從人權與社會正義觀點反思醫務社會工作人員在活體器官捐贈者社會心理評估中的角色

Reflections of Medical Social Workers’Roles in Living Organ Donors’Psychosocial Assessment: Human Rights and Social Justice Perspectives

研究目的：本研究以人權與社會正義觀點來探討醫務社會工作人員在活體器官捐贈社會心理評估中的角色、任務以及工作內容，以確保捐贈者自主、自願及知情下同意器官捐贈的行為。
研究方法：本研究採立意取樣，訪談現職從事活體器官捐贈社會心理評估工作或曾任職衛生福利部核准之活體肝臟移植或活體腎臟移植醫院之醫務社會工作人員。
研究結果：訪談資料顯示，醫務社會工作人員在活體器官捐贈社會心理評估的工作內容是透過會談來確認捐贈者是權利主體，其捐贈決定是自主、自願以及知情下同意；同時，捐贈者的性別、身心障礙或族群等脆弱性特質形塑捐贈決策中的角色期待、家庭關係壓力與脅迫。
研究結論：醫務社會工作人員在捐贈者社會心理評估裡的角色既是知情同意倫理彰顯者，以捐贈者為中心，進行充權，使其具備權利意識來決定同意或拒絕器官捐贈；也是捐贈者權益維護者，協助捐贈者審視捐贈決策的情境與社會脈絡，保護捐贈者不因脆弱性特質，遭受不公對待，而進行捐贈決策。

Research Purpose Liver and kidney transplants are the most common forms of living organ transplants in Taiwan. According to Article 8, item 1, paragraphs 1 and 2 of the Human Organ Transplant Act, consent to organ donation should be given in a condition of“sound mental capacity”and“free will.”To avoid coercion or organ trafficking and selling in situations of living organ donation and transplantation, a thorough assessment and examination must be performed prior to the procedure. This study examined how medical social workers (MSWs) adopted human rights and social justice perspectives in the psychosocial assessment of living organ donors before surgery to ensure donors’autonomy and willingness.
Method A purposive sampling technique was adopted that involved interviewing 12 MSWs (three males and nine females) assigned to living-donor liver transplant hospitals approved by the Ministry of Health and Welfare or working in psychosocial assessment of living organ donation at the time of interviewing. Interviews were conducted between March 23 and April 10, 2021. Thematic analysis was used to analyze the qualitative data.
Results According to the research findings, the psychosocial assessment of living organ donation focuses on the donor’s demographic characteristics such as gender, age, marital status, and employment to ensure relationships between the donor and the recipient. It is also necessary to have information about the donor’s family system because potential donors are frequently under pressure to donate organs owing to role expectations. MSWs feel confident in their roles as professionals in the psychosocial evaluation of living organ donation since psychosocial evaluation is an essential skill to acquire in social work education. Furthermore, MSWs must ensure that potential donors’decisions are made freely and without any coercion, even though MSWs are not the only ones who respect and protect the donor’s rights to autonomy and self-determination during the psychosocial assessment process. Additionally, when donors are placed in oppressive situations during the donation decision-making process, MSWs must be aware of their vulnerability based on their gender, disability, or ethnicity to empower them to resist potential oppression or exploitation. In other words, the social work profession values the notion of social justice and emphasizes acknowledging service users’possible existence of the social injustice faced by disadvantaged groups. Psychosocial assessments of living donors help potential donors become aware of whether their characteristics, such as gender, ethnicity, or disability, cause them to be dominated and exploited. According to our findings, female family members, such as spouses, daughters, or daughters-in-law, are sometimes required to sacrifice themselves to donate living organs to other family members, especially when the female is financially reliant.
Conclusion The results suggest that MSWs are expected to maintain consciousness of rights to protect the free will, autonomy, and self-determination freedom of potential living organ donors. Moreover, based on social justice, MSWs are expected to protect living organ donors from the pressures caused by interpersonal relationships and social roles. Consequently, the role of medical social workers in the psychosocial evaluation of living organ donations may be viewed as an advocate for human rights and social justice practitioners.