Research on Psychosocial and Ethical Aspects of Living Donor Liver Transplantation

活体肝移植的心理社会和伦理方面的研究

• 批准号: 15590456
• 负责人: AKABAYASHI Akira
• 金额: $ 2.24万
• 依托单位: The University of Tokyo
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2003
• 资助国家: 日本
• 起止时间: 2003 至 2005
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-15590456/
• 关键词: organ transplantation; living donor liver transplantation; psychosocial aspects; qualitative study; professional ethics; biomedical ethics; informed consent

Shortage of organs and advance of transplantation techniques have drawn international attention to living donor liver transplantation (LDLT), especially adult-to-adult right lobe hepatectomy. This study aims to construct a decision-making model of the psychological process leading up to donation in adult LDLT for a donor.Twenty-two donors (15 males and 7 females, an average age of 37.9±10.1 (SD)) were interviewed using a semi-structured format. Questions included how participants felt when they first learned of the need for transplantation, circumstances of conversation (s) with family about who should be the donor, and so forth. Interviews were conducted after the operation (mean 12.6±5.2 days), lasted 48 minutes on average and ranged in duration from 20 to 77 minutes. All interviews were tape-recorded, transcribed verbatim, and analyzed based on grounded theory.A decision-making model was developed consisting of five-stages : (1) recognition, (2) digestion, (3) decision-making, (4) reinforcement, and (5) resolution. The second and the third stages described donors' experiences of "reaching a decision;" the latter two described that of "facing transplantation." The central theme of this model was "having no choice," which consisted of four codes : (1) priority of life, (2) only LDLT, (3) for family, and (4) only me. Although the reality of having no choice existed as a psychological burden, it concurrently motivated each participant to donate throughout the process.The model of "having no choice" describes the psychological process of donors' decision-making in LDLT. This study's framework serves as an essential tool for healthcare professionals to understand a donor's experience and, based on that understanding, to provide sufficient support to the donor.

器官短缺和移植技术的进步引起了国际社会对活体肝移植（LDLT）的关注，特别是成人对成人右叶肝切除术。本研究旨在构建成人 LDLT 捐献者捐献前心理过程的决策模型。采用半结构化形式对 22 名捐献者（15 名男性和 7 名女性，平均年龄 37.9±10.1 (SD)）进行了访谈。问题包括参与者第一次得知需要移植时的感受、与家人讨论谁应该成为捐赠者的对话情况等。访谈在术后进行（平均12.6±5.2天），平均持续48分钟，持续时间从20到77分钟不等。所有访谈均进行录音、逐字转录，并基于扎根理论进行分析。开发了一个决策模型，包括五个阶段：(1) 识别、(2) 消化、(3) 决策、(4) 强化和 (5) 解决。第二和第三阶段描述了捐助者“做出决定”的经历；后两者描述的是“面临移植”。这个模型的中心主题是“别无选择”，它由四个准则组成：（1）生活优先，（2）只有LDLT，（3）家庭，以及（4）只有我。尽管别无选择的现实作为一种心理负担存在，但它同时激励了每个参与者在整个过程中进行捐赠。“别无选择”模型描述了LDLT中捐赠者决策的心理过程。这项研究的框架是医疗保健专业人员了解捐赠者经历的重要工具，并在此基础上为捐赠者提供足够的支持。

项目成果

Akabayasyi, A. et al.: "Living related liver transplantation"Gut. 52(1). 152 (2003)

Akabayasyi, A. 等人：“活体相关肝移植”Gut。

Three patterns of voluntary consent in the case of adult to adult living related liver transplantation in Japan.

日本成人对成人活体肝移植自愿同意的三种模式。

• 发表时间: 2004
• 期刊: Transplantation Proceedings 36
• 作者: Fujita;M.;Slingsby;B.T.;Akabayashi;A.
• 通讯作者: A.

Three patterns of voluntary consent in the case of adult to adult living related liver transplantation in Japan

日本成人对成人活体肝移植自愿同意的三种模式

• 发表时间: 2004
• 期刊: Transplantation Proceedings 36(5)
• 作者: Fujita;M;Slingsby;BT;Akabayashi;A.
• 通讯作者: A.

Administrative legislation in Japan : guidelines on scientific and ethical standards

日本的行政立法：科学和道德标准指南

• 发表时间: 2004
• 期刊: Cambridge Quarterly of Healthcare Ethics 13(3)
• 作者: Slingsby;BT;Nagao;N;Akabayashi;A.
• 通讯作者: A.

Akabayasyi, A. et al.: "Perspectives on advance directive in Japanese society."BMC Medical Ethics. 4:5. (2003)

Akabayasyi, A. 等人：“日本社会预先医疗指示的观点”。BMC 医学伦理学。