care/姑息治療

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.

醫(yī)生被允許在什么階段提取器官至關(guān)重要。在不到一半的歐洲國家，這一過程可以在心臟停止(器官損傷開始)后開始，而不是在大腦也停止工作的時(shí)候。在整個(gè)歐洲，器官提取前的“心跳停止判斷”時(shí)間從5分鐘到20分鐘不等。

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，無論如果我們也難做到從死者作為來源以獲取足夠的腎。而且，只有1% -2%的人死于適合捐贈(zèng)器官的方式——例如，死于意外事故造成的腦損傷。所以活體供給者是需要的。一些國家，如愛爾蘭和德國，要求活體捐贈(zèng)者與患者保持密切聯(lián)系。但是許多人允許人們將腎臟捐獻(xiàn)給他們選擇的任何人。49歲的美國婦女保拉金(Paula King)看到自己的親戚苦于找不到合適的骨髓捐贈(zèng)者，當(dāng)時(shí)家里沒有人有著合適能匹配的骨髓，于是決定把一個(gè)腎捐給一個(gè)陌生人。金女士表示:“我想在一個(gè)陌生人的協(xié)助下去減輕另外一個(gè)家庭的負(fù)擔(dān)?！痹谟?，這種所謂的“非直接”捐贈(zèng)者占活體器官移植的近10%。

詞匯

Sustained/ ?維持（sustain的過去式和過去分詞）；承受

at the mercy of/完全由…支配;任由…擺布

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 ?ne 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.

在過去，老年人很少被認(rèn)為是潛在的捐贈(zèng)者。但是巴爾的摩約翰霍普金斯大學(xué)的Dorry Segev說，很明顯這是一種誤導(dǎo)。事實(shí)上，他說，預(yù)測一個(gè)25歲的人一生中腎衰竭的風(fēng)險(xiǎn)是很困難的，而一個(gè)在70年里一直表現(xiàn)良好的人，如果只有一個(gè)腎，可能也不會(huì)有問題。2014年至2018年，美國65歲及以上的活體腎捐贈(zèng)者數(shù)量翻了一番;年齡在50-64歲之間的人增加了四分之一以上。

詞匯

Misguided/被誤導(dǎo)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.

腎臟捐贈(zèng)者通常需要住院兩天，大約一個(gè)月才能康復(fù)。大約20%的患者會(huì)出現(xiàn)一些并發(fā)癥，大多是輕微的。在許多國家，一些潛在的捐助者被旅行費(fèi)用和其他費(fèi)用嚇住了。在荷蘭，活體器官捐贈(zèng)者的比例是世界上最高的，腎臟捐贈(zèng)者有三個(gè)月的帶薪假期來恢復(fù)，同時(shí)還要支付相關(guān)的費(fèi)用，甚至像養(yǎng)狗這樣的需要。相比之下，在美國，捐贈(zèng)人只能得到一些支付的費(fèi)用，而且只有在他們很窮的時(shí)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.

幾乎一半的腎臟捐贈(zèng)者都不是他們想要幫助的人的生理匹配對象。因此有了腎臟交換計(jì)劃的發(fā)展。在這種情況下，唯有當(dāng)有人代表另一個(gè)病人捐獻(xiàn)腎臟時(shí)，病人才能從合適的活體捐贈(zèng)者那里得到一個(gè)腎臟。由韓國于1991年率先推行的全國腎臟換腎計(jì)劃，已被澳大利亞、加拿大和許多歐洲國家采納。在美國，一些移植中心和一些非盈利組織經(jīng)營著自己的移植中心。

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 “l(fā)ife 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 bene?cial 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.

英國的交換計(jì)劃每季度進(jìn)行一次算法搜索來挖掘匹配者。非定向捐獻(xiàn)者是很寶貴的，因?yàn)樗麄兛梢栽谧钚枰臅r(shí)候出現(xiàn)，這取決于血型和其他標(biāo)準(zhǔn)的組合，因此啟動(dòng)一系列其他匹配——極大地增加了移植的數(shù)量。國家醫(yī)療服務(wù)系統(tǒng)的Lisa Burnapp說，腎-腎交換計(jì)劃的捐贈(zèng)者會(huì)在最短的時(shí)間內(nèi)安排手術(shù)，不是因?yàn)橛行┤丝赡軙?huì)違約(這很少見)，而是因?yàn)椤吧l(fā)生在人身上”。比如，在很長一段時(shí)間內(nèi)，受者可能會(huì)因?yàn)椴〉锰囟鵁o法進(jìn)行手術(shù)，或者可能會(huì)發(fā)生一些意想不到的事情來阻止捐贈(zèng)者進(jìn)行手術(shù)。這類方案對已經(jīng)輸血或正在等待第二次移植的人特別有益，因?yàn)檫m合他們的抗體組合的獻(xiàn)血者可能極其罕見。阿拉巴馬大學(xué)伯明翰分校的Jayme Locke說，如果美國所有的活體捐贈(zèng)者都通過全國范圍內(nèi)的交換來分配，那么來自這些志愿者的腎臟移植將會(huì)翻倍。

詞匯

Algorithmic/算法的；規(guī)則系統(tǒng)的