Weng Li-Chueh, Huang Hsiu-Li, Lee Wei-Chen, Tsai Yu-Hsia, Lin Ching-Rong, Wang Woan-Shyuan, Wang Yi-Wen, Yang Tsui-Yun, Tseng Li-Chuan
School of Nursing, College of Medicine, Chang Gung University, Taoyuan.
Department of General Surgery, Chang Gung Memorial Hospital Linkuo.
Medicine (Baltimore). 2018 Dec;97(52):e13898. doi: 10.1097/MD.0000000000013898.
Living donor liver transplantation has advantages over deceased organ liver transplantation. However, the living liver donor candidates must be carefully assessed before surgery. Candidates may be excluded for various reasons. The purpose of this study was to evaluate the psychological profiles of excluded living liver donor candidates according to the reason for exclusion.A descriptive and cross-sectional study was conducted. Donor candidates were invited to participate if they were at least 20 years of age, related biologically or by marriage to the recipient (within 5 degrees), and had undergone living donor evaluation. Among the 338 participants recruited from August 2013 to December 2015, 116 were excluded for the following reasons: a medical condition (n = 35), failure to be chosen (n = 63), or withdrawal from the selection process (n = 18). The psychological profiles of these 3 exclusion groups were evaluated.There were no significant group differences in age, sex, education level, religion, marital status, and consanguinity (P > .05). The withdrawal group had fewer recipients with an hepatitis B virus infection than did the other groups (χ = 9.28, P = .01). Additionally, compared with the unchosen group, the withdrawal group had lower intimacy with the recipient (F = 5.32, P = .006) and higher ambivalence (F = 5.53, P = .005). In terms of family relationship parameters, the withdrawal group had lower family cohesion than the medical condition and unchosen groups (F = 4.44, P = .01), lower family expressiveness than the medical condition group (F = 3.76, P = .03), and higher family conflict than the medical condition and unchosen groups (F = 7.05, P = .001). The withdrawal group also had lower emotional social support than the medical condition group (F = 3.55, P = .03). There were no significant group difference in motivation, expectations, donation-related concerns, informational social support, value social support, instrumental social support, and health-related quality of life.The living donor candidates who withdrew from the selection process had obvious ambivalence, poorer family relationships, and insufficient emotional social support. The transplantation team should respect the autonomy of the candidate's decision and mitigate the impact of the donation decision on living liver donor candidates.
活体肝移植相对于尸体器官肝移植具有优势。然而，活体肝供体候选人在手术前必须进行仔细评估。候选人可能因各种原因被排除。本研究的目的是根据排除原因评估被排除的活体肝供体候选人的心理状况。
进行了一项描述性横断面研究。如果供体候选人年龄至少20岁，与受者有生物学或婚姻关系（五代以内），并且已经接受过活体供体评估，则邀请他们参与。在2013年8月至2015年12月招募的338名参与者中，116人因以下原因被排除：健康状况（n = 35）、未被选中（n = 63）或退出选择过程（n = 18）。对这3个排除组的心理状况进行了评估。
在年龄、性别、教育水平、宗教、婚姻状况和血缘关系方面，各组之间无显著差异（P >.05）。退出组中感染乙型肝炎病毒的受者比其他组少（χ = 9.28，P = 0.0）。此外，与未被选中组相比，退出组与受者的亲密度较低（F = 5.32，P = 0.006），矛盾情绪较高（F = 5.53，P = 0.005）。在家庭关系参数方面，退出组的家庭凝聚力低于健康状况组和未被选中组（F = 4.44，P = 0.01），家庭表达性低于健康状况组（F = 3.76，P = 0.03），家庭冲突高于健康状况组和未被选中组（F = 7.05，P = 0.001）。退出组的情感社会支持也低于健康状况组（F = 3.55，P = 0.03）。在动机、期望、捐赠相关担忧、信息社会支持、价值社会支持、工具性社会支持和健康相关生活质量方面，各组之间无显著差异。
退出选择过程的活体供体候选人存在明显的矛盾情绪、较差的家庭关系和不足的情感社会支持。移植团队应尊重候选人决定的自主性，并减轻捐赠决定对活体肝供体候选人的影响。
