Kirchner Katja, Lauerer Michael, Nagel Eckhard
Institut für Medizinmanagement und Gesundheitswissenschaften, Universität Bayreuth, Bayreuth, Deutschalnd.
Institut für Medizinmanagement und Gesundheitswissenschaften, Universität Bayreuth, Bayreuth, Deutschalnd.
Z Evid Fortbild Qual Gesundhwes. 2023 Sep;181:10-18. doi: 10.1016/j.zefq.2023.04.006. Epub 2023 Jun 16.
Partly because of a lack of governmental commitment in educational work, tissue donation is largely unknown in the German population, although it has an increasing relevance for patient care. Due to the progress in research, the shortage of donor tissues in Germany is constantly increasing and has to be compensated by imports. In contrast, nations such as the USA are self-sufficient in donor tissue and can even export it. Since not only individual but also institutional factors (e.g., legal framework, allocation principles and the organization of tissue donation) can lead to these national differences in donor rates, the present systematic literature review will investigate how these factors influence the willingness to donate tissue.
Relevant publications were systematically searched in seven databases. The search command consisted of English and German terms for the two search components "tissue donation" and "health care system". Papers published in English or German between 2004 and May 2021 and focusing on the analysis of institutional factors influencing the willingness to donate tissue post-mortem for transplantation were included (inclusion criteria); studies on blood and organ and living donation as well as publications not dealing with institutional factors influencing the willingness to donate tissue were excluded (exclusion criteria). In reporting, we followed the PRISMA 2020 statement.
Of 1,398 hits, seven were finally included after screening. Many of the remaining studies focused on organ donation or non-institutional aspects of tissue donation. Only two studies considered the central population perspective. Furthermore, five publications originate from an Australian research group and focus on the international allocation of tissues. The results highlight the inadequate state of research and at the same time suggest that both tissue bank organization and allocation principles may influence the willingness to donate tissue. At the same time, the publications indicate that tissue donors are often not informed about a potential commercial use or an international allocation of tissues, which represents an ethical-legal conflict.
The results indicate that institutional factors may influence people's willingness to donate. In particular, the lack of societal awareness of the issue results in various areas of tension for which recommendations for action have been developed. In order to prevent a slump in tissue donations because of socially unacceptable practices, further population-based studies should explore the institutional framework conditions that society demands for tissue donation.
部分由于政府在教育工作中缺乏投入，尽管组织捐赠对患者护理的重要性日益增加，但在德国民众中，组织捐赠在很大程度上并不为人所知。由于研究的进展，德国供体组织的短缺问题不断加剧，必须通过进口来弥补。相比之下，美国等国家在供体组织方面能够自给自足，甚至还能出口。由于不仅个人因素，而且制度因素（如法律框架、分配原则和组织捐赠的方式）都可能导致这些国家在捐赠率上存在差异，因此本系统文献综述将研究这些因素如何影响组织捐赠的意愿。
在七个数据库中系统地搜索相关出版物。搜索指令由“组织捐赠”和“医疗保健系统”这两个搜索组件的英文和德文术语组成。纳入2004年至2021年5月期间以英文或德文发表的、专注于分析影响死后组织捐赠用于移植意愿的制度因素的论文（纳入标准）；排除关于血液、器官和活体捐赠的研究以及未涉及影响组织捐赠意愿的制度因素的出版物（排除标准）。在报告过程中，我们遵循了PRISMA 2020声明。
在1398条命中记录中，经过筛选最终纳入了7条。其余许多研究集中在器官捐赠或组织捐赠的非制度方面。只有两项研究考虑了核心人群的观点。此外，有五篇出版物来自澳大利亚的一个研究小组，专注于组织的国际分配。研究结果凸显了研究的不足，同时表明组织库的组织方式和分配原则都可能影响组织捐赠的意愿。与此同时，这些出版物表明，组织捐赠者往往未被告知组织可能的商业用途或国际分配情况，这构成了伦理 - 法律冲突。
研究结果表明制度因素可能会影响人们的捐赠意愿。特别是，社会对该问题缺乏认识导致了各个方面的紧张关系，为此已制定了行动建议。为了防止因社会不可接受的做法导致组织捐赠量下滑，应开展更多基于人群的研究，探索社会对组织捐赠所要求的制度框架条件。
