The choice of communication specialist for family member of organ donation and corresponding strategy for work difficulty
-
摘要: 家属沟通是器官捐献与移植流程中不可缺少的一环,该环节的核心是通过人与人之间的沟通建立信任关系。谈话者的一言一行将直接影响潜在捐献者家属对器官捐献产生的总体印象。无论最终是否同意捐献,家属可能会将其亲身经历和感受与身边的亲友分享,进行二次传播。因此,在临床实践中,“器官捐献家属沟通的最佳人选”一直是器官捐献工作者致力探讨的问题。纵观不同国家或地区的经验,由于社会体制、文化背景、组织架构、临床实践等方面的差异,各国就该问题有不同的建议和做法,本文将围绕该议题展开讨论,总结当前家属沟通工作的难点并提出应对策略。Abstract: Communication with the family members of donors is an integral part of the organ donation and transplantation, and the core of it lies in building trust through interpersonal communication. Every word and deed from the communicator will directly affect the overall impression of family members of potential donors towards organ donation. Regardless of whether or not granted the donation ultimately, family members may share their personal experiences and feelings with friends and relatives around them, which develops a secondary dissemination. Therefore, "the choice of best candidate for communication with family members of organ donation" has been an issue that organ donation practitioners have been working on in clinical practice. Taking into consideration of the experiences from different countries or regions, various advices and practices on this issue have been proposed due to differences in social systems, cultural background, organizational structure, clinical practice, etc. In this paper, we had a discussion on this topic, summarize the difficulties currently encountered in communication with family members and propose corresponding strategies.
-
图 1 2017年部分欧盟国家器官捐献家属拒绝率[5]
Figure 1. Family members' rejection rate of organ donation in some European Union countries in 2017
-
[1] 黄伟, 司晶, 徐哲, 等.移植医院协调员队伍建设及工作流程探讨[J].武汉大学学报(医学版), 2016, 37(4):670-673. DOI: 10.14188/j.1671-8852.2016.04.036.HUANG W, SI J, XU Z, et al. Coordinators: the communication link of organ donation work[J]. Med J Wuhan Univ, 2016, 37(4):670-673. DOI: 10.14188/j.1671-8852.2016.04.036. [2] 彭博, 蒋继贫.技术与文化:器官捐献中的文化困境及其历史渊源[J].医学与哲学, 2019, 40(10):19-24. DOI:10. 12014/j.issn.1002-0772.2019.10.05.PENG B, JIANG JP. Technology and culture: the cultural dilemma in organ donation and its historical origin[J]. Med Philos, 2019, 40(10): 19-24. DOI:10.12014/j.issn. 1002-0772.2019.10.05. [3] 赖彦华, 杨建荣.我国器官捐献现状及展望[J].中国临床新医学, 2019, 12(10):1045-1048. DOI: 10.3969/j.issn.1674-3806.2019.10.01.LAI YH, YANG JR. Current situation and prospect of organ donation in China[J]. Chin J New Clin Med, 2019, 12(10):1045-1048.DOI:10.3969/j.issn.1674-3806. 2019.10.01. [4] 高汉, 王彧, 姜莉, 等.论器官捐献中家属意愿的影响因素与对策[J].医学与哲学, 2016, 37(9A):45-48. DOI: 10.12014/j.issn.1002-0772.2016.09a.13.GAO H, WANG Y, JIANG L, et al. Influencing factors of family members' willingness for organ donation and the corresponding solutions[J]. Med Philos, 2016, 37(9A):45-48. DOI: 10.12014/j.issn.1002-0772.2016.09a.13. [5] GODT. Global Observatory on Donation and Transplantation 2017[EB/OL].[2019-12-28]. http://www.transplant-observatory.org/. [6] SHEPHERD L, O'CARROLL RE, FERGUSON E. An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: a panel study[J]. BMC Med, 2014, 12:131. DOI: 10.1186/s12916-014-0131-4. [7] BELOUCIF S. Opt-in or opt-out for organ transplantation[J]. Curr Opin Anaesthesiol, 2012, 25(2):199-203. DOI: 10.1097/ACO.0b013e3283504c33. [8] JIANG WS, MARIA PG, GLORIA P, et al. The beauty of the data-focusing on the trend of global organ donation[J/CD]. Chin J Transplant (Electr Vers), 2019, 13(01):28-33. DOI: 10.3877/cma.j.issn.1674-3903.2019.01.007. [9] 潘爱军, 王庞, 谢朝阳, 等.为生命接力, ICU助力器官捐献的关键策略[J].器官移植, 2020, 11(2): 288-292. DOI: 10.3969/j.issn.1674-7445.2020.02.017.PAN AJ, WANG P, XIE ZY, et al. Key strategies of ICU in promoting organ donation: a relay for life[J]. Organ Transpalnt, 2020, 11(2): 288-292. DOI: 10.3969/j.issn.1674-7445.2020.02.017. [10] DOMÍNGUEZ-GIL B, DELMONICO FL, SHAHEEN FA, et al. The critical pathway for deceased donation: reportable uniformity in the approach to deceased donation[J]. Transpl Int, 2011, 24(4):373-378. DOI: 10.1111/j.1432-2277.2011.01243.x. [11] SIMPKIN AL, ROBERTSON LC, BARBER VS, et al. Modifiable factors influencing relatives' decision to offer organ donation: systematic review[J]. BMJ, 2009, 338:b991. DOI: 10.1136/bmj.b991. [12] CHANDLER JA, CONNORS M, HOLLAND G, et al. "Effective" requesting: a scoping review of the literature on asking families to consent to organ and tissue donation[J]. Transplantation, 2017, 101(5S Suppl 1):S1-S16. DOI: 10.1097/TP.0000000000001695. [13] KENTISH-BARNES N, DURANTEAU J, MONTLAHUC C, et al. Clinicians' perception and experience of organ donation from brain-dead patients[J]. Crit Care Med, 2017, 45(9):1489-1499. DOI: 10.1097/CCM.0000000000002581. [14] SIMINOFF LA, GORDON N, HEWLETT J, et al. Factors influencing families' consent for donation of solid organs for transplantation[J]. JAMA, 2001, 286(1):71-77. DOI: 10.1001/jama.286.1.71. [15] SHEMIE SD, ROBERTSON A, BEITEL J, et al. End-of-life conversations with families of potential donors: leading practices in offering the opportunity for organ donation[J]. Transplantation, 2017, 101(5S Suppl 1):S17-S26. DOI: 10.1097/TP.0000000000001696. [16] 李育玮.影响器官捐献协调员的工作技能及对策分析[C]// 2012中国器官移植大会论文汇编.北京: 中华医学会器官移植学分会, 2012: 301. [17] LENZI JA, SARLO R, ASSIS A, et al. Family informed consent to organ donation--who performs better: organ procurement organizations, in-hospital coordinators, or intensive care unit professionals?[J]. Transplant Proc, 2014, 46(6):1672-1673. DOI: 10.1016/j.transproceed.2014.05.036. [18] RAMSI MA, AL MAEENI SM, AL SEREIDI HM, et al. United Arab Emirates' future perspective: converting potential organ donors into actual organ donors in an academic setting[J]. Exp Clin Transplant, 2020, 18(2):177-181. DOI: 10.6002/ect.2019.0251. [19] BECKER F, ROBERTS KJ, NADAL M, et al. Optimizing organ donation: expert opinion from Austria, Germany, Spain and the U.K[J]. Ann Transplant, 2020, 25:e921727. DOI: 10.12659/AOT.921727. [20] SARLO R, PEREIRA G, SURICA M, et al. Impact of introducing full-time in-house coordinators on referral and organ donation rates in Rio De Janeiro Public Hospitals: a health care innovation practice[J]. Transplant Proc, 2016, 48(7):2396-2398. DOI: 10.1016/j.transproceed.2015.11.044. [21] CZERWIŃSKI J, PSZENNY A, WODERSKA A, et al. Transplant coordinators' opinions regarding the decreasing indicator of organ donation from deceased donors in Poland[J]. Transplant Proc, 2018, 50(7):1962-1966. DOI: 10.1016/j.transproceed.2018.05.002. [22] SHAFER TJ, DAVIS KD, HOLTZMAN SM, et al. Location of in-house organ procurement organization staff in level Ⅰ trauma centers increases conversion of potential donors to actual donors[J]. Transplantation, 2003, 75(8):1330-1335. DOI: 10.1097/01.TP.0000060532.70301.32. [23] SALIM A, BROWN C, INABA K, et al. Improving consent rates for organ donation: the effect of an inhouse coordinator program[J]. J Trauma, 2007, 62(6):1411-1415. DOI: 10.1097/TA.0b013e3180479876.