活體捐贈肝臟候選人之術前考量與矛盾

Abstract

目的：本研究旨在暸解活體捐贈肝臟候選人之術前考量及矛盾。 方法：採立意取樣，從台灣北部某一醫學中心，於2009年4月至10月的活體捐贈肝臟候選人，共102人作為研究樣本。扣除草率填答者2位後，有效問卷共100份，其中男性52人，女性48人。本研究使用之測量工具為既有及自製之結構式問卷，內容除個人基本資料外，另包含了焦慮與憂鬱量表、社會支持量表、手術前之考量量表、手術前之矛盾量表等。所有資料均由研究者面談個案取得，經過整理和建檔之後，利用SPSS13.0統計軟體進行分析。 結果：活體捐贈肝臟候選人在接受手術之前有許多考量，針對「身體層面」，有器官切除、傷口與恢復、身體活動與手術成功等考量；針對「經濟層面」，有費用與工作的考量；針對「心理與社會層面」，有感受與照護問題的考量。複迴歸統計分析發現，活體捐贈肝臟候選人之自覺與受贈者的親密程度越低、焦慮程度越高、家人親友支持程度越低及心理與社會考量程度愈高者，其術前矛盾程度越高。 建議：1.利用本研究所發展的術前考量量表，依照考量內容與程度製作成衛教手冊，讓候選人暸解捐贈手術的相關資訊後，再做出捐贈器官的決定；2.在活體捐贈肝臟候選人接受手術之前，醫護人員可利用量表評估其焦慮程度、家人親友支持程度及其在心理與社會層面的考量，以掌握其是否有矛盾的情形發生；3.醫護人員針對術前矛盾程度高的個案，應適時提供諮詢和支持；4.醫療服務機構在訓練醫護人員時，可加強對於手術個案的術前評估技術及溝通輔導技巧。

Objective:To investigate the living donor candidates`s concerns and ambivalence before sugery( when the liver transplantation is planed for the relatives). Method: This research was performed to obtain the purposive sampling, which would be the living donor candidates at one medical center in Taipei, Taiwan from April to October in 2009. The questionnaire was completed in 100 candidates for liver transplantation, including 52 males and 48 females, and the rate of completion was 98% (100 out of 102). Three questionnaires, including the anxiety and depression scale, the social support scale, and the concern scale, were used to analyze the interrelationship with the ambivalence scale for liver procurement procedure. The data of the questionaires were analyzed using the SPSS 13.0 software to evaluate the interrelationships. Results: The living donor candidates for liver transplantation have different degrees of physical, economical and psychological and social concerns before transplantation. Physical dimension of concern included four factors: organ resection, surgery wound and recovery from sugery, influence of physical activities, the mortality and complication rate of donors and recipients. Economical dimension of concern included the fee of surgery and insurance and the influence of income and job. Psychological and social dimension of concern were the feeling of mind and the postoperation care. The level of the ambivalence as a candidate for living liver donor was associated with lower intimacy level with recipient, higher anxiety status, lower family and friend support, and higher psychological and social concerns in summary. Recommendation: (1) This preoperative concern scale for living liver transplantation will help the medical health carers to offer the detailed information to the living donor candidates, (2) Medical staff can use the scale to evaluate the ambivalence when occurred by assessing the anxiety status, the support from family and friend and psychological and social dimensions of concern, (3). Health carers should offer delicate advice and support to avoid the conflict before transplantation when occurred.