Joffe Ari R, Anton Natalie R, deCaen Allan R
Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada.
Pediatrics. 2008 Nov;122(5):e967-74. doi: 10.1542/peds.2008-1210.
There has been debate in the ethics literature as to whether the donation-after-cardiac-death donor is dead after 5 minutes of absent circulation. We set out to determine whether pediatricians consider the donation-after-cardiac-death donor as dead.
A survey was mailed to all 147 pediatricians who are affiliated with the university teaching children's hospital. The survey had 4 pediatric patient scenarios in which a decision was made to donate organs after 5 minutes of absent circulation. Background information described the organ shortage, and the debate about the term "irreversibility" applied to death in donation after cardiac death. Descriptive statistics were used, with responses between groups compared by using the chi(2) statistic.
The response rate was 54% (80 of 147). In each scenario, when given a patient described as dead with absent circulation for 5 minutes, <or=60% of respondents strongly agreed/agreed that the patient is definitely dead, <or=50% responded that the patient is in the state called "dead," and <or=56% strongly agreed/agreed that the physicians are being truthful when calling the patient dead. On at least 1 of the scenarios, 38 (48%) of 147 responded uncertain, disagree, or strongly disagree that the patient is definitely dead. Although the patients in the 4 scenarios were in the identical physiologic state, with absent circulation for 5 minutes, 12 (15%) of 80 respondents did not consistently consider the patients in the state called "dead" between scenarios. Fewer than 5% of respondents answered strongly agree/agree to allow donation after cardiac death while also answering disagree/strongly disagree that the patient is definitely dead, suggesting little support to abandon the dead-donor rule.
Most pediatrician respondents were not confident that a donation-after-cardiac-death donor was dead. This suggests that additional debate about the concept of irreversibility applied to donation after cardiac death is needed.
伦理文献中一直存在关于心脏死亡后捐赠者在循环停止5分钟后是否已死亡的争论。我们着手确定儿科医生是否将心脏死亡后捐赠者视为已死亡。
向隶属于大学教学儿童医院的所有147名儿科医生邮寄了一份调查问卷。该调查问卷包含4个儿科患者场景，其中在循环停止5分钟后做出了捐赠器官的决定。背景信息描述了器官短缺情况，以及关于“不可逆性”一词应用于心脏死亡后捐赠中的死亡的争论。使用描述性统计方法，通过卡方统计量比较组间回答情况。
回复率为54%（147名中的80名）。在每个场景中，当给出一名被描述为循环停止5分钟后已死亡的患者时，≤60%的受访者强烈同意/同意该患者肯定已死亡，≤50%的受访者回答该患者处于“已死亡”状态，≤56%的受访者强烈同意/同意医生称患者已死亡时是如实相告。在至少一个场景中，147名受访者中有38名（48%）对患者肯定已死亡表示不确定、不同意或强烈不同意。尽管4个场景中的患者处于相同的生理状态，循环停止5分钟，但80名受访者中有12名（15%）在不同场景中对处于“已死亡（状态）”的患者的看法并不一致。不到5%的受访者在回答强烈同意/同意心脏死亡后允许捐赠的同时，又回答不同意/强烈不同意患者肯定已死亡，这表明几乎没有人支持放弃死亡捐赠者规则。
大多数参与调查的儿科医生对心脏死亡后捐赠者已死亡并不确定。这表明需要对应用于心脏死亡后捐赠的不可逆性概念进行更多的争论。
