活體腎臟捐贈考量面向之探討：單一醫學中心社會工作評估紀錄回溯性研究

Exploration of Considerations in Living Kidney Donation: A Retrospective Study of Social Work Records in a Medical Center

為回應我國法律規定，醫務社工師透過社會心理評估協助團隊瞭解活體器官捐贈者充分知情、自主同意與各項因應準備度。本研究運用混合式研究方法，採取次級資料分析，針對248筆活體腎臟捐贈術前評估紀錄進行內容暨文本分析。紀錄欄位運用REDCap系統建立編碼架構，呈現捐受人口特性與捐贈考量的統計；再結合質性紀錄文本分析，探討捐贈決策過程的經驗樣貌。
本研究發現，部分捐贈者會於評估前查找相關資訊，或於就診過程中徵詢相關意見，獲得對移植捐贈的正向認知，形成捐贈決策考量依據。若以受贈者年齡性別分組檢視，受贈者的生活品質、捨不得受贈者受苦、捐與受之間的情感連結，是各種組合普遍認定的捐贈考量。然而當受贈者為青年男女，捐贈者考量為受贈者發展階段的需求，以及健康議題對生活與未來造成的影響；中年男性受贈者其捐贈者考量則著重於共同生活的品質。整體而言，決策歷程中的正向認知、以家庭為中心的責任脈絡與共存共好的期待，是親屬間活體器官捐贈的主要考量面向。依據研究發現，在捐贈移植治療方法的宣導、提供兼具充權與同理的社會心理術前評估、落實知情同意，提升評估者對於家內決策的性別敏感度，建立評估會談與紀錄架構，以及未來研究應持續探查影響女性捐贈者決策考量的相關因素等面向提出具體建議。

In compliance with the laws and regulations of our country, medical social workers conduct psychosocial assessments to assist the team in determining whether the living donors are fully informed, voluntary, and well prepared in all aspects. This study adopted a mixed methods strategy and analyzed the contents and texts of 248 pretransplant evaluations of living kidney donors via secondary data analysis. Combining the quantitative data coded in REDcap with qualitative analysis of texts, this study shows the characteristics of donors, considerations of donation, and the decision-making process.
This study found that some donors sought relevant information before evaluation or consulted others during the medical process, finally gaining positive perceptions of organ transplantation, affecting their decisions regarding donation. When recipients were grouped by age and gender, the recipient’s quality of life, reluctance to see the recipient suffer, and emotional connections between donors and recipients were commonly considered by all groups. However, when the recipient were young adults, the main considerations of the donors were the needs of the recipient’s development and the impact of health issues on life and the future. In the case of middle-aged male recipients, donor considerations focused on the quality of shared life. Overall, the main considerations for related living organ donation were positive perceptions during the decision-making process, responsibilities based on the family-centered context, and expectations of coexistence and mutual benefits. This study also provides specific recommendations for practice, including promoting information of the medical procedure of donation and transplantation, conducting empowering and empathetic pretransplant psychosocial assessment, ensuring informed consent, enhancing gender sensitivity in household decision-making, establishing a framework for interviewing and recording and investigating factors influencing female donors in the future.