Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA.
Crit Care Med. 2013 Jul;41(7):1733-44. doi: 10.1097/CCM.0b013e31828a219e.
Donation after cardiac death has been endorsed by professional organizations, including the American Academy of Pediatrics as a means of increasing the supply of transplantable organs. However, ethical concerns have been raised about donation after cardiac death, especially in children. This study explores the views of pediatric intensive care physicians on the ethics of pediatric donation after cardiac death.
Internet survey.
Physician members of the American Academy of Pediatrics Section of Critical Care.
Physicians were emailed an anonymous survey consisting of four demographic items and 16 items designed to assess their views on the ethics of pediatric donation after cardiac death. Responses to ethics items were rated on a 5-point scale ranging from strongly disagree to strongly agree. Physicians were also given the opportunity to provide free-text comments regarding their views.
Of the 598 eligible physicians, 264 (44.1%) responded to the survey. Of these, 193 (73.4%) were practicing in a transplant center and 160 (60.6%) participated in at least one donation after cardiac death procedure at the time of survey completion. Two hundred twenty (83.4%) agreed or strongly agreed that regarding donation after cardiac death, parents should be able to make decisions based on the best interests of their child. Two hundred twenty-two (84.1%) agreed or strongly agreed that it is not acceptable to harvest organs from a child before the declaration of death, consistent with the Dead Donor Rule. However, only 155 (59.1%) agreed or strongly agreed that the time of death in donation after cardiac death can be conclusively determined. Twenty-nine (11.0%) agreed or strongly agreed that the pediatric donation after cardiac death donor may feel pain or suffering during the harvest procedure.
Most pediatric intensive care physicians agree that the Dead Donor Rule should be applied for donation after cardiac death and that donation after cardiac death can be consistent with the best interest standard. However, concerns about the ability to determine time of death for the purpose of organ donation and the possibility of increasing donor pain and suffering exist.
心脏死亡后的捐献已得到专业组织的认可，包括美国儿科学会，将其作为增加可移植器官供应的一种手段。然而，人们对心脏死亡后的捐献提出了伦理方面的担忧，尤其是在儿童中。本研究探讨了儿科重症监护医师对心脏死亡后儿童捐献的伦理看法。
互联网调查。
美国儿科学会重症监护科医师成员。
向儿科重症监护医师发送了一份匿名调查，其中包括 4 个人口统计学项目和 16 个旨在评估他们对心脏死亡后儿科捐献伦理看法的项目。对伦理项目的回答是在 5 分制上进行评分的，范围从强烈不同意到强烈同意。还为医师提供了发表意见的自由文本评论的机会。
在 598 名符合条件的医师中，有 264 名（44.1%）对调查做出了回应。其中 193 名（73.4%）在移植中心工作，160 名（60.6%）在调查完成时至少参与了一次心脏死亡后的捐献程序。220 名（83.4%）同意或强烈同意，在心脏死亡后的捐献方面，父母应该能够根据孩子的最大利益做出决定。222 名（84.1%）同意或强烈同意，在宣告死亡之前，从儿童身上摘取器官是不可接受的，这符合“死亡供体规则”。然而，只有 155 名（59.1%）同意或强烈同意，在心脏死亡后的捐献中，可以明确确定死亡时间。29 名（11.0%）同意或强烈同意，在器官摘取过程中，儿科心脏死亡后捐献的供体可能会感到疼痛或痛苦。
大多数儿科重症监护医师同意，“死亡供体规则”应适用于心脏死亡后的捐献，而且心脏死亡后的捐献可以符合最佳利益标准。然而，人们对确定器官捐献目的的死亡时间的能力以及增加供体疼痛和痛苦的可能性表示担忧。
