Institute for Healthcare Studies, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Am J Transplant. 2011 Dec;11(12):2569-74. doi: 10.1111/j.1600-6143.2011.03814.x. Epub 2011 Nov 2.
The Organ Procurement and Transplantation Network (OPTN) mandates that organ recipients provide "specific informed consent" before accepting organs that the OPTN defines as "increased risk". However, the OPTN does not provide specific guidelines for what information should be disclosed to potential recipients. Such vagueness opens the door to inadequate informed consent. This paper examines the ethical dimensions of informed consent when the prospective living donor has self-reported behaviors associated with increased risk for infection transmission. Donor privacy is a primary ethical concern that conflicts with recipients' informed consent for use of increased risk organs. We propose that both the increased risk status and the specific behavior be disclosed to the recipient. Because the actual risk posed is linked to the type of risk behavior, disclosure is therefore needed to make an informed decision. The donor's risk behavior is material to recipients' decision making because it may impact the donor-recipient relationship. This relationship is the foundation of the donation and acceptance transaction, and thus comprises a critical feature of the recipient's informed consent. Optimizing a recipient's informed consent is essential to protecting patient safety and autonomy.
器官获取和移植网络（OPTN）要求器官接受者在接受 OPTN 定义为“增加风险”的器官之前提供“具体的知情同意”。然而，OPTN 并未为应向潜在接受者披露哪些信息提供具体指导方针。这种模糊性为不充分的知情同意打开了大门。本文探讨了当潜在的活体供者报告与感染传播风险增加相关的行为时，知情同意的伦理维度。供者隐私是一个主要的伦理关注点，与接受者使用增加风险器官的知情同意相冲突。我们建议向接受者披露增加的风险状况和具体行为。因为实际风险与风险行为的类型有关，所以需要披露这些信息以做出明智的决策。供者的风险行为对接受者的决策至关重要，因为它可能影响供者-接受者关系。这种关系是捐赠和接受交易的基础，因此构成了接受者知情同意的关键特征。优化接受者的知情同意对于保护患者的安全和自主权至关重要。
