器官捐贈者家屬於器官摘除術後之健康需求:長期性追蹤(II)

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行政院國家科學委員會專題研究計畫成果報告

計畫名稱：器官捐贈者家屬於器官摘除術後之健康需求：長期性追縱（II）

計畫編號：NSC - 88 - 2314 - B - 002 - 339

執行期限：87 年 08 月 01 日至 88 年 07 月 31 日

主持人：施富金 副教授 台大醫學院護理學系

一、中文摘要 器官捐贈對器捐者家屬成員而言，是一個複雜的決定。學者對於此決定對器官者家屬的 影響甚少發表研究。本研究目的含 (1) 探討器捐家屬對器官捐贈決定之評價；(2) 探討 器官捐贈對器捐家屬生活之正、負面影響；與 (3) 分析器捐家屬在移植術後一年內對醫 護人員的期望。20 位器捐家屬（10 男，10 女）參與本研究，捐贈者年齡介於 19 - 42 歲 (mean 27.65±7.11) 歲，參與本研究者年齡介於 25 - 56 (mean 47.20±8.53) 歲，主要為 捐贈者之父母親、姊姊，及配偶。所有個案皆認為器捐為一正確決定，90%的個案表示 此決定對其有下列負面影響：擔心捐贈者死後的狀況 (85%)；面對家庭成員中反對器官 捐贈者之壓力 (75%)；及其他人輕視器官捐贈之壓力 (40%)。40%的個案表示有下列正 面影響：對於幫助他人覺得榮幸 (20%)；與家人的關係更親近 (10%)；對生命更加珍惜 (10%)；及改變目標而立志學醫 (10%)。個案期望移植團隊幫助他們處理相關法律事宜 (75%)；提供相關文件以獲得保險給付 (70%)；避免過於宣揚他們作器捐的決定 (70%)； 及提供關於受贈者的相關資訊 (60%)。在這段持別時期，作器官捐贈的決定對於中國人 器捐家屬而言，有多層面的影響。健康照護者應主動接觸其家庭成員，並對於那些情緒 失常者提供心理或精神上的幫助。關於器捐家屬對移植團隊的期望，及他們的需求是否 應轉介給更合適的個人需要更進一步的研究。 關鍵詞：器官捐贈家屬、健康需求、移植術後 二、Abstract

Purpose. Organ donation is a complex decision for donor's family members. The impact of

cadaveric organ donation on donor families has not been well investigated. The purpose of this study were: 1) to follow Chinese family members' appraisal of their decision to donate organs; 2) to explore the possible negative and positive impact of organ donation on their family life; and 3) to analyze the expectant help from the health care providers during the first year after donation.

Methods. Twenty (10 men and 10 women) family members of cadaveric organ donors who

signed consent forms at National Taiwan University Hospital agreed to participated in this project and completed semi-structured interviews in the sixth month after donation.

Results. The donors were between 19 and 42 years old (mean 27.65±7.11 years). The participants ranged in age from 25 to 56 (mean 42.20 ± 8.53) years old. The type of kinship of the participants included the donor's parents, elder sister, and spouse. All subjects

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reported that their decision to donate organs was correct. Ninety percent of the subjects reported the following negative impacts: worry about the donor's after-life (85%); stress from controversy over the decision to donate among the family members (75%); and stress from others' devaluation of the donation (40%). Forty percent of the subjects reported some positive impacts, such as having a sense of reward for helping others (20%); having closer family relationships (10%); having an increased sense of appreciation for life (10%); and planning to shift life goals to the study of medicine (10%). The subjects expected the transplant team to help them by resolving legal proceedings and settlements associated with accidents (75%); submitting the necessary documents to receive health care payments from the insurance company (70%); avoiding over-publicizing their decision to donate (70%); and providing information related to organ recipients (60%).

Conclusion. The decision to donate has multidimensional impacts on Chinese organ donors'

families during this particular stage. Health care providers need to take the initiative in detecting maladapted family members, and providing psychologic or psychiatric intervention for those who have abnormal emotional disorders. The legitimacy of their expectations for transplant team members and whether their requests should be referred to more approapriate individuals requires further investigation.

Keywords: organ donors' families, health need, after-donation transition

三、緣由與目的 器官捐贈對器捐者家屬成員而言，是一個複雜的決定。學者對於此決定對器官者家 屬的影響甚少發表研究。本研究目的含 (1) 探討器捐家屬對器官捐贈決定之評價；(2) 探討器官捐贈對器捐家屬生活之正、負面影響；與 (3) 分析器捐家屬在移植術後一年內 對醫護人員的期望。 四、結果與討論 20位器捐家屬（10男，10女）參與本研究，捐贈者年齡介於19 - 42歲 (mean 27.65± 7.11) 歲，參與本研究者年齡介於25 - 56 (mean 47.20±8.53) 歲，主要為捐贈者之父母 親、姊姊，及配偶。所有個案皆認為器捐為一正確決定，90%的個案表示此決定對其有 下列負面影響：擔心捐贈者死後的狀況 (85%)；面對家庭成員中反對器官捐贈者之壓力 (75%)；及其他人輕視器官捐贈之壓力 (40%)。40%的個案表示有下列正面影響：對於 幫助他人覺得榮幸 (20%)；與家人的關係更親近 (10%)；對生命更加珍惜 (10%)；及改 變目標而立志學醫 (10%)。個案期望移植團隊幫助他們處理相關法律事宜 (75%)；提供 相關文件以獲得保險給付 (70%)；避免過於宣揚他們作器捐的決定 (70%)；及提供關於 受贈者的相關資訊 (60%)。在這段持別時期，作器官捐贈的決定對於中國人器捐家屬而 言，有多層面的影響。健康照護者應主動接觸其家庭成員，並對於那些情緒失常者提供 心理或精神上的幫助。關於器捐家屬對移植團隊的期望，及他們的需求是否應轉介給更 合適的個人需要更進一步的研究。 五、計畫成果自評

3 本研究初步的研究成果已如期順利完成，並受邀順利發表於 1998 年第 34 屆日本移 植醫學會年會。此論文發表後，立即引起日本移植醫學界、社會大眾及新聞媒體之矚目， 並熱烈討論。此外，研究者亦已將此研究成果列入國內器官移植護理師及社工人員訓練 之必要教材之一，且正式的研究成果現正投稿中。最後，台大醫院移植小組亦參考本研 究結果，敦請一位精神專科醫師作為器官移植協調護理師日常照顧此類個案之諮詢者。 六、參考文獻

1. Shih FJ. Concepts related to Chinese patients' perceptions of health, illness, and person: Issues of conceptual clarity. Acci Emerg Nurs 1996;4:208-215.

2. Lin Lan P. Marriage and families. Taipei, TW: Eu-Shih, 1996;44-68 (in Chinese). 3. Shih FJ. Perceptions of self in the intensive care unit after cardiac surgery among adult

Taiwanese and American-Chinese patients. Intl J Nurs Stud 1997;34(1):17-26. 4. Buse S, Pieper B. Impact of cardiac transplantation on the spouse's life. Heart Lung

1990;19:641-648.

5. Mishel MH, Murdaugh C. Family adjustment to heart transplantation: Redesigning the dream. Nurs Res 1987;36:332-338.

6. Nolan MT, Cupples SA, Brown MM, et al. Perceived stress and coping strategies among families of heart transplant candidates during the organ waiting period. Heart Lung 1992;21:540-547.

7. Voepel-Lewis T, Ketefian S, Starr A, White MJ. Stress, coping, and quality of life in family members of kidney transplant recipients. ANNA J 1990;17:427-431.

8. Russel S, Jacob RG. Living-related organ donation: The donor's delemma. Patient Educ Counsel 1993;21:89-99.

9. Rodgers RH. Toward a theory of family development. J Marriage Fam 1964;26:264. 10. McCubbin HI, Cauble AE, Patterson JM. Family stress, coping, and social support.

Springfield, Ill: Thomas, 1982.

11. Nolan MT, Augustine SM. Transplantation nursing - acute and long term management. Norwalk, CT: Appleton & Lange, 1995:45-75, 361-375.

12. Department of Health. Public health in Taiwan ROC. Taipei, TW: The Executive Yuen, Republic of China, 1997:24.

13. Bureau of National Affair. The percentage of Taiwanese women's marriage, education and occupation in 1988. Taipei, TW: The Executive Yuen, Republic of China, 1989 (in Chinese).

14. Reitz NN, Callender CO. Organ donation in the African-American population: A fresh perspective with a simple solution. J Natl Med Assoc 1993;85(5):353-358.

15. Li Yuan GC, Chi Uen HC. Taiwan. Taipei, TW: Advanced, 1997 (in Chinese). 16. Creecy RF, Wright R, Berg WE. Discriminators of willingness to consider cadaveric

kidney donation among black Americans. Soci Work in Health Care 1992;18(1):73-105.

17. White MJ, Ketefian S, Starr AJ, Voepel-Lewis T. Stress, coping, and quality of life in adult kidney transplant recipients. ANNA J 1990;17:421-425.