Paul Katharina T, Avezaat Cees J J, Ijzermans Jan N, Friele Roland D, Bal Roland A
University of Vienna, Austria
Erasmus Medical Center, The Netherlands.
Health (London). 2014 Jul;18(4):369-87. doi: 10.1177/1363459313501357. Epub 2013 Oct 1.
An increasing number of patients become eligible for organ transplants. In the Netherlands, at the level of policy discourse, growing waiting lists are often referred to as a persistent "shortage" of organs, producing a "public health crisis." In this way, organ donation is presented as an ethical, social, and medical necessity. Likewise, policy discourse offers a range of seemingly unambiguous solutions: improving logistical infrastructure at the level of hospitals, developing organizational and legal protocols, as well as public information campaigns. Instead of taking these problem and solution definitions as given, we critically examine the relationship between policy discourse and clinical practice. Based on a historical review, first, we trace the key moments of transformation where organ donation became naturalized in Dutch policy discourse, particularly in its altruistic connotation. Second, based on in-depth interviews with medical professionals, we show how those involved in organ donation continue to struggle with the controversial nature of their clinical practice. More specifically, we highlight their use of different forms of knowledge that underlie clinicians' "transition work": from losing a patient to "gaining" a donor.
越来越多的患者符合器官移植的条件。在荷兰，在政策讨论层面，不断增加的等待名单常常被称为器官的持续“短缺”，从而引发了一场“公共卫生危机”。通过这种方式，器官捐赠被视为一种伦理、社会和医学上的必要行为。同样，政策讨论提供了一系列看似明确的解决方案：改善医院层面的后勤基础设施、制定组织和法律协议以及开展公众宣传活动。我们并非将这些问题和解决方案的定义视为既定事实，而是批判性地审视政策讨论与临床实践之间的关系。基于历史回顾，首先，我们追溯器官捐赠在荷兰政策讨论中自然化的关键转变时刻，特别是其利他主义内涵。其次，基于对医学专业人员的深入访谈，我们展示了参与器官捐赠的人员如何继续与他们临床实践的争议性本质作斗争。更具体地说，我们强调他们在临床医生“过渡工作”（从失去一名患者到“获得”一名捐赠者）中所使用的不同形式知识的情况。
