活體肝臟移植捐贈者及受贈者面對移植事件之經驗

Abstract

由於醫療進步，肝臟移植對末期肝病病人而言，成為治療的一個新選擇，但因屍體器官短缺，使活體肝臟移植比率大增，本研究目的在瞭解經過活體肝臟移植手術後捐贈者及受贈者之手術歷程、適應經驗及互動關係。 本研究以現象學為觀點，採立意取樣，在北部某一所醫學中心收案，收案時間為2011年8月到2012年5月，本研究訪談捐贈者12位及受贈者11位，共23位，其中有十一組(N=22)捐贈者及受贈者為配對的。本研究以一對一深入訪談方式進行會談，經過分析與歸納，將結果分為三部份：「捐贈者的手術歷程及適應經驗」、「受贈者的手術歷程及適應經驗」、「捐贈者及受贈者手術前、後互動比較」。捐贈者訪談時間範圍為23分~80分鐘，平均為53分鐘。手術歷程歸納為三主題：第一主題「不確定」:其內容為(1)情況不妙、(2)矛盾；第二主題「忍受痛苦」:其內容為(1)快點結束、(2)忍受生理痛苦；第三主題「確認復原」:其內容為(1)我是否已恢復? (2)重新檢視、(3)對生命更有體悟、(4)回歸正常。受贈者訪談時間為25~85分鐘，平均為56分鐘。手術歷程歸納為四個主題，第一主題「死亡威脅」:(1)術前黑暗的日子、(2)得知需要移植的衝擊。第二主題「矛盾」:(1)求生意識強烈、(2)選擇人選；(3)內心掙扎；第三主題「希望復原」:(1)身體虛弱、(2)感受復原；第四主題「重新出發」(1)回顧過去、(2)檢視現在、(3)展望未來。本研究將捐贈者及受贈者的適應經驗分為「內在認知」及「外在行為」兩大主題。第一主題「內在認知」含(1)正向思考、(2)及折衷想法。第二主題「外在行為」分為(1)面對處理、(2)設限防護。本研究分析十一組捐、受贈者互動關係，比較術前及術後的關係變化，發現兩個部份變化，分別為「互動型態轉變」及「互動次數增加」。本研究結果可幫助捐、受贈者表達自己的經驗，讓臨床的醫護人員瞭解其內心真正感受，促進彼此互動關係，以提升照護品質。

Owing to the progress of medicine, liver transplantation has become the treatments of choice for end stage liver disease. However, live donor liver transplantation (LDLT) outnumbered cadaveric transplantation greatly at Taiwan due to the shortage of cadaveric donor. This study aimed to investigate the experience of donors and recipients throughout LDLT, the interactions between donors and recipients, and their adaptations for such experience. In this retrospective study, a total of 23 interviewees, 12 donors and 11 recipients, were enrolled from a medical center at northern Taiwan between August 2011 to May 2012. The one-by-one in-depth interview was performed with purposive sampling and phenomenological point of view. The interviews can be divided into three parts: donor adaptation to the transplant experience, recipient adaptation to transplant experience, and the interactions between donor and recipient. The time for donor interview ranged between 23 to 80 minutes (mean 53 min). The donor experience can be grouped into themes of uncertainty, suffering, and confirming of recovery. In the theme of “uncertainty”, they were informed of the bad condition of their family and the possible contraindications for liver donation. In the theme of “suffering”, they experienced physical pain of surgery and hoped everything passed quickly. In the third theme of “recovery”, they experienced periods of doubt of recovery, re-examine, more experience of life, and return to normal life. The adaptation to these experiences can be divided into themes of cognitive and overt act. The cognitive act included positive perception and compromised idea, and the overt act included facing the recovery process and restrictions after liver donation operation. The time for recipient interview ranged from 25 to 85 minutes (mean 56 min), and can be divided into four different themes. In the first theme of “facing the threat of death”, they experienced the dark days of liver failure, and the shock when they were informed the need for liver transplant. In the second theme of “contraindication”, they experienced the questions of wish to live, where comes the donor, and the struggles between live donor and cadaveric donor liver transplantation. In the third theme of “recovery”, they experienced weakness after operation and feeling of recovery after transplant. In the forth theme of “restart”, they review the past days, check the present days, and look to the future days. As to the cognitive adaptation to these experiences, they had positive perception and compromised their idea. In the overt act, they faced the process of transplantation and accepted the restriction of life after the transplant. This study also compared the interactive relationship between donor and recipient preoperatively and postoperatively, and demonstrated major differences of the change of interactive pattern and the increase of interaction frequency. The results of this study can help patients to express their experiences, the clinical health providers to understand the real feelings of patients, and to promote mutual interactions between them to enhance the quality of care.