Research on Psychosocial and Ethical Aspects of Living Donor Liver Transplantation

器官短缺和移植技术的进步引起了国际社会对活体供肝移植(LDLT)的重视，尤其是成人对成人右叶肝切除术。本研究以半结构式访谈方式，以22名捐献者(男15人，女7人，平均年龄37.9±10.1岁)为研究对象，构建了成人供者捐献心理过程的决策模型。问题包括参与者第一次得知需要移植时的感受，与家人(S)就谁应该捐献器官的对话情况，等等。访谈于术后(平均12.6±5.2天)进行，持续时间20~77分钟，平均48分钟。所有访谈都被录音，逐字转录，并根据扎根理论进行分析。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赠者“做出决定”的经历；后两个阶段描述了“面对移植”的经历。这个模型的中心主题是“别无选择”，它由四个代码组成：(1)生命优先，(2)只有LDLT，(3)家庭，(4)只有我。虽然别无选择的现实作为一种心理负担存在，但它同时激励着每个参与者在整个过程中进行捐赠。这项研究的框架是医疗保健专业人员了解捐赠者的经验并在此基础上为捐赠者提供足够支持的重要工具。

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.