Transplant Québec, 4100 Rue Molson #200, Montréal, QC H1Y 3N1, Canada; Canadian Donation and Transplantation Research Program (CDTRP), Room 6002, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; Division of Pediatric Intensive Care, Centre Mère-Enfant Soleil du CHU de Québec, 2705 boul Laurier, Québec, Québec, Canada.
Canadian Donation and Transplantation Research Program (CDTRP), Room 6002, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; Department of Sociology and Anthropology, B750 Loeb Building, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada.
Transplant Rev (Orlando). 2021 Dec;35(4):100635. doi: 10.1016/j.trre.2021.100635. Epub 2021 Jun 19.
Pre-mortem interventions (PMIs) are performed on patients before the determination of death in order to preserve or enhance the possibility of organ donation. These interventions can be ethically controversial, and we thus undertook a scoping review of the ethical issues surrounding diverse PMIs.
Using modified scoping review methods, we executed a search strategy created by an information specialist. Screening and iterative coding of each article was done by two researchers using qualitative thematic analysis, and narrative summaries of coded themes were presented.
We identified and screened 5365 references and coded 196 peer-reviewed publications. The most frequently cited issues were related to possible harms to the patient who is a potential donor, and legitimacy of consent. The most controversial issue was that PMIs may place patients at risk for physical harm, yet benefit is accrued mainly to recipients. Some authors argued that lack of direct medical benefit to the still living patient precluded valid consent from surrogate decision makers (SDMs), while many stated that some medical risk could be approved by SDMs if it aligns with non-medical benefits valued by the patient.
PMIs require consensus that benefit includes concepts beyond medical benefit to the patient who is a potential donor. Informed consent must be confirmed for each PMI and not assumed to be part of general consent for donation. Risk must be proportionate to the potential benefit and newly proposed interventions should be reviewed carefully for medical efficacy and potential risks.
在确定死亡之前对患者进行生前干预（PMIs），以保存或增加器官捐献的可能性。这些干预措施在伦理上可能存在争议，因此我们对围绕各种 PMIs 的伦理问题进行了范围综述。
使用改良的范围综述方法，我们执行了由信息专家创建的搜索策略。两位研究人员使用定性主题分析对每篇文章进行筛选和迭代编码，并呈现编码主题的叙述性摘要。
我们确定并筛选了 5365 篇参考文献，并对 196 篇同行评议出版物进行了编码。引用最多的问题与对可能成为供体的患者造成的潜在伤害以及同意的合法性有关。最具争议的问题是 PMIs 可能使患者面临身体伤害的风险，但受益主要归因于受者。一些作者认为，PMIs 缺乏对仍存活患者的直接医疗益处，从而排除了替代决策者（SDMs）的有效同意，而许多人则表示，如果与患者重视的非医疗利益一致，SDMs 可以批准某些医疗风险。
PMIs 需要达成共识，即受益包括超出潜在供体患者的医疗受益的概念。必须对每项 PMI 进行知情同意确认，而不能假定为一般捐赠同意的一部分。风险必须与潜在利益成比例，并且应仔细审查新提出的干预措施，以评估其医疗效果和潜在风险。
