Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Surgery, University of Maryland, Baltimore, Maryland.
Am J Transplant. 2019 Aug;19(8):2232-2240. doi: 10.1111/ajt.15310. Epub 2019 Mar 14.
Donation before circulatory death for imminently dying patients has been proposed to address organ scarcity and harms of nondonation. To characterize stakeholder attitudes about organ recovery before circulatory death we conducted semistructured interviews with family members (N = 15) who had experienced a loved one's unsuccessful donation after circulatory death and focus groups with professional stakeholders (surgeons, anesthesiologists, critical care specialists, palliative care specialists, organ procurement personnel, and policymakers, N = 46). We then used qualitative content analysis to characterize these perspectives. Professional stakeholders believed that donation of all organs before circulatory death was unacceptable, morally repulsive, and equivalent to murder; consent for such a procedure would be impermissible. Respondents feared the social costs related to recovery before death were too high. Although beliefs about recovery of all organs were widely shared, some professional stakeholders could accommodate removal of a single kidney before circulatory death. In contrast, family members were typically accepting of donation before circulatory death for a single kidney, and many believed recovery of all organs was permissible because they believed the cause of death was the donor's injury, not organ procurement. These findings suggest that definitions of death and precise rules around organ donation are critical for professional stakeholders, whereas donor families find less relevance in these constructs for determining the acceptability of organ donation. Donation of a single kidney before circulatory death warrants future exploration.
为了解决器官短缺和不捐献的危害，有人提议在循环死亡前为即将死亡的患者捐献器官。为了描述利益相关者对循环死亡前器官恢复的态度，我们对 15 名经历过亲人在循环死亡后捐献不成功的家属进行了半结构化访谈，并对专业利益相关者（外科医生、麻醉师、重症监护专家、姑息治疗专家、器官获取人员和政策制定者）进行了焦点小组讨论（N=46）。然后，我们使用定性内容分析来描述这些观点。专业利益相关者认为，在循环死亡前捐献所有器官是不可接受的，在道德上令人反感，等同于谋杀；这种程序的同意是不允许的。受访者担心与死亡前恢复相关的社会成本太高。尽管普遍认为可以恢复所有器官，但一些专业利益相关者可以接受在循环死亡前切除单个肾脏。相比之下，家属通常接受在循环死亡前捐献单个肾脏，许多人认为可以允许恢复所有器官，因为他们认为死亡原因是捐赠者的受伤，而不是器官获取。这些发现表明，死亡的定义和器官捐献的具体规则对专业利益相关者至关重要，而对于确定器官捐献的可接受性，捐赠者家属则认为这些结构的相关性较小。在循环死亡前捐献单个肾脏值得进一步探讨。
