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      Transplante de fígado e alocação dos órgãos no Brasil: entre Rawls e o utilitarismo Translated title: Liver transplants and organ allocation in Brazil: from Rawls to utilitarianism Translated title: Trasplante de hígado y asignación de órganos en Brasil: entre Rawls y el utilitarismo

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          Abstract

          Resumo: O processo de doação e transplante hepático no Brasil revela grandes desigualdades entre regiões e Unidades da Federação, desde a captação de órgãos até o implante do fígado. Em 2006, o escore MELD (Model for End-stage Liver Disease), inspirado no modelo estadunidense e baseado no princípio da necessidade, foi introduzido no Brasil para a alocação de fígado. Porém, as desigualdades no nosso país têm comprometido, parcialmente, o sucesso dessa iniciativa. Em outros países, já se presencia uma crescente discussão sobre o benefício de modelos que tentam harmonizar utilitarismo e necessidade. O presente artigo revisa a literatura pertinente com um foco especial na realidade brasileira.

          Translated abstract

          Abstract: The process of liver donations and transplants in Brazil reveals major inequalities between regions and states of the country, ranging from uptake of the organs to their transplantation. In 2006, the MELD score (Model for End-stage Liver Disease), inspired by the U.S. model and based on the principle of need, was introduced in Brazil for liver transplant allocation. However, Brazil’s inequalities have partially undermined the initiative’s success. Other countries have already benefited from growing discussion on the benefits of models that seek to harmonize utilitarianism and need. The current article reviews the relevant literature with a special focus on the Brazilian reality.

          Translated abstract

          Resumen: El proceso de donación y trasplante hepático en Brasil revela grandes desigualdades entre regiones y unidades de la federación, desde la captación del órgano hasta el implante del mismo. En 2006, el marcador MELD (Model for End-stage Liver Disease), inspirado en el modelo estadounidense, y basado en el principio de necesidad, fue incorporado en Brasil para la asignación en trasplantes de hígado. No obstante, las desigualdades en nuestro país han comprometido, parcialmente, el éxito de esta iniciativa. En otros países, ya se vive una creciente discusión sobre el beneficio de modelos que intentan armonizar utilitarismo y necesidad. Este artículo revisa la literatura pertinente, centrándose especialmente en la realidad brasileña.

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          Are there better guidelines for allocation in liver transplantation? A novel score targeting justice and utility in the model for end-stage liver disease era.

          To design a new score on risk assessment for orthotopic liver transplantation (OLT) based on both donor and recipient parameters.
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            Personal responsibility within health policy: unethical and ineffective

            This paper argues against incorporating assessments of individual responsibility into healthcare policies by expanding an existing argument and offering a rebuttal to an argument in favour of such policies. First, it is argued that what primarily underlies discussions surrounding personal responsibility and healthcare is not causal responsibility, moral responsibility or culpability, as one might expect, but biases towards particular highly stigmatised behaviours. A challenge is posed for proponents of taking personal responsibility into account within health policy to either expand the debate to also include socially accepted behaviours or to provide an alternative explanation of the narrowly focused discussion. Second, a critical response is offered to arguments that claim that policies based on personal responsibility would lead to several positive outcomes including healthy behaviour change, better health outcomes and decreases in healthcare spending. It is argued that using individual responsibility as a basis for resource allocation in healthcare is unlikely to motivate positive behaviour changes, and is likely to increase inequality which may lead to worse health outcomes overall. Finally, the case of West Virginia's Medicaid reform is examined, which raises a worry that policies focused on personal responsibility have the potential to lead to increases in medical spending overall.
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              Liver transplantation around the world.

              In the past few years, there have been important changes in the development of liver transplantation around the world. In particular, several emerging countries have rapidly developed transplant programs. There have also been important changes in liver allocation, utilization of donors by cardiac death, and living donors. A review of the practices in different countries around the world will help provide the reader with a better appreciation of their own program as well as the recognition of potential areas of improvement based on the experience of their colleagues.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                csp
                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro, RJ, Brazil )
                0102-311X
                1678-4464
                November 2018
                : 34
                : 11
                : e00155817
                Affiliations
                [1] São Leopoldo Rio Grande do Sul orgnameUniversidade do Vale do Rio dos Sinos Brazil
                [2] Porto Alegre orgnameHospital de Clínicas de Porto Alegre Brasil
                Article
                S0102-311X2018001103001
                10.1590/0102-311x00155817
                30427414
                5206e42e-7275-4edd-809d-c82bd470976a

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 06 September 2017
                : 03 August 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 39, Pages: 0
                Product

                SciELO Public Health


                Transplante de Fígado,Obtenção de Tecidos e Órgãos,Política de Saúde,Liver Transplantation,Tissue and Organ Procurement,Health Policy,Trasplante de Hígado,Obtención de Tejidos y Órganos,Política de Salud

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