Abstract:
Controlled organ donation after circulatory death (DCD) was re-introduced in the UK in 2008, in efforts to increase rates of organs for transplant. Following reintroduction, there were debates about the ethics of DCD, including whether potential DCD donors receive end-of-life care which is in their best interests. Since this time, DCD has become a routine donor pathway in the NHS. In this article, we present findings from an ethnographic study examining the everyday practices of DCD in two English Trusts. Drawing on the concept of death brokering and Bea\'s (2020) call to consider organ donation as embedded and routine practice within health care, we look at how DCD is integrated into end-of-life care in intensive care units. We show how DCD is made routine at the end-of-life via the practices of health professionals who create an active separation between discussions about death and donation; reproduce usual ways of doing things in end-of-life care; and respect the distinction between patient/donor, dying and death. In doing so, we argue these function to preserve the patienthood of the potential donor, ensuring DCD operates as an integrated part, and culturally accepted form of, good end-of-life care for potential donors, their relatives, and health professionals alike.
摘要:
2008年,在英国重新引入了循环系统死亡后的受控器官捐赠(DCD),以努力提高器官移植率。在重新引入之后,有关于DCD伦理的争论,包括潜在的DCD捐赠者是否获得最符合他们利益的临终关怀。从这次开始,DCD已成为NHS中的常规供体途径。在这篇文章中,我们提供了一项人种学研究的结果,该研究研究了两个英国信托基金中DCD的日常实践。借鉴死亡经纪的概念和Bea\'s(2020)呼吁将器官捐赠视为医疗保健中的嵌入式和常规做法,我们来看看DCD是如何整合到重症监护病房的临终关怀中的。我们展示了如何通过卫生专业人员的做法使DCD在生命结束时成为常规,这些专业人员在关于死亡和捐赠的讨论之间建立了积极的分离;在生命结束护理中重现通常的做事方式;并尊重患者/捐赠者之间的区别,死亡和死亡。在这样做的时候,我们认为这些功能是为了保护潜在捐赠者的耐心,确保DCD作为一个整体部分运作,和文化上接受的形式,为潜在的捐赠者提供良好的临终关怀,他们的亲戚,和健康专业人士一样。