• 系統編號 RN9408-0633
• 計畫中文名稱 由醫療團隊觀點談器官移植照護的倫理困境
• 計畫英文名稱 Contemporary Ethical Dilemma Related to Organ Transplantation from the Perspectives of Health Professionals
• 主管機關 行政院國家科學委員會 • 計畫編號 NSC92-2314-B038-047
• 執行機構 臺北醫學大學護理學系
• 本期期間 9208 ~ 9307
• 報告頁數 11 頁 • 使用語言 中文；英文
• 研究人員 施富金; 朱樹勳; 賴明坤 Shih, Fu-Jin; Chu, Shu-Hsun; Lai, Ming-Kuen
• 中文關鍵字 台灣器官移植議題; 醫療團隊觀點; 挑戰
• 英文關鍵字 Taiwan organ transplant issue; Health professional's perspective; Challenge
• 中文摘要
目的: 本研究計劃目的為： (1) 探討目前及未來五年，台灣從事器官移植相關 醫療人員所面臨的挑戰； (2) 針對這些挑戰提出建議方案。 方法:
針對台灣本地從事器官移植相關醫療人員如醫師、器官移植協調護理 師、護理人員及社工。以半結構問卷訪談收集資料，並以質性內容分析法分 析質性資料。 結果共有 30 名從事器官移植醫療人員參與本研究，包括外科醫師（n = 10）、器官移植協調護士（n = 6）、護理人員（n = 10）及 社工（n = 4）。目前及未來五年內，台灣器官移植醫療人員所面臨的挑戰包括： (1) 器官來源勸捐仍有困難，特別在社會接受程度、移植者期望 恢復的社會角色、法律保障等方面； (2) 器官捐贈者家庭成員所面臨的衝擊，這些包括具血緣關係與姻親關係之家屬； (3) 如何兼顧醫療的專業 性、病人自我期望、及社會支持（合理的經濟負擔、平衡的社會期望角色），提供長期有效的照護方案幫助常住國外的移植者； (4) 透過幫助潛 在器贈者及其家人尋找生命的意義；(5) 醫療人員、器移植贈者、移植者如何面對日益複雜的法律問題； (6) 移植者的經濟負擔如何維持長期照 護的生活品質； (7) 醫療人員處理關於基因醫學方面的能力，包括轉化概念至臨床實證應用的能力，及如何在道德原則的歧見上取得共識的能力。
關於上述所面臨的挑戰，其因應策略可分為下列參個方向： 一、增強醫療照護人員處理器官移植相關複雜問題的能力，包括 (1) 與器官移植、基 因醫學相關領域的知識與技能； (2) 醫療社會學方面，包括影響健康、生命、死亡、人際關係、家庭結構與權力的台灣文化背景價值觀與信念系 統； (3) 社會支持包括人際間、社區間、國家健康政策與經濟支持； (4) 醫學倫理學；及 (5) 醫學法律諮詢。 二、促進跨領域及學門的有效合 作，包括器官醫療團隊、非器官移植之醫療團隊、社會學家、經濟專家、社會福祉促進者、媒體以及社會大眾；團隊成員應包括來自社會團體、
政府機構、志工團體、器官捐贈者的家屬 以及移植者的家屬等。 三、繼續倡導器官捐贈的優點，並追蹤器官捐贈同意卡的效益性。 結論: 台灣 擁有 2 千 3 百萬人，人民勤奮工作，珍惜生命，追求自我實現、更好的生活品質，並致力成為 21 世紀國際公民。紮根於此文化下，台灣器捐 醫療人員為提昇器官移植照護品質所面對的挑戰，將比過去更具廣度與深 度。這些挑戰跨當代不同領域的醫療團隊專業與基因學。此外，目前及
未來五年，台灣器官移植醫療人員須結合政府及民間的倫理、人類社會科學資源專家，整合其知識體系。上述建議策略之相關訓練課程亦應儘快 進行。
• 英文摘要
Purpose. The purposes of this study were (a) to explore the most challenging organ transplant (OT) health issues in contemporary Taiwan and the near five years perceived by OT health professionals including surgeons, coordinating nurses, nurses, and social workers who took care of the transplant recipients;
and (b) to explore the suggested protocols for these challenges. Method. OT health professionals including transplant surgeons, coordinating nurses, nurses, and social workers that took care of the transplant recipients in Taiwan were invited to completed semi-structured interviews. Qualitative data were analyzed by content analysis. Results. Thirty OT health professionals including surgeons (n = 10), coordinating nurses (n = 6), nurses (n = 10), and social workers (n = 4) participated in this project. The most challenging OT health issues today and in the near five years in Taiwan were identified as (a) difficulties in recruiting organs from the aspects of societal acceptance, resuming expectant social roles, legal protection, in particular; (b) conflicts on decision on organ donation for other families and relatives among native and marriage families; (c) effective long-term care programs for the recipients who are frequent travelers from the aspects of medical professionalism, self-expectations, and social support such as affordable financial burden, and balanced social roles expectations; (d) helping potential donors, recipients, and their families searching for meaning of life through OT; (e) more complex legal issues for both health professionals and their clients including donors and recipients; (f) more demanding financial needs for long-term care with quality of life for the recipients; and (g) health professionals？？ competency in managing genetic medicine issues including applying concept to empirical practice and lacking of consensus on ethical jeopardize. The directions and strategies for these challenges were suggested focusing on directions. Firstly, empowering health professionals？？
competency in managing more complex and sophisticated OT health issues from the aspects of (a) professional knowledge and skills in each medical
societies related to OT medicine and genomic science; (b) medical sociology including Taiwanese cultural background value and belief systems related to the concepts of health, life and death, interpersonal relationship, family structure and power; (c) social support including interpersonal, community, national well-being policy, and financial support; (d) ethnic medicine; and (e) medical legal consultations. Secondly, fostering interdisciplinary collaborative effectiveness between OT health team members, non-OT health professionals, sociologist, financial experts, social well-being experts, media, and public.
The team members should include professional experts from various societies, governmental officials, volunteer groups, donor？？s families, recipients and their families and so on. Finally, continuously promoting advocating merits of OT and following-up the effectiveness of identification card with OT
willingness. Conclusions. With about 23 milion population, most Taiwanese are hard workers and treasure their lives in pursuing self-actualization, better quality of life and learning to play the role of global citizen in the 21st century. Rooted in this culture, the challenges of providing quality of OT care faced by Taiwanese OT health professionals are much more complex with broader scope and more in-depth domains and facets than ever. These challenges are identified to cover contemporary professionalism from various medical societies and genomic science. In addition, ethnics, human social science and integrative collaborative systems linking medical, human resources experts from governmental and ...
