潛在屍體器官捐贈者家屬拒絕捐贈決策歷程之研究

Abstract

隨著臺灣器官捐贈制度日趨成熟，社會大眾對器官捐贈的接受度逐漸提升，相關研究亦多聚焦於成功捐贈案例的經驗與悲傷關懷。然而，在臨床實務中，病人或家屬選擇拒絕捐贈的情形並不少見，卻較少有研究深入探討拒絕捐贈家屬的心理歷程與決策困境，導致對整體器官捐贈決策過程的理解仍顯不足。因此，本研究旨在探討潛在器官捐贈者家屬面對捐贈決策時的心理歷程，以及促使其最終拒絕捐贈的考量因素。 本研究採用質性研究方法，訪談五位曾拒絕捐贈之潛在器官捐贈者的家屬，以主題式分析法進行資料整理與詮釋。研究結果發現，器官捐贈的決策並非單一個體的選擇，而是家庭系統與社會脈絡互動下形成的結果。家屬的決策受到多重因素影響，包括病人意願的轉變與不確定性、家庭信念與溝通障礙、醫療資訊取得的不對等、文化與宗教信仰的影響、以及面對死亡的情感壓力與哀傷反應等。這些交織的因素不僅形塑家屬的認知與回應，也突顯醫療團隊於推動器官捐贈過程中，應更細膩地掌握溝通時機與策略，並適時提供情感支持與資訊澄清。 本研究提出以下實務建議：醫療團隊應強化溝通彈性與敏感度，掌握合適的勸募時機，建立制度化的勸募後關懷與追蹤機制。同時，建議將器官捐贈正式納入「預立醫療照護計畫」（Advance Care Planning, ACP）的討論項目，促使病人在意識清楚階段時表達意願。此外，可透過學校教育、社區活動與宗教合作等多元方式宣導器官捐贈，並設計具文化敏感度的溝通素材，鼓勵家庭提早展開捐贈議題的對話。 未來研究方面，建議可運用標準化量表評估家屬在不同決策階段的認知與情緒反應，並納入成功與未成功捐贈個案進行對照分析。亦可採用混合方法設計，深入探討各影響因素之間的交互作用；同時擴大樣本來源與參與者組成，以掌握不同文化背景與家庭結構下的決策經驗，提升研究的代表性與實用性。

As Taiwan’s organ donation system continues to mature, public acceptance of organ donation has steadily increased, and most existing research has focused on the experiences of successful donations and grief care. However, in clinical practice, it is not uncommon for patients or their families to decline organ donation. Yet, few studies have explored the psychological processes and decision-making dilemmas faced by families who refuse donation, resulting in an incomplete understanding of the overall organ donation decision-making process. Therefore, this study aims to investigate the psychological journey of families of potential organ donors when facing donation decisions, as well as the key factors that lead to their ultimate refusal to donate. This qualitative study involved in-depth interviews with five family members of potential organ donors who had declined donation. Data were analyzed using thematic analysis. The findings reveal that the decision to donate is not solely an individual choice, but the outcome of complex interactions within family systems and broader social contexts. Family decisions were influenced by multiple factors, including changes and uncertainties in the patient’s expressed wishes, familial beliefs and communication barriers, unequal access to medical information, cultural and religious beliefs, and the emotional stress and grief associated with facing death. These interwoven factors shaped how families perceived and responded to donation requests, underscoring the need for healthcare teams to carefully consider the timing and strategy of communication, while also offering timely emotional support and clear information. Based on the findings, the following practical recommendations are proposed: healthcare teams should enhance flexibility and sensitivity in communication, identify appropriate timing for donation discussions, develop context-responsive dialogue strategies, and establish systematic follow-up and bereavement support mechanisms. It is also recommended that organ donation be formally integrated into Advance Care Planning (ACP) discussions to allow patients to express their wishes while still cognitively able. Furthermore, public awareness efforts can be strengthened through school education, community outreach, and partnerships with religious organizations, along with the development of culturally sensitive communication materials that encourage early family discussions about organ donation. For future research, it is suggested to use standardized scales to assess families’ cognitive and emotional responses at different decision-making stages and to conduct comparative analyses between successful and unsuccessful donation cases. A mixed-methods approach may also be employed to further explore the interplay of influencing factors. Expanding the sample pool and participant diversity could offer insights into decision-making experiences across various cultural backgrounds and family structures, enhancing the representativeness and applicability of the research.