死亡与重生：器官移植手术中社会工作服务的拓展

社会工作作为医疗团队中的一员,不仅认识到器官移植对病人及其家属、移植医学以及社会风气的积极意义与消极限制,而且注重围绕移植手术的不同阶段为病患及其家属开展心理及社会评估、个案与家庭辅导、资源整合以及社会支持等服务。     

Death and organ procurement: public beliefs and attitudes

Although "brain death" and the dead donor rule--i.e., patients must not be killed by organ retrieval--have been clinically and legally accepted in the U.S. as prerequisites to organ removal, there is little data about public attitudes and beliefs concerning these matters. To examine the public attitudes and beliefs about the determination of death and its relationship to organ transplantation, 1351 Ohio residents >18 years were randomly selected and surveyed using random digit dialing (RDD) sample frames. The RDD telephone survey was conducted using computer-assisted telephone interviews. The survey instrument was developed from information provided by 12 focus groups and a pilot study of the questionnaire. Three scenarios based on hypothetical patients were presented: "brain dead," in a coma, or in a persistent vegetative state (PVS). Respondents provided personal assessments of whether the patient in each scenario was dead and their willingness to donate that patient's organs in these circumstances. More than 98 percent of respondents had heard of the term "brain death," but only one-third (33.7%) believed that someone who was "brain dead" was legally dead. The majority of respondents (86.2%) identified the "brain dead" patient in the first scenario as dead, 57.2 percent identified the patient in a coma as dead (Scenario 2), and 34.1 percent identified the patient in a PVS as dead (Scenario 3). Nearly one-third (33.5%) were willing to donate the organs of patients they classified as alive for at least one scenario, in seeming violation of the dead donor rule. Most respondents were not willing to violate the dead donor rule, although a substantial minority was. However, the majority of respondents were unaware, misinformed, or held beliefs there were not congruent with current definitions of "brain death." This study highlights the need for more public dialogue and education about "brain death" and organ donation.     

Truthfulness in transplantation: non-heart-beating organ donation

The current practice of organ transplantation has been criticized on several fronts. The philosophical and scientific foundations for brain death criteria have been crumbling. In addition, donation after cardiac death, or non-heartbeating-organ donation (NHBD) has been attacked on grounds that it mistreats the dying patient and uses that patient only as a means to an end for someone else's benefit.     

Multiple listing for organ transplantation: autonomy unbounded

Recently, debate about the distribution of scarce organs for transplantation has focused on whether patients should have the right to place themselves on waiting lists at several transplant centers, thereby gaining an advantage over other potential recipients. This article explores the social and ethical issues raised by multiple listing, contrasting policies adopted at the national level with those implemented in New York State. It concludes by examining the implications of the debate for broader questions about entitlement and access to health care.     

Current status of psychological research in organ transplantation

Research addressing the psychological concomitants of organ transplantation is reviewed. Specifically, cognitive, behavioral, and psychosocial correlates of kidney, heart, liver, and bone marrow transplantation in both children and adults are discussed. Despite several conceptual and methodological shortcomings of the psychologically-based research in this area, results seem to indicate that organ transplantation is associated with many psychological issues at pretransplantation, posttransplantation, and follow-up periods. Implications of these general findings for the advancing roles of the health psychologist in organ transplantation are discussed.     

Wisdom in clinical reasoning and medical practice

Exploring informal components of clinical reasoning, we argue that they need to be understood via the analysis of professional wisdom. Wise decisions are needed where action or insight is vital, but neither everyday nor expert knowledge provides solutions. Wisdom combines experiential, intellectual, ethical, emotional and practical capacities; we contend that it is also more strongly social than is usually appreciated. But many accounts of reasoning specifically rule out such features as irrational. Seeking to illuminate how wisdom operates, we therefore build on Aristotle’s work on informal reasoning. His account of rhetorical communication shows how non-formal components can play active parts in reasoning, retaining, or even enhancing its reasonableness. We extend this account, applying it to forms of healthcare-related reasoning which are characterised by the need for wise decision-making. We then go on to explore some of what clinical wise reasoning may mean, concluding with a case taken from psychotherapeutic practice.

Life,Death, and Life After Death: Meanings of the Relationship Between Death Anxiety and Religion

ABSTRACT

A sample of 389 individuals completed a death anxiety scale and a series of items that measured self-reported religious practices and beliefs. Those lowest in religious practices and beliefs were significantly higher in death anxiety. Contrary to some prior research, depth of belief had a stronger negative association with death anxiety than did religious activities. Strongest relationships had to do with concepts of life after death. The oldest respondents reported the least death anxiety.     

Death anxiety,altruism, self‐efficacy,and organ donation intention among Japanese college students: A moderated mediation analysis

The shortage of organs for transplantation in Japan has alerted health professionals to the low organ donation rate among Japanese people. The unique cultural view of death and altruism has been suggested leading to their low intent to donate cadaveric organs. A cross‐sectional survey was conducted in Japan to investigate the interplay of death anxiety, altruism, and self‐efficacy in influencing Japanese college students' intention to sign donor cards, in order to mobilise this large potential source of organ donors in the future. Six hundred and seven Japanese non‐donor card signers voluntarily completed a self‐administered questionnaire. The results of mediation and moderated mediation analyses with bootstrap approach suggest that death anxiety indirectly hinders Japanese people's intention to become a donor card signer through lowering of self‐efficacy, while altruism intensifies the positive impact of self‐efficacy on signing intention. These findings provide useful insights for organ procurement organisations seeking behavioural change not only in Japan but also in multi‐ethnic societies with a substantial Japanese population.     

The Institute of Medicine's report on non-heart-beating organ transplantation

In December 1997, the Institute of Medicine (IOM) released a report on medical and ethical issues in the procurement of non-heart-beating organ donors. This report had been requested in May 1997 by the Department of Health and Human Services (DHHS). We will here describe the genesis of the IOM report, the medical and moral concerns that led the DHHS to sponsor it, the process of producing it, and its conclusions. The analyses, findings, and recommendations of the report are also reviewed, in particular the central issues that led to suggestions for policy changes.     

Knowledge and attitudes of Polish university students toward organ donation and transplantation

Although the number of patients needing organ transplantation systematically increases, recent years have seen a considerable shortage of donors. The level of knowledge and attitudes toward donation are critical factors in achieving the required balance between supply and demand. This pilot study assessed the knowledge, opinions, and behaviors related to organ donation and transplantation among 625 students representing eight different fields of study from the University of Rzeszow in south-eastern Poland. Although the participants provided evidence of knowledge about human organ donation and transplantation, they were aware of the main organs of the human body for potential transplants, and generally showed positive attitudes; only 24% of the subjects indicated their willingness to register as a donor; only 3% stated that they had already registered and had a donor card. The findings suggest that good intentions do not translate into action and that Poland needs to develop a nation-wide, up-to-date, and youth-oriented health education program that builds on favorable attitudes toward organ donation and transplantation.     

Shame,Death, and Dying

This paper deals with the influence of shame on the way in which Western society, particularly North America, is coping with death and dying. From being a familiar event, death and dying have become a shameful aspect of life. Thus, this paper provides some understanding of this important transformation, and it challenges some of our present attitudes regarding death and dying. These human experiences are not the ultimate manifestation of a failure, either from a personal or a medical perspective, but the only way through which human beings acquire the fullness of life, as Christian faith reveals.     

中日器官移植法律制度初步比较与分析

比较分析我国新施行的《人体器官移植技术临床应用管理暂行规定》和日本现行的《器官移植法》,从立法背景、立法前器官移植开展情况、法规整体情况、立法调整范围、立法目的与理念、监督管理机构、禁止器官买卖、器官摘取事项、处罚等九个方面进行,并对借鉴日本《器官移植法》,完善我国器官移植立法提出了建议.