不一致的价值观和算法公平性:美国器官分配优先权制度回顾。

IF 3 1区 哲学 Q1 ETHICS
Reid Dale, Maggie Cheng, Katharine Casselman Pines, Maria Elizabeth Currie
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引用次数: 0

摘要

背景:器官获取与移植网络(OPTN)最终规则指导着国家器官移植政策,规定了公平的器官分配和特定器官优先分层系统。目前的分配评分依赖于死亡率预测:我们研究了器官优先级系统的伦理优先级与相关风险模型的统计设计之间的一致性。我们在 PubMed 上检索了有关美国器官分配历史、政策和伦理的文献:我们发现了 127 篇相关文章,涉及肾移植(19 篇)、肝移植(60 篇)、肺移植(24 篇)、心脏移植(23 篇)以及移植的可及性(1 篇)。目前的风险评分强调模型性能,忽视了变量选择中的伦理问题。将种族、性别和地域限制纳入分类变量缺乏生物学依据,因此模糊了循证模型与歧视之间的界限。对风险评分缺乏全面的伦理和公平评估,一些文献仅对终末期肝病模型(MELD)和肾脏捐献者风险指数(KDRI)的算法公平性进行了有限的讨论。我们揭示了美国器官分配评分所依据的不一致的伦理标准。具体而言,我们强调了 MELD 中的例外点、KDRI 中的种族纳入、肺分配评分中的地域限制以及心脏分级系统中风险分层的不足,这些都为医疗服务不足的人群造成了障碍:我们鼓励努力解决器官分配模型中的统计和伦理问题,并敦促在制定政策时实现标准化和透明化,以确保公平、公正和基于证据的风险预测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Inconsistent values and algorithmic fairness: a review of organ allocation priority systems in the United States.

Background: The Organ Procurement and Transplant Network (OPTN) Final Rule guides national organ transplantation policies, mandating equitable organ allocation and organ-specific priority stratification systems. Current allocation scores rely on mortality predictions.

Methods: We examined the alignment between the ethical priorities across organ prioritization systems and the statistical design of the risk models in question. We searched PubMed for literature on organ allocation history, policy, and ethics in the United States.

Results: We identified 127 relevant articles, covering kidney (19), liver (60), lung (24), and heart transplants (23), and transplant accessibility (1). Current risk scores emphasize model performance and overlook ethical concerns in variable selection. The inclusion of race, sex, and geographical limits as categorical variables lacks biological basis; therefore, blurring the line between evidence-based models and discrimination. Comprehensive ethical and equity evaluation of risk scores is lacking, with only limited discussion of the algorithmic fairness of the Model for End-Stage Liver Disease (MELD) and the Kidney Donor Risk Index (KDRI) in some literature. We uncovered the inconsistent ethical standards underlying organ allocation scores in the United States. Specifically, we highlighted the exception points in MELD, the inclusion of race in KDRI, the geographical limit in the Lung Allocation Score, and the inadequacy of risk stratification in the Heart Tier system, creating obstacles for medically underserved populations.

Conclusions: We encourage efforts to address statistical and ethical concerns in organ allocation models and urge standardization and transparency in policy development to ensure fairness, equitability, and evidence-based risk predictions.

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来源期刊
BMC Medical Ethics
BMC Medical Ethics MEDICAL ETHICS-
CiteScore
5.20
自引率
7.40%
发文量
108
审稿时长
>12 weeks
期刊介绍: BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
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