肾移植中的同意问题。
Issues of consent in renal transplantation.
作者信息
McLaren A, Morris-Stiff G, Casey J
机构信息
High Wycombe General Hospital, Buckinghamshire, UK.
出版信息
Ann R Coll Surg Engl. 2001 Sep;83(5):343-6.
BACKGROUND
Renal transplantation is a semi-elective procedure. The specific risks of surgery are well-known. Obtaining informed consent is a complex process made more complicated in transplantation by the long-term nature of some of the risks involved.
METHODS
A questionnaire survey was conducted of consultant transplant surgeons to establish current practice regarding the levels of information and risks discussed as part of the consent process.
RESULTS
Responses were received from 47 (76%) of consultants. Risks were discussed by a range of individuals. Pre-assessment clinics were used by 70% of units to start the process. Only 74% routinely discussed malignancy and only 75% the risks of cytomegalovirus infection. Risks with individual organs were discussed by 32 (68%)--particularly HLA match, cold ischaemia, sensitisation, donor age and caused of donor death.
CONCLUSIONS
The current practice identified by this study falls broadly within General Medical Council guidelines on informed consent. There is wide variation in current practice which is highlighted and discussed in relation to case law and the levels of risk that a patient should expect to be informed of.
背景
肾移植是一种半选择性手术。手术的具体风险众所周知。获得知情同意是一个复杂的过程，而由于某些相关风险的长期性，在移植手术中这一过程变得更加复杂。
方法
对移植外科顾问医生进行问卷调查，以确定当前在作为同意过程一部分所讨论的信息水平和风险方面的做法。
结果
收到了47名（76%）顾问医生的回复。一系列人员参与了风险讨论。70%的单位利用术前评估诊所启动这一过程。只有74%的单位常规讨论恶性肿瘤，只有75%的单位讨论巨细胞病毒感染风险。32名（68%）医生讨论了单个器官的风险——特别是人类白细胞抗原匹配、冷缺血、致敏、供体年龄和供体死亡原因。
结论
本研究确定的当前做法大致符合英国医学总会关于知情同意的指南。当前的做法存在很大差异，结合判例法以及患者应期望被告知的风险水平对此进行了强调和讨论。
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