Lewandowski Amber N, Skillings Jared Lyon
Richard DeVos Heart and Lung Transplant Program, Spectrum Health, Grand Rapids, MI, USA.
Glob Cardiol Sci Pract. 2016 Sep 30;2016(3):e201626. doi: 10.21542/gcsp.2016.26.
In the United States, there is a significant shortage of available donor organs. This requires transplant professionals to hold simultaneous, yet divergent roles as (1) advocates for patients who are in need of a lifesaving transplant, and (2) responsible stewards in the allocation of scarce donor organs. In order to balance these roles, most transplant teams utilize a committee based decision-making process to select suitable candidates for the transplant waiting list. These committees use medical and psychosocial criteria to guide their decision to list a patient. Transplant regulatory bodies have established medical standards for identifying appropriate medical candidates for transplantation. However, transplant regulatory bodies have not developed policies to standardize psychosocial criteria for listing patients. This affords transplant centers the autonomy to develop their own psychosocial criteria for determining which patients will be placed on the transplant waiting list. This lack of a standardized policy has resulted in inconsistent psychosocial practices amongst transplant centers nationwide. Since there has been no formal review of the inconsistency in psychosocial policy and practice, this paper seeks to explore the non-standardized psychosocial approach to organ transplant listing. The authors review factors that are relevant to the standardization of the psychosocial decision-making process, including shared decision-making, clinician judgment, bias in decision-making and moral distress in transplant staff. We conclude with a discussion about the impact of these issues on psychosocial practices in solid organ transplantation.
在美国，可用的捐赠器官严重短缺。这就要求移植专业人员同时扮演截然不同的角色：一是作为需要挽救生命的移植患者的倡导者，二是作为稀缺捐赠器官分配的负责任管理者。为了平衡这些角色，大多数移植团队采用基于委员会的决策过程来挑选移植等待名单上的合适候选人。这些委员会使用医学和社会心理标准来指导他们将患者列入名单的决定。移植监管机构已经制定了确定合适移植医学候选人的标准。然而，移植监管机构尚未制定政策来规范将患者列入名单的社会心理标准。这使得移植中心有自主权制定自己的社会心理标准，以确定哪些患者将被列入移植等待名单。这种缺乏标准化政策的情况导致全国移植中心的社会心理实践不一致。由于尚未对社会心理政策和实践中的不一致进行正式审查，本文旨在探讨器官移植名单的非标准化社会心理方法。作者回顾了与社会心理决策过程标准化相关的因素，包括共同决策、临床医生判断、决策中的偏见以及移植工作人员的道德困扰。最后，我们讨论了这些问题对实体器官移植社会心理实践的影响。
