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[德国关于器官捐赠的新法律——临床医生对其影响、潜力及局限性的看法]

[New German laws on organ donation-clinicians' perspectives on effects, potential and limitations].

作者信息

Fehring Zoë, Boehme Philip, Wirth Stefan, Fehring Leonard

机构信息

Fakultät für Gesundheit, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448, Witten, Deutschland.

Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Heusnerstraße 40, 42283, Wuppertal, Deutschland.

出版信息

Urologe A. 2021 Dec;60(12):1570-1578. doi: 10.1007/s00120-021-01645-y. Epub 2021 Oct 13.

Abstract

BACKGROUND

The new German laws on organ donation of 2019 and 2020 intend to increase the organ donation rate. They include the optimization of organizational structures, the introduction of an online registry to document the patient's will and measures to improve information of the public. To date, little is known about clinicians' perspectives on these new laws.

METHODS

We conducted a two-stage sequential-mixed-method study. As part of an online survey, 1235 physicians from more than 90 hospitals throughout Germany participated.

RESULTS

Many clinicians name structural deficits as causes for the low donation rate in Germany. Less than half of the physicians who are exposed to organ donors regularly consider themselves to be adequately educated about organ donation. Physicians' educational discussions with patients have a significant influence on patients' decision-making but are rarely provided by doctors. In the decision-making situation, relatives are often overwhelmed because they have dealt with the topics of death and organ donation too little during their lifetime. General practitioners play a key role in educating and informing the population. Only a few respondents expect a positive impact on the organ donation rate by the introduction of an online donation registry.

CONCLUSION

With the latest legislation, the most relevant structural deficits named by physicians have been addressed. An additional increase in organ donation rate could be achieved through professionalized care for relatives. A more frequent public discussion about death and organ donation could facilitate decision-making by relatives in individual cases.

摘要

背景

2019年和2020年德国出台的新器官捐赠法旨在提高器官捐赠率。这些法律包括优化组织结构、引入在线登记系统以记录患者意愿以及改善公众信息的措施。迄今为止,对于临床医生对这些新法律的看法知之甚少。

方法

我们开展了一项两阶段的序贯混合方法研究。作为在线调查的一部分,来自德国90多家医院的1235名医生参与其中。

结果

许多临床医生指出,结构缺陷是德国捐赠率低的原因。经常接触器官捐赠者的医生中,不到一半的人认为自己接受了关于器官捐赠的充分教育。医生与患者的教育性讨论对患者的决策有重大影响,但医生很少进行此类讨论。在决策过程中,亲属往往不知所措,因为他们一生中很少接触死亡和器官捐赠的话题。全科医生在对公众进行教育和提供信息方面发挥着关键作用。只有少数受访者预计引入在线捐赠登记系统会对器官捐赠率产生积极影响。

结论

通过最新立法,医生指出的最相关的结构缺陷已得到解决。通过为亲属提供专业化护理,可以进一步提高器官捐赠率。更频繁地就死亡和器官捐赠进行公开讨论可以促进亲属在个别情况下做出决策。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6fca/8654720/a1313f29df89/120_2021_1645_Fig1_HTML.jpg

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