成人活體肝臟捐贈者決策與捐贈經驗之探討

Abstract

由於屍體肝臟捐贈數量的短缺，以及肝病末期病人治療上的需求，面對活體肝贈移植手術，捐贈者在作決策的過程中常以病人的生命為優先考量。但是，過程中承擔了醫療風險且無健康利益可言，所以作決策時常須面臨個人、家庭、社會文化等各層面的考量。隨著活體肝臟移植率的增加，將會有愈來愈多的活體肝臟捐贈者，針對這群服務對象的醫療需求，值得醫療人員更進一步深入瞭解，因此本研究目的在了解成人活體肝臟捐贈者之決策與捐贈經驗。 本研究於北部一所醫學中心進行收案，於97年8月至98年8月，共收案11位捐贈者，以焦點民族誌研究法，運用半結構式深度訪談與參與式觀察等方式，收集捐贈者之主觀生活經驗，經由歸納與分析，探討捐肝決策對其影響與意義。 研究發現捐贈者在做捐肝決策前，內心歷經種種衝突；決定捐肝後，捐贈者努力尋求心靈上的平衡；雖然經歷令人矛盾的決策，與生命中重大的手術事件，但相對的，內心卻因此獲得平安與重生。也許過程中會遭遇受贈者不愛惜新生命的狀況，這個階段確實令捐贈者感到氣憤與無力感，但他們終究認為「捐肝」至少有過努力與付出，心中才不會留有遺憾。 研究結果有助於醫療人員及社會大眾，了解成人活體肝臟捐贈者之決策與捐贈經驗，其中捐肝之決策對捐贈者身心層面造成的衝擊，以及如何協助捐贈者度過此過程，以減少過程中的衝擊。

As the shortage of number of body liver donors and the treatment needs for terminally ill patients. Face of living donor liver transplants gifts, donors in the process of decision-making, often the patient's life is top priority. But, donors had undertaken during the medical risks and no health benefits at all. So to make decisions often have to face personal, family, social and cultural considerations at all levels. With the rate of living donor liver transplantation to increase, there will be more and more living liver donor, for the medical needs of these clients, it is worthy of further in-depth understanding of medical staff. The purpose of this study is to understand the experience and decision-making of adult living-donors liver transplantation. In this study, a medical center in northern Taiwan were recruited on August 97 to 98 years in August, enrolled a total of 11 donors, an focus ethnographic study method was applied. The subjective life experiences of these donors were collected using semi-structured deep interviews and participatory observations and the results were analyzed and complied in order to study the effect and meanings of decision-making of adult living-donors liver transplantation on their lives. The study found that the donor liver in the donor before making any decision to do after all kinds of inner conflicts. After the decision to donate the liver, donors efforts to find spiritual balance. Although the decision-making experience and major surgery with life events is contradictory. In contrast, the inner peace and rebirth has thus been. May be encountered during the care recipient is not the situation of new life, this stage to make the donor feel really angry and powerlessness. But they eventually that 'donated liver' at least had a hard and pay, the mind will not leave regrets. The study results will help health professionals and the public to understand the experience and decision-making of adult living-donors liver transplantation, and the decision on which tax the liver donors the impact of physical and mental level, and how to assist donors through the process to reduce the impact of the process.