Hammami Muhammad M, Hammami Muhammad B, Aboushaar Reem
Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Alfaisal University College of Medicine, Riyadh, Saudi Arabia.
Patient Prefer Adherence. 2020 Jan 29;14:173-189. doi: 10.2147/PPA.S230286. eCollection 2020.
Organ donation is commonly evaluated by biomedical ethicists based largely on principlism with autonomy at the top of the "moral mountain." Lay people may differ in the way they invoke and balance the various ethical interests. We explored lay people's ethical attitudes to organ donation.
Respondents (n=196) ranked 42 opinion-statements on organ donation according to a 9-category symmetrical distribution. Statements' scores were analyzed by averaging-analysis and Q-methodology.
Respondents' mean (SD) age was 34.5 (10.6) years, 53% were women, 69% Muslims (30% Christians), 29% Saudis (26% Filipinos), and 38% healthcare-related. The most-agreeable statements were "Acceptable if benefit to recipient large," "Explicit donor consent and family approval for live donation," "Acceptable if directed to family member," and "Explicit donor consent and family approval for postmortem donation." The most-disagreeable statements were "Donor consent and family approval not required for postmortem donation," "Acceptable with purely materialistic motivation," and "Only donor no-known objection for postmortem donation." Women, Christians, and healthcare respondents gave higher rank to "Explicit donor consent and family approval for live donation," "Only donor family consent required for postmortem donation," and "Acceptable if organ distribution equitable," respectively, and Muslims gave more weight to donor/family harm (p ≤0.001). Q-methodology identified various ethical resolution models that were associated with religious affiliation and included relatively "motives-concerned," "family-benefit-concerned," "familism-oriented," and "religious or non-religious altruism-concerned" models. Of 23 neutral statements on averaging-analysis, 48% and 65% received extreme ranks in ≥1 women and men Q-methodology models, respectively.
器官捐赠通常由生物医学伦理学家进行评估，主要基于原则主义，其中自主性处于“道德山峰”之巅。普通民众在援引和平衡各种伦理利益的方式上可能存在差异。我们探讨了普通民众对器官捐赠的伦理态度。
196名受访者根据9类对称分布对42条关于器官捐赠的观点陈述进行排序。通过均值分析和Q方法对陈述得分进行分析。
受访者的平均（标准差）年龄为34.5（10.6）岁，53%为女性，69%为穆斯林（30%为基督徒），29%为沙特人（26%为菲律宾人），38%与医疗保健相关。最受认可的陈述是“如果对接受者益处大则可接受”、“活体捐赠需捐赠者明确同意和家属批准”、“如果捐赠给家庭成员则可接受”以及“死后捐赠需捐赠者明确同意和家属批准”。最不认可的陈述是“死后捐赠无需捐赠者同意和家属批准”、“出于纯粹物质动机可接受”以及“死后捐赠仅需捐赠者无异议”。女性、基督徒和医疗保健受访者分别对“活体捐赠需捐赠者明确同意和家属批准”、“死后捐赠仅需捐赠者家属同意”以及“如果器官分配公平则可接受”给予了更高排名，而穆斯林更看重捐赠者/家属的伤害（p≤0.001）。Q方法确定了与宗教信仰相关的各种伦理解决模式，包括相对“关注动机”、“关注家庭利益”、“以家族主义为导向”以及“关注宗教或非宗教利他主义”的模式。在均值分析的23条中性陈述中，分别有48%和65%在≥1个女性和男性Q方法模型中获得极端排名。
1）总体而言，接受者的益处、捐赠者明确同意和家属批准的要求、捐赠者与接受者的关系以及动机是主要考虑因素；2）一些陈述的排名与受访者的人口统计学特征相关；3）Q方法确定了各种伦理解决模式，这些模式在均值分析中部分被掩盖；4）我们的受访者中强烈的美德和家族主义方法为反对原则主义的充分性提供了一些实证证据。
