台灣民眾對器官勸募政策之態度

Public Attitudes towards Organ Procurement Policy in Taiwan

張凱廸(Kai-Ti Chang)

指導教授 ： 蔡甫昌

國立臺灣大學/醫學院/醫學教育暨生醫倫理研究所/碩士(2022年)

https://doi.org/10.6342/NTU202203885

摘要

器官移植被視為是器官衰竭時治療成效最佳的治療、同時能降低醫療支出。台灣的器官移植起步甚早、且移植後的器官存活率與病人存活率俱佳。惟台灣的屍體器官捐贈率遠遠落後於西班牙、美國等先進國家。著眼於世界上移植率高的國家幾乎都採行推定同意制、且近年亦有多國自選擇同意制改為推定同意制，我國亦有學者提出此做法。本於政策的推動應有廣泛的民意基礎，但我國少有相關研究，故進行此民調收集我國民眾對器官捐贈相關議題之看法，並與十年前相近的民調進行比較。
本研究分析2020年11月蔡甫昌教授執行之器官捐贈相關議題電話訪問，該研究抽樣訪查全國20歲以上之居民，共收集1126份有效樣本。結果顯示：願意於死後捐贈器官自身器官者者為70%、但器官捐贈卡簽署率只有8.7%。捐贈意願較高的次族群分別為：年紀較輕者、教育程度較高者、未婚者、無宗教信仰者、家庭月收入較高者，並達顯著差異。但性別、居住縣市(或地區)不影響個人之器官捐贈的意願。家屬是否同意死亡之親屬捐贈其器官，在死者明確表達捐或不捐的意願時，認為應以死者意見為主而非家屬意見為主的比例比十年前上升，意味著我國社會在重視家庭意見之餘，對個體意見的尊重益顯增加。在器官捐贈制度上，47.3%支持選擇同意制、46.9%支持強制徵詢制、只有2.6%支持推定同意制。年紀較輕者、教育程度較高者、家庭月收入較高者較傾向支持強制徵詢制，但與宗教信仰、婚姻狀態、居住地區、性別無關。
研究結果顯示：我國支持器官捐贈者眾、但登記為器官捐贈者寡；不喜推定同意制、但對強制徵詢制的接受度不錯。故研究者認為應先落實人體器官移植條例中，戶政與監理機關確實詢問換證民眾的器官捐贈意願，佐以醫護人員在面對潛在捐贈者時，以推定同意制的精神去詢問個人或家屬器官捐贈之可能，期能因此改變增加我國器官供給量，嘉惠更多器官衰竭病人。

關鍵字

器官捐贈制度 ； 器官勸募政策 ； 器官捐贈意願 ； 家屬同意 ； 選擇同意 ； 推定同意 ； 強制選擇 ； 民意調查

並列摘要

Organ transplantation is regarded as the most effective treatment for organ failure, and can reduce healthcare expenditure. Organ transplantation in Taiwan started very early, and the post-transplant organ survival and patient survival are good. However, Taiwan's cadaveric organ donation rate is far behind that of advanced countries such as Spain and the United States. With regard to that almost all countries with a high organ donation rate in the world have adopted the presumed consent system, some scholars have proposed this practice. However, an effective policy ought to be wildly accepted by the citizens before putting into practice. This poll was conducted to collect the opinions of residents in Taiwan on issues related to organ donation, and compared with the similar polls performed ten years ago.
We analyzed a telephone poll conducted by Dr. Daniel Fu-chang Tsai in November 2020, which was a sample survey of residents over the age of 20 nationwide in November 2020 by telephone, and a total of 1,126 valid samples were collected. The results showed that 70% were willing to donate their own organs after death, but only 8.7% signed the organ donation card. The subgroups with higher willingness to donate are: younger age, higher education level, unmarried, non-religious, and higher monthly family income. However, gender and county of residence do not affect an individual's willingness to donate organs. When the deceased clearly expresses his willingness to donate or not to donate, the proportion of survey respondents who values the deceased's opinion rather than the family's opinion is higher than that of ten years ago. Regarding the organ donation system, 47.3% supported the informed consent system, 46.9% supported the mandatory choice system, and only 2.6% supported the presumed consent system. Younger people, people with higher education level, and people with higher monthly household income are more inclined to support the mandatory consultation system. Religion, marital status, living area, and gender did not affect the preferences of different organ donation system.
The research revealed: organ donation is wildly accepted by our citizens, but there are few registered organ donors. The majority of the respondents cannot accept the presumed consent system, but accepted mandatory consultation system. Therefore, the researchers suggest that the first step is to practice mandatory requirement system more strictly since the Transplantation Act has required the competent authorities to inquire about citizens’ willingness of organ donation when changing their identity card, driver license or NHI Card. Besides, when facing potential donors, the healthcare providers ought to inquire about the possibility of organ donation from dying individual or his family members with the concept of presumed consent.

並列關鍵字

organ donation system ； organ recruitment polic ； willingness to donate organs ； family consent ； opt-out consent ； mandatory choice ； public opinion survey

參考文獻

1. 蔡甫昌, 台灣民眾對器官捐贈相關議題態度調查之比較. 2020, 臺大醫院109年度研究計畫: 臺北市.

2. Tsai, H.I. and H.P. Yu, A review of nationwide population study of organ transplantation in Taiwan. Acta Anaesthesiol Taiwan, 2016. 54(2): p. 70-4.

3. 廖麗鳳, 臺灣屍體器官捐贈資料分析之研究, in 生死與健康心理諮商研究所. 2021, 國立臺北護理健康大學: 台北市. p. 160.

4. International Registry in Organ Donation and Transplantation. IRODaT Newsletter 2018. [Internet] 2019; Available from: https://www.irodat.org/img/database/pdf/IRODaT%20Newsletter%202019-March.pdf.

5. Organ Procurement and Transplantation Network. Deceased Donors Recovered in the U.S. by Donor Ethnicity: National Data. [Internet] 2021 June 9, 2021 [cited 2021 June 9]; Available from: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#.