Danesh Ahmad, Nedjat Saharnaz, Asghari Fariba, Jafarian Ali, Fotouhi Akbar
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran.
Hepat Mon. 2012 Aug;12(8):e6183. doi: 10.5812/hepatmon.6183. Epub 2012 Aug 20.
Although liver transplantation is the last resort for treating end stage liver diseases, this medical procedure is not available for all needful patients because of inadequate organ supply. Therefore, guidelines have been developed by medical experts to regulate the process. Some professionals believe that medical criteria are inadequate for organ allocation in all situations and may not secure fairness of organ allocation.
The current study has been designed to identify decision criteria about allocation of donated liver to potential recipients from public points of view.
This is a qualitative study that was conducted through individual interviews and Focus Group Discussions. Individual interviews were conducted among patients' companions and nurses in one of the two liver transplant centers in Iran. Group discussions were conducted among groups of ordinary people who had not dealt previously with the subject. Data was analyzed by Thematic Analysis method.
Most of the participants in this study believe that in equal medical conditions, some individual and societal criteria could be used to prioritize patients for receiving donated livers. The criteria include psychological acceptance, ability to pay post-operative care costs, being breadwinner of the family, family support, being socially valued, ability to be instructed, lack of mental disorders, young age of the recipient, being on waiting list for a long time, lack of patient's role in causing the illness, first time transplant recipient, critical medical condition, high success rate of transplantation, lack of concurrent medical illnesses, not being an inmate at the time of receiving transplant, and bearing Iranian nationality.
Taking public opinion into consideration may smooth the process of organ allocation to needful patients with equal medical conditions. It seems that considering these viewpoints in drafting organ allocation guidelines may increase confidence of the society to the equity of organ allocation in the country. This strategy may also persuade people to donate organs particularly after death.
尽管肝移植是治疗终末期肝病的最后手段，但由于器官供应不足，并非所有有需要的患者都能接受这一医疗程序。因此，医学专家制定了指导方针来规范这一过程。一些专业人士认为，医学标准在所有情况下都不足以用于器官分配，可能无法确保器官分配的公平性。
本研究旨在从公众角度确定将捐赠肝脏分配给潜在受者的决策标准。
这是一项定性研究，通过个人访谈和焦点小组讨论进行。在伊朗两个肝移植中心之一，对患者家属和护士进行了个人访谈。对以前未接触过该主题的普通人群组进行了小组讨论。采用主题分析法对数据进行分析。
本研究中的大多数参与者认为，在同等医疗条件下，可以使用一些个人和社会标准来确定患者接受捐赠肝脏的优先顺序。这些标准包括心理接受度、支付术后护理费用的能力、家庭经济支柱、家庭支持、社会价值、接受指导的能力、无精神障碍、受者年龄小、等待名单时间长、患者患病非自身原因、首次移植受者、危急医疗状况、移植成功率高、无并发疾病、接受移植时非囚犯以及具有伊朗国籍。
考虑公众意见可能会使向医疗条件相同的有需要患者分配器官的过程更加顺利。在起草器官分配指导方针时考虑这些观点似乎可以增强社会对该国器官分配公平性的确信。这一策略也可能会说服人们特别是在死后捐赠器官。
