活体肝移植中供体动机分析
Analysis of donor motivations in living donor liver transplantation.
作者信息
Abdeldayem Hesham, Kashkoush Samy, Hegab Bassem Soliman, Aziz Amr, Shoreem Hany, Saleh Shereef
机构信息
National Liver Institute, Menofeyia University , Cairo , Egypt.
出版信息
Front Surg. 2014 Jul 8;1:25. doi: 10.3389/fsurg.2014.00025. eCollection 2014.
OBJECTIVES
The introduction of the living donor liver transplantation (LDLT) in Egypt as in elsewhere, has raised important psychological conflicts and ethical questions. The objective of this study was to get better understanding of the potential donors' motives toward LDLT.
METHODS
This study was conducted on consecutive 193 living-liver donors who underwent partial hepatectomy as donors for LDLT during the period between April 2003 and January 2013, at the National Liver Institute Menoufeyia University, Egypt. Potential donors were thoroughly evaluated preoperatively through a screening questionnaire and interviews as regard their demographic data, relationship to the potential recipient, and motives toward proceeding to surgery. They were assured that the information shared between them and the transplant center is confidential.
RESULTS
The donors' mean age was 25.53 ± 6.39 years with a range of 18-45 years. Males represented 64.7% and females were 35.3%. The most common donors (32.1%, n = 62) were sons and daughters to their parents (sons: n = 43, daughters: n = 19) while parents to their offsprings represent 15% (mothers: n = 21, fathers: n = 8). Brothers and sisters represent 16.5% (brothers: n = 22, sisters: n = 10). Nephews and nieces giving their uncles or aunts were 14%. The number of wives donating to their husbands was 11 (5.7%). Interestingly, there was no single husband who donated his wife. Among the remaining donors, there were 11 cousins and 1 uncle. Unrelated donors were 20 (10.4%). Several factors seemed to contribute to motivation for donation: the seriousness of the potential recipient condition, the relationship and personal history of the donor to the potential recipient, the religious beliefs, the trust in the health care system, and family dynamics and obligations.
CONCLUSION
Absolute absence of coercion on the living-liver donor's motives may not be realistic because of the serious condition of the potential recipient. It is mandatory that the donor is truly willing to donate.
目的
与其他地方一样，活体肝移植（LDLT）在埃及的引入引发了重要的心理冲突和伦理问题。本研究的目的是更好地了解潜在供体进行LDLT的动机。
方法
本研究对2003年4月至2013年1月期间在埃及曼努菲亚大学国家肝脏研究所作为LDLT供体接受部分肝切除术的193名连续活体肝供体进行。通过筛查问卷和访谈对潜在供体进行术前全面评估，内容包括他们的人口统计学数据、与潜在受体的关系以及进行手术的动机。他们被告知他们与移植中心共享的信息是保密的。
结果
供体的平均年龄为25.53±6.39岁，范围为18 - 45岁。男性占64.7%，女性占35.3%。最常见的供体（32.1%，n = 62）是其父母的子女（儿子：n = 43，女儿：n = 19），而子女的父母占15%（母亲：n = 21，父亲：n = 8）。兄弟姐妹占16.5%（兄弟：n = 22，姐妹：n = 10）。侄子侄女捐给叔叔阿姨的占14%。妻子捐给丈夫的有11人（5.7%）。有趣的是，没有一个丈夫捐给妻子。在其余供体中，有11个堂兄弟姐妹和1个叔叔。非亲属供体有20人（10.4%）。几个因素似乎促成了捐赠动机：潜在受体病情的严重性、供体与潜在受体的关系和个人历史、宗教信仰、对医疗保健系统的信任以及家庭动态和义务。
结论
由于潜在受体的严重病情，完全不存在对活体肝供体动机的强制可能不太现实。供体必须真正愿意捐赠。
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