간 및 신장이식 수술에서 병원 진료량과 진료결과의 관계

유태욱 고려대학교 2006 국내박사

There is substantial evidence that the volume of surgical procedures in a hospital has an inverse relationship with patient outcomes such as mortality. The objectives of this study were to determine whether outcome of liver and kidney transplantation are different between low and high volume hospitals in Korea. Data from KONOS(Korean Network for Organ Sharing)were analyzed for transplants performed from 2000 to 2004. Patients were followed from the date of transplantation to the time of death. Hospitals were assigned to low volume(below 20 cases per year) and high volume(equal or above 20 cases per year). A Cox proportional hazards model was used to estimate mortality hazard ratios adjusted for dependent variables such as clinical characteristics and hospital volumes. The outcome variables were 30 day mortality, 1 year survival rate and 3 year survival rate. A total of 1,848 liver transplants in 15 hospitals and 3,727 kidney transplants in 57 hospitals were identified. The unadjusted survival rate of liver transplantation patients in high volume hospitals were significantly higher than that of lower volume hospitals; 94.49 vs 79.02 for 30 day survival, 87.8% vs 70.1% 1 year survival and 82.3% vs 65.8% for 3 year survival, respectively. After adjustment, liver transplantation at lower hospital was associated with a significant higher risk of death rate compared to high volume hospitals. Hazard ratios were 3.97(95% CI, 2.44-6.46) for 30 day mortality, 2.71(95% CI, 1.82-4.02) for 1 year mortality, and 2.49(95% CI, 1.71-3.62) for 3 year mortality. The unadjusted survival rate of renal transplantation patients in high volume hospitals were significantly higher than that of lower volume hospitals; 98.6% vs 96.6% 1 year survival rate and 98.0% vs 94.8% for 3 year survival rate, respectively. After adjustment, renal transplantation at low volume hospitals were associated with a significant higher risk of death rate compared to high volume hospitals. Hazard ratios were 2.39 (95% CI, 1.41-4.04) for 1 year mortality and 2.63(95% CI, 1.65-4.20) for 3 year mortality. There was no significant differences for 30 day mortality for renal transplants. between two hospital groups. These study revealed significant differences in mortality between low and high volume hospitals. Transplant outcomes were better at high volume hospitals. Further studies are needed to show the clear minimal threshold volume. Also future work should examine process variables that differ between high and low volume hospitals, and examine the interaction of cormorbid conditions. ____________________________________________________________________ Key Words; Volume, Outcome, Liver Transplantation, Renal Transplantation, Mortality Rate, Survival Rate 우리나라의 장기이식술은 1969년 신장이식을 시작으로 지속적인 발전이 이루어졌고, 1988년에는 간이식이 시행되어 장기이식에 대한 사회적 관심이 증대되면서 1999년에는 ‘장기 등 이식에 관한 법률’이 제정되었다. 하지만 장기이식술의 질적인 성장에도 불구하고, 장기이식의 수요에 비하여 공급이 절대적으로 부족하여 소중한 장기를 이용한 장기이식술의 진료결과를 향상시킬 필요성이 제기되고 있으며, 제도적인 뒷받침을 위한 장기이식의 진료량과 이식환자의 생존율인 진료결과에 대한 연구가 요구되어지고 있다. 본 연구는 2000년부터 2004년 사이에 간 및 신장 이식술을 시행한 전국의 모든 의료기관을 대상으로 같은 기간에 각 병원의 이식술 건수와 이식술을 시행 받은 환자의 사망에 대한 자료를 조사하여 병원 진료량과 진료결과의 관계를 분석하였으며, 추적관찰 종료시점은 2005년 6월까지였다. 자료는 국립장기이식관리센터에서 관리하는 자료를 사용하였다. 장기이식의 병원 진료량은 해당기간 동안 각 병원에서 시행한 간 및 신장이식술의 연간 평균건수로 정의하였고, 각각의 진료량 구분은 연간 건수에 따라 소진료량군(20건/년 미만), 다진료량군(20건/년 이상)으로 나누었다. 이식술의 진료결과는 이식 후 30일 이내 사망률, 1년 생존율 및 3년 생존율 세 가지를 측정하였다. 이식술의 진료량 외에 생존율인 진료결과에 영향을 줄 수 있는 변수들을 혼란변수로 정의하였으며, 의료기관 및 의사 특성, 환자 및 질병 특성을 포함하였다. 2000년부터 2004년까지 국내에서 이루어진 간이식 건수는 15개 의료기관에서 총 1,848건이고, 분석단위를 병원으로 했을 때 이식술 진료량 평균은 123.20± 247.40건이었다. 신장이식 건수는 57개 기관에서 3,727건이 이루어졌고, 이식술 진료량 평균은 65.39±121.95건이었다. 간이식 환자의 진료량-진료결과 관계에서 이식 후 30일 이내 사망률은 소진료량군에서 21.0%, 다진료량군에서 5.5%로 유의한 차이가 있었다(p<.001). 1년 생존율은 소진료량군에서 70.1%, 다진료량군에서 87.8%이었고, 3년 생존율은 소진료량군에서 65.8%, 다진료량군에서 82.3%로 다진료량군에서 유의하게 높았다. 콕스비례위험모형(Cox proportional harzard model)을 이용한 다중회귀분석을 실시하여 혼란변수로 선정한 의료기관 및 의사 특성, 환자 및 질병 특성을 보정한 후, 진료량과 생존율의 관계를 분석한 결과 간이식환자의 경우, 다진료량군에 비해 소진료량군의 보정 위험비는 30일 이내 사망률에서 3.97(95% CI, 2.44-6.46), 1년 사망률에서 2.71(95% CI, 1.82-4.02), 3년 사망률에서 2.49(95% CI, 1.71-3.62)로 위험비가 증가하였다. 신장이식 환자의 진료량-진료결과 관계에서 신장이식 후 30일 이내 사망률은 소진료량군에서 0.7%, 다진료량군에서 0.6%로 유의한 차이가 없었다(p=0.6593). 1년 생존율은 소진료량군에서 96.6%, 다진료량군에서 98.6%이었고, 3년 생존율은 소진료량군에서 94.8%, 다진료량군에서 98.0%로 다진료량군에서 유의하게 높았다. 콕스비례위험모형(Cox proportional harzard model)을 이용한 다중회귀분석을 실시하여 혼란변수로 선정한 의료기관 및 의사특성, 환자 및 질병 특성을 보정한 후, 진료량과 생존율의 관계를 분석한 결과 신장이식환자의 경우, 다진료량군에 비해 소진료량군의 보정 위험비는 30일 이내 사망률에서 1.05(95% CI, 0.27-4.09), 1년 사망률에서 2.39(95% CI, 1.41-4.04), 3년 사망률에서 2.63(95% CI, 1.65-4.20)로 역시 유의하게 위험비가 증가하여 진료량에 따른 진료결과의 차이를 뚜렷하게 보여주었다. 연구 결과, 환자 요인의 영향을 보정한 후에도 의료기관의 간 및 신장이식 수술에서 병원 진료량과 생존율인 진료결과 사이에 관련성이 있었다. 이러한 관점에서 볼 때, 우리나라에서도 장기이식에 관한 전문가 그룹 내의 권고기준 설정과 같은 제도적 방안을 통해 장기이식 의료기관별 장기이식술 기준량을 마련할 필요성이 있다고 할 수 있다. 중심단어; 진료량, 진료결과, 간이식, 신장이식, 사망률, 생존율

腦死와 臟器移植의 法理에 관한 硏究

金安女 全北大學校 2003 국내석사

Many People have been strove to maintain human life eternally since human history. However, on account of the development of nowadays' mechanical enlightenment, sudden deaths frequently occur accident unexpectedly. Although they lead to death, the concept of death become much variation due to developments of medical practice or scientific technique-the brain death come to the fore. The brain death is the status : Artificially maintains life restoration, Concentrate ones thought, even ones respiration expires into comma, by the medical cure for the breath, nutrition and for the evacuation. Life means organized and unified body that the assertion to the brain death as living soul is not real life opinion spread widely even partly ones organ functions, because of all the unified organs lose their roles since for some 30-years. Up until Oct. 31, 2002, almost over ten-thousand people in our country who want eagerly others organs whose lives are in the brain death, in order to prolong their lives by transplantation, however, available organs for the transplantation are always insufficient. In this regard, in order to attain fresh organs successfully, the law of the brain death will be approved by this Government advocated mainly by the medical circle in our country to transplanting organs. The issue of the transplantation of the organs importantly dealt. The transplantation of the organ means surgical treatment in order to cure patients transplanting extracted tissue or organs that have extracted from human organ or that of animal alive or dead body. It has classified according to where the organs are obtained-self-transplantation, family transplantation, different kind transplantation. The organ transplantation has originated from skin transplantation and has developed when the immunized system has clarified medically and so called cyclospoline, a medicine of inhibitive action for rejection symptoms has made. The surgical operations such as for kidney, heart, liver and pancreas transplantation have been developed, however, the problems of donating organs, conservation of them and after the operation of transplantation of the organs are remained still. Awaiting numbers for the organic transplantation as of October, 2002, they are 10,017, that of aliving numbers are 1,369, and that of the brain deaths (include the cornea) are 129, and the cornea transplantation numbered 81 from the deads. It has been well known everywhere on the problems of lawful to the organ transplantation or the brain death, however, when we observe the enforced legislative bill, the brain death might be acknowledged unless breaking the heart-attack principle, the extracting organs from the brain deaths make lawful on which medical circle manages by free will now. Thus, we observe the facets of medical, social, and of humanity. We can take first uncertainty of doctor's decision. Advocators on the brain death assert it on two facets. One is meaningless treatment to the brain death, adding financial and spiritual pains to their family, whose lives are likely dead ; the other problem is arose moral to our medical science and doctors. The existens of medical science and its purpose is for the human : to help the painful ones, patients, and dying ones. The selling and buying organs are the on the first topic to say regarding social aspect. It is the very issues on the matter of the brain death and the transplantation of the organs. Therefore punishment regulations are advanced, notice to the legislative rule in this time. The improvement measures to the transplantation of organs and the brain death for their legalization are : 1. They must have from the motivation of love. 2. They must keep righteousness both to the donator and receiver. After getting to know all of the information, donator's consent shall be induceand the donating act gains inner value to the absolute condition. The designation of the brain death is not to transfer into it from all the heart-death but it aims at the recognization of the brain death, because the case is only one percent of the brain death in all of the death decision. All of the problem around the brain death and the organ transplantation have been arose by the development of artificial respiration and the remarkable medical technique. Of cause all of the background of the brain death and the organ transplantation are not only on the development of medical technique but also absolutely great issue harboring by human from long ancient and still on the stake. Therefore, the brain death and organ transplantation are not only of the issue for medical science and law but also for the religion, for the society, philosophy, and for the culture that they should be recognized and be researched.

한국 장기이식 거버넌스의 변화

유정모 성균관대학교 2018 국내석사

본 연구는 한국 장기이식 거버넌스의 변화를 분석하여 사회문제 해결에 있어 협력적 거버넌스가 나타나는 과정과 개별 거버넌스가 가진 장·단점과 협력적 거버넌스의 이점을 탐색하였다. 연구는 거버넌스를 사회적 조정양식으로 정의하였다. 또한 사회문제를 개별 행위자가 만족하지 못하는 상황으로 바라보았으며, 사회문제를 해결하였으나 여전히 남아있는 문제 혹은 새로운 사회문제를 해결하기 위해 사회의 환경을 변화시키는 것을 거버넌스의 변화로 보았다. 이를 바탕으로 한국 장기이식에 있어 개별 행위자들이 사회문제를 해결하기 위해 사용한 사회적 조정양식과 거버넌스의 변화 방향을 분석하였다. 본 연구의 분석결과는 다음과 같다. 초기 장기이식 거버넌스에 있어 개별 행위자들은 장기이식을 활성화시키기 위해 행위자 간의 네트워크를 활용하여 사회문제를 해결하고자 하였다. 그러나 네트워크 거버넌스가 가지고 있는 폐쇄성과 비공식성으로 인해 장기매매와 뇌사의 법적 불인정과 같은 현상들이 나타났으며, 이를 해결하기 위해 정부는 법을 제정하여, 문제를 해결하고자 하였다. 정부의 장기이식과 관련한 법의 제정은 네트워크 거버넌스가 가진 폐쇄성과 비공식성의 문제를 해결하는데 있어 효과적이었으나, 과도한 계층제적 통제로 인해 과거에 비해 장기이식의 건수는 오히려 감소하게 되었다. 이에 따라 정부는 감소한 장기이식 건수를 높이기 위해 시장 거버넌스의 요소를 도입하였는데, 이는 뇌사자 발굴 병원과 장기기증자에 대한 인센티브로 나타난다. 이러한 시장요소의 도입 이후 지속적인 장기이식의 활성화를 위해 뇌사추정자 의무신고제도를 도입하였다. 현재 장기이식과 관련한 주요 쟁점은 장기이식에 있어 기증자에 대한 예우와 사회 분위기 조성으로 과거 도입되었던 시장 거버넌스적인 요소들을 축소하기 위한 움직임이 나타나고 있다. 이상의 분석을 통해 본 연구는 개별 행위자들이 인식하는 사회문제를 해결하는데 있어 하나의 사회적 조정양식을 사용하기 보다는 다양한 사회적 조정양식을 혼합하여 사용하는 것이 효과적임을 확인하였으며, 특정시점에서 사용한 사회적 조정양식이 한계를 가질 경우 거버넌스의 변화를 통해 새로운 사회적 조정을 모색하는 것을 발견할 수 있었다.

뇌사와 장기이식의 윤리적 문제에 관한 연구

이태관 동아대학교 교육대학원 2003 국내석사

현대 의학과 의료기술의 발달은 인간의 삶과 죽음에 대한 새로운 문제를 던져주고 있다. 인공소생술과 생명연장 장치의 발달은 죽음의 기준을 뇌사로 주장하게 되었고, 장기이식 수술의 발달은 장기의 기증과 분배에 있어서 많은 윤리적 문제를 일으키고 있다. 심장과 같은 장기를 이식할 경우 그것은 사람의 생존에 불가결한 가장 중요한 장기인 동시에 오직 하나 밖에 없는 것이기 때문에 이식할 장기는 결국 사체로부터 적출할 수밖에 없다. 그런데 심장사에 도달한 후에 적출할 심장을 가지고 이식해서는 그 성공률이 낮아져서 바람직한 효용을 기대하기가 어렵다. 따라서 뇌사단계에서 심장과 같은 하나밖에 없는 장기의 적출이 필요하게 되어 종래의 죽음에 대한 개념의 변경이 불가피하게 되었다. 이처럼 뇌사가 논란의 대상이 되고 문제가 되는 것은 장기이식과 밀접하게 연관되기 때문이다. 장기이식 수술의 성공을 위해서는 보다 신선하고 좋은 장기가 필요하기 때문에 필연적으로 뇌사의 인정이 요구되는 것이다. 따라서 여기서는 일정하고 통일된 뇌사판정기준에 비추어서 인간의 죽음을 판정해야 된다. 오늘날 장기이식이 활발하게 시행됨에 따라 의학 분야에서는 과거에 없었던 새로운 윤리적 문제들에 대한 많은 관심을 일으키게 되었으며, 이에 우리는 장기이식에 대한 올바른 논의와 윤리적 방향이 제시되어야 한다. 우리는 어떤 행동이 도덕적인가의 여부를 판단할 때 윤리원칙들과 규칙들을 활용한다. 장기이식과 관련된 행위를 정당화하는 원칙으로는 자율성 존중의 원칙, 악행금지의 원칙, 선행의 원칙, 그리고 정의의 원칙 네 가지 근본적인 윤리원칙들에 의해서 고려되어진다. 장기분배의 문제도 공정하고 투명한 원칙에 의해서 분배되어져야 한다. 본 연구는 여러 가지 죽음의 정의에 대한 이해를 바탕으로 하여 현대 의학의 발달로 인하여 새롭게 대두된 죽음의 판정기준인 뇌사와 관련된 윤리적 문제에 대해서 살펴보고, 장기이식의 윤리적 문제와 장기분배의 문제에 대해서 다루고자 한다. The development of modern medicine and medical technology is raising new issues in relation to human life and death. The advancement of resuscitation and life extension equipment has led to the assertion of brain death as the criterion of death. And the development of organ transplantation has brought many ethical problems with organ donation and allocation. A particular organ like heart which is essential to human existence cannot avoid being extracted from corpse because it is the one and only organ. But cardiac transplantation with heart that is extracted after the organ is judged dead is difficult to be effective and successful. Thus the one and only organ like heart needs to be extracted when brain death. This inevitably changes the definition of death. The reason why brain death becomes a controversial issue is because it is closely related with organ transplantation. To make the transplantation successful requires more fresh and good organs. For this reason, brain death recognition is essential. Thus human death should be determined according to consistent, uniform standards of brain death judgement. More attention becomes paid to new ethical issues that have not existed in the field of medicine before as organ transplantation is actively pursued. In this sense, ethics about the operation should be established in a right direction. In determining whether a particular behavior is moral or not. we use ethical principles and rules. Four fundamental ethical principles which justify behaviors related to organ transplantation include 'the Principle of Respect for Autonomy', 'the Principle of Non-maleficence, 'the Principle of Beneficence' and 'the Principle of Justice'. In addition, organ allocation should be implemented in accordance with just, transparent principles. Thus the purpose of this study is to analyze ethical issues in relation to brain death and organ transplantation, which have been newly raised following the development of modern medicine, and problems with organ allocation, on the basis of understanding different definitions of death.

장기이식의 윤리성에 대한 태도연구 : Q방법론적 접근

조민정 이화여자대학교 대학원 1998 국내석사

臟器移植에 관한 형사정책적 硏究

윤영수 경상대학교 대학원 2002 국내석사

'The law on transplanting internal organs and etc.' was enacted and promulgated on February 8, 1999 and has been enforced since February 9, 2000 with a view to eradicating the illegal transactions of internal organs violating the provisions of the Constitutional Law on the dignity of human beings and running counter to the concepts of social ethics and providing all persons that need organ transplant with equal opportunity and at the same time legalizing the practices of extracting internal organs from brain-dead persons and increasing the supply of organs and giving new life to those who suffer from chronic organ failure. Yet the trouble is that the organ donation of brain-dead persons has decreased to about 33 percent and that transplant from living bodies has dropped to 20 percent. And organ transactions are still carried on and problems related to organ transplant have come to the forefront, and there is a need for a revision of the Law. In this context, this study focused on taking a look at the problems which have taken place since the enforcement of the Law as well as problems related to organ transplant from the viewpoint of the original purport of the Law and the criminal policies of the nation. Chapter II formulated organ transplant, part of doctors' medical treatment on the basis of established discussions by interpreting the concept in a broad and narrow sense, dealing with the features and kinds of transplant. Then the chapter covered the process of organ transplant, which was introduced as a therapeutic method, here to stay and evolving from a experimental stage with the development of Cyclosporine, a immunosuppressant in the 1970s, and took a look at the current practices of organ transplantation on the basis of the reports of medical fields and statistics related to organ transplants. Particularly, in Korea's case, the chapter dealt with the situation before and after the establishment of 'the law on transplanting internal organs and etc. ' Also the chapter took a brief look at American UNOS and Korean KONOS, the networks of organ distribution across the nation. Chapter II handled the history and contents of the Korean 'law on transplanting internal organs and etc. ' after taking a look at the process of foreign countries establishing the organ transplantation law and its contents in consideration of the fact that world-wide discussions about the legalization of organ transplant were launched in the process of organ transplant taking root as a therapeutic method due to the development of medicine and Korea; and that Korea established the law by making reference to the established laws of foreign countries. Chapter IV linked problems with brain death, the agreement of donors to the extraction of organs, and the illegal transactions of human organs, which come from the fact that organ transplants are a special medical behavior in need of the organs of others to the provisions of 'the law on transplanting internal organs and etc. ' First, problems with Brain death dealt with the adoption or rejection of the Brain-death theory, the determination criteria of Brain death and the provisions of the cause of death of brain-death people. Second, the agreement of organ donors, or their families, to organ extraction is of great importance, since organ transplant is not related to a medical treatment designed to help the donors, but capable of incurring serious problems or doing harm to the donors and the dead bodies, should be handled with care. Opinions about the subjects of the right to agreement the range and priority of those with right to agreement, and the method and limits of agreement, etc, may come into conflict with each other. This problem is closely connected with the difficulties of obtaining organs for transplant. The chapter dealt with the problems in terms of Brain-death persons and the deceased. Third, there are problems related to the illegal transactions of human organs in the wake of a discrepancy between organ supply and demand. Most of the nations around the world ban such transactions and punish those who commit a organ-related crime. But illegal organ transactions seem not to disappear because of such a discrepancy and a human desire for healthy longevity, so the chapter took a look at the problems of organ transaction. Chapter V brought the foreign cases, where human dignity and value and human rights were involved, to the forefront in relation to the transplant of ‘fetus's organs and etc.’ and took a look at the problems with the realities of abortion in Korea. On this basis, the research presented solutions to treatment using ‘fetus's organs and etc, ’ in relation to abortion problems. There have been attempts at materializing organ transplant and treatment using embryo cloning or human cloning. These problems of embryo cloning and human cloning cannot be morally, socially and legally legitimized, but the trends of the world seem to take priority in the matter. So the researcher thinks it necessary that legal devices should be worked out on the basis of a thorough analysis of problems with embryo cloning or human clone and the trends of the world. Chapter VI presented innovations about major problems related to organ transplant in consideration of the purport of 'the law on transplanting internal organs and etc.' and its problems related to the enforcement of the law as well as the results of the established researches. In conclusion, the researcher would like to make the following suggestions. Poor people with chronic organ failure should be given at least the minimum chance for an organ transplant, the national health insurance system should include all the areas of organ transplant and financial resources should be secured. As organ donors belong to a lower economic bracket, they should be provided with some compensation for a living. The researcher think it natural that those donors should be compensated in return for their organ donation to the humanitarian demand for free organ donation only means trying to ban commercial transaction.

간호사의 뇌사자 장기이식에 대한 태도와 호스피스완화의료에 관한 지식

이광흠 부산가톨릭대학교 대학원 2020 국내석사

본 연구의 목적은 간호사의 뇌사자 장기이식에 대한 태도와 호스피스완화의료에 관한 지식의 정도를 파악하고 이들 변수 간의 관계를 확인하여, 뇌사자 및 가족을 위한 지지적인 간호중재를 개발하고 뇌사자 장기이식의 활성화를 위한 기초자료를 제공하고자 시행하였다. 자료 수집은 2019년 12월 01일부터 2020년 3월 31일까지 실시하였으며, B광역시에 소재한 3개 대학병원의 1년 이상 경력을 가지고, 호스피스완화병동 근무 및 전문 교과 과정을 이수하지 않은 간호사 중 편의 표출한 238명을 대상으로 시행된 서술적 조사연구이다. 수집된 자료는 SPSS/WIN 25.0 프로그램을 이용하여 빈도와 백분율, 평균과 표준편차, independent t-test, one-way ANOVA, Scheffé test, Pearson’s correlation coefficient로 분석하였다. 본 연구의 결과는 다음과 같다. 1. 대상자의 뇌사자 장기이식에 대한 태도 점수는 총점 5점 중 평균 3.63±0.76점으로 비교적 긍정적으로 나타났으며, 하위요인별로 뇌사를 죽음으로 인정(요인 2)이 평균 3.92±0.74으로 가장 높게 측정되었고, 장기이식의 돌봄(요인 4) 3.84±0.69, 뇌사인정의 위험성(요인 3) 3.41±0.86, 뇌사 장기기증에 대한 수용(요인 1) 3.37±0.74순으로 나타났다. 2. 대상자의 호스피스완화의료에 관한 지식 점수는 평균 8.18±2.44점(20점 만점)이었으며, 문항별로 ‘통증조절에서 보조적 요법을 사용하는 것은 중요하다.’가 가장 높은 정답률을 보였다. ‘임종 시 환자 가족이 환자 곁을 지키는 것은 중요하다.’의 정답률이 가장 낮았으나 이는 우리나라 문화와 상반되는 정답이여서 제외하고 ‘위약을 사용하는 것은 어떤 유형의 통증 치료에는 적절하다.’가 가장 낮은 문항이었다. 3. 대상자의 일반적 특성에 따른 뇌사자 장기이식에 대한 태도는 성별(t=3.01, p=.003), 연령(F=2.88, p=.037), 최종학력(F=3.15, p=.045), 결혼 상태(t=-3.12, p=.002), 자녀여부(t=2.22, p=.027), 뇌사자 간호 경험(t=2.39, p=.018)에 따라 유의한 차이가 있었다. 4. 대상자의 일반적 특성에 따른 호스피스완화의료에 관한 지식은 최종학력(F=6.79, p<.001), 직위(F=4.38, p=.014)에 따라 통계적으로 유의한 차이가 있었다. 5. 대상자의 뇌사자 장기이식에 대한 태도와 호스피스완화의료에 관한 지식 간에는 유의한 상관관계가 나타나지 않았다. 이상의 결과를 통하여 호스피스완화의료와 뇌사자 장기이식은 같은 법적 테두리에서 제도가 시행되고 있음에도 실제 호스피스현장에서는 관심을 받지 못하고 있는 것으로 나타났다. 존엄하고 품위 있는 죽음을 맞을 수 있도록 환자와 가족에게 돌봄을 제공한다는 측면에서 호스피스 대상자와 더불어 뇌사자 및 사별가족도 돌봄 서비스의 수혜자가 된다고 하겠다. 즉 호스피스 서비스의 철학 및 윤리의 본래 취지에 따라 서비스 대상을 확장할 필요가 있으며, 나아가 뇌사와 관련된 죽음의 존엄성 유지, 장기이식 및 사별가족간의 갈등과 같은 윤리적 쟁점을 해결하기 위해서는 뇌사자 장기이식에 대한 간호사의 인식개선과 더불어 제도적인 보완을 위한 국가·정책적 차원의 지원이 요구된다. The purpose of this study was to understand nurses attitudes toward brain-death organ transplantation and the degree of knowledge about hospice and palliative care, check the relationship between these variables, develop supportive nursing interventions for brain-death and family, and provide basic data for activating brain-death organ transplantation. The data collection was conducted from December 1, 2019 to March 31, 2020, and is a descriptive research study conducted on 238 nurses who have more than a year of experience in three university hospitals located in B Metropolitan City and have not completed hospice and palliative ward and specialized curriculum. The collected data were analyzed with frequency and percentage, mean and standard deviation, independent t-test, one-way ANOVA, Scheffé test, Pearson's correlation coefficient, using the SPSS/WIN 25.0 program. The results of this study are as follows. 1. The subject's attitude toward brain-death organ transplantation was relatively positive, averaging 3.63±0.76 out of 5 points, and by sub-factor, brain-death was recognized as death (factor 2) with the highest average of 3.92±0.74, the care of organ transplantation (factor 4) was 3.84±0.69, the risk of brain death recognition (factor 3) was 3.41±0.86, and the acceptance of brain death organ donation (factor 1) was 3.37±0.74. 2. The subject's knowledge score on hospice and palliative care averaged 8.18±2.44 out of the total score of 20, and the question 'Using auxiliary therapy in pain control' showed the highest correct answer rate. 'It is important for the patient's family to stand by the patient when dying' had the lowest correct answer rate, but this was contrary to Korean culture so it was be excepted. The lowest question was 'Using placebo is appropriate for any type of pain control'. 3. The difference in attitudes toward brain-death organ transplantation according to the general characteristics of the subjects is gender (t=3.01, p=.003), age (F=2.88, p=.037), final education (F=3.15, p=.045), state of marriage (t=-3.12, p=.002), child status (t=2.22, p=.027), brain-death experience (t=2.39, p=.018). 4. There were statistically significant differences in knowledge of hospice and palliative care according to the general characteristics of the subject, depending on the final educational background (F=6.79, p<.001), and position (F=4.38, p=.014). 5. The relationship between the subject's attitude toward brain-death organ transplantation and knowledge of hospice and palliative care has shown that the two variables are not significantly correlated. The above results show that hospice palliative care and brain-death organ transplantation are not receiving attention at the actual hospice site even though the system is in place under the same legal framework. In terms of providing care to patients and their families so that they can die with dignity and value, brain-death and bereavement families as well as those subject to hospice care will also benefit from the care service. In other words, it is necessary to expand the scope of the service in accordance with the original purpose of the philosophy and ethics of hospice service. Furthermore, in order to resolve ethical issues such as maintaining the dignity of death related to brain-death, organ transplantation and conflicts between separated families, national and policy support for institutional supplementation is required along with improving nurses awareness of organ transplantation of brain-death.

뇌사, 장기기증 및 장기이식에 대한 부산시민의 지식과 태도

정웅재 부산가톨릭대학교 생명과학대학원 2010 국내석사

우리나라에서 2000년 2월 뇌사가 공식적으로 인정되었다. 뇌사의 인정은 또 다른 의미로 장기적출 대상자가 될 수 있음을 의미하므로 장기적출 또한 합법화되어 장기기증과 장기이식이 활성화 될 것으로 기대하였다. 그러나 현실은 장기기증에 대한 국민의식의 미비로 여전히 매우 낮은 수준으로 뇌사자장기기증이 인구 100만 명당 3.5명으로 미국이나 독일의 20%수준에 불과한 실정이다. 최근 선종한 김수환 추기경의 안구기증으로 인해 많은 사람들이 장기기증에 대하여 새롭게 인식하게 되었다. 그러나 장기이식에 대한 국민의식이 항구적으로 유지되지 않은 상태에서는 장기기증이 특별한 사건으로 인해 잠시 주목을 받기는 하지만 오랜 기간 지속적으로는 유지되기는 어려운 실정이다. 그리고 실제로 뇌사자가 발생한다하더라도 장기기증 수준을 활성화시키는 데에는 뇌사를 죽음으로 인정하는 사회적인 공감대가 형성되어야 하는 것은 물론 뇌사자의 장기 기증절차 또한 단순해 져야 할 것이다. 이에 본 연구는 부산시민을 대상으로 뇌사와 장기기증 및 장기이식에 대한 지식과 태도를 분석하고 일반적 특성이 뇌사 및 장기기증에 미치는 영향을 분석함으로서 장기기증에 관한 기초자료를 제공하고 나아가 본 조사로 인하여 장기기증에 관한 국민의식을 제고할 목적으로 시도되었다. 연구대상은 부산시민이였으며 자료수집기간은 2009년 7월 14일부터 8월 31까지 47일 동안이었다. 자료의 수집방법은 연구보조원들을 사전교육 한 후 조사대상자에게 조사목적을 설명하고 대상자가 동의한 경우 대상자 본인이 직접 설문지에 기입 하도록 한 후 바로 회수하는 방법을 사용하였으며 총 2,200부를 회수하여 응답이 불완전한 설문지 158부를 제외하고 2,042부를 최종분석 자료로 사용하였다. 연구도구는 선행연구를 토대로 조사의 목적에 맞게 재구성한 구조화된 설문지였으며, 설문문항은 일반적인 특성 11문항, 뇌사, 장기기증 및 이식에 관한 지식 20문항, 장기이식 및 기증의 태도 33문항, 뇌사에 대한 태도 20문항 등 총 101문항으로 구성되었다. 자료 분석을 위해 한글 SPSS 17.0을 사용 하였으며, 구체적인 분석방법으로는 대상자의 일반적인 특성을 파악하기 위해 빈도분석을 실시하였다. 또한, 대상자의 뇌사 및 장기기증에 대한 인식과 태도는 요인분석 후 평균과 표준편차, 그리고 χ2-test, T-test 그리고 ANOVA로 검증을 실시하였고, 대상자의 일반적 특성에 따른 장기기증 의사에 대한 관련성을 파악하기 위하여 로지스틱 회귀분석을 실시하였다. 본 연구의 결과를 간략하게 요약하면 다음과 같다. 첫째, 대상자 중 장기기증에 대하여 들은 경험이 있는 경우는 71.6%였으며, 처음 접하게 된 매체는 방송으로 73.7%이었다. 둘째, 장기기증의사가 있는 경우는 54.6%이었으며, 장기기증을 결심하게 된 동기는 ‘장기기증센터의 홍보활동을 보고’가 35.0%로 가장 많았고, 그 다음으로는 ‘유명인사의 장기기증을 보고’가 23.1%이었다. 셋째, 뇌사에 대한 인지도에서는 남자 92.8%, 여자 89.5%로 매우 높았다. 뇌사판정에 대해서는 남자 83.7%, 여자 77.5%가 인지하고 있었으며 장기기증절차에 대해서는 남자 49.7%, 여자 40.6%가 인지하고 있었다. 넷째, 이식이 가능한 장기에 대한 지식은 남·여 모두 신장, 각막, 간, 심장 그리고 골수에서는 높았으나 폐, 췌장, 위 그리고 대장에 대해서는 지식이 낮았다. 다섯째, 장기기증 의사에 따른 뇌사, 장기기증 및 장기이식에 대한 지식은 남자의 경우 모든 문항에서 ‘장기기증의사가 있는 대상자’가 높았으며 전체 항목에서 통계적으로 유의한 차이가 있었다. 여자에서는 ‘장기기증의사가 있는 대상자’의 지식이 높았으나 남자와 같이 모든 항목에서 통계적으로 유의한 차이가 나타나지는 않았다. 여섯째, 일반적 특성에 따른 장기기증 및 장기이식에 대한 태도에서 장기기증 의사가 있는 경우는 다음과 같았다. 수용적 태도요인에서는 나이가 많을수록 통계적으로 유의한 차이가 있었다. 배타적태도요인에서는 나이가 많을수록, 기혼자 그리고 종교 있는 자에서 통계적으로 유의한 차이가 있었다. 긍정적 태도요인에서는 남자, 연령이 높을수록, 기혼자 그리고 종교가 있는 자에서 유의한 차이가 있었다. 일곱째, 일반적 특성에 따른 뇌사에 대한 태도에서 장기기증의사가 있는 경우는 다음과 같다. 사망인정 태도요인에서는 남자, 연령이 높을수록, 기혼자 그리고 종교가 없는 자에서 유의한 차이가 있었다. 수용적 태도요인에서는 남자, 연령이 높을수록, 기혼자 그리고 종교가 있는 자에서 유의한 차이가 있었다. 배타적 태도요인에서는 남자, 연령이 높을수록 그리고 기혼자에서 유의한 차이가 있었다. 종교적 태도요인에서 종교가 없는 자에서 유의한 차이가 있었다. 여덟째, 일반적 특성이 장기기증에 대한 태도에 미치는 영향요인으로는 성별, 연령, 본인이나 가족의 만성질환 또는 불치병여부, 종교, 장기기증에 대한 수용적 태도요인, 배타적 태도요인, 긍정적 태도요인이었다. 아홉째, 일반적 특성이 뇌사에 대한 태도에 영향을 미치는 요인으로는 성별, 본인이나 가족의 만성질환 또는 불치병여부, 종교, 사망인정 태도요인, 수용적 태도요인, 배타적 태도요인이었다. 이상의 분석 결과를 바탕으로 장기기증에 대한 국민들의 인식도를 높이고 사회적 공감대를 형성하기 위해서는 무엇보다도 방송과 같은 대중적인 매스미디어를 통한 대국민 홍보활동이 무엇보다 중요하다. 대중매체를 통하여 제공되는 장기기증과 장기이식에 대한 내용은 불특정다수로 하여금 장기기증에 대하여 노출의 빈도를 높이게 되어 장기기증에 대한 인식의 전환을 유도할 수 있을 것이다. 또한 장기기증센터나 관련기관이 범국민적 이벤트를 마련함으로써 장기기증에 대한 국민의식을 전환시키고 나아가 장기기증을 실천할 수 있는 계기가 마련될 수 있도록 다각적 노력이 있어야 할 것이다. In January, 2002, brain death was formally recognized as death in Korea. Recognition of brain death as death also means that those who are brain death can be subjects of extracting organs, and thereby it was expected that organ donation and transplantation would be revitalized with legalized organ extraction. However, the reality is that because of people's lack of consciousness on organ donation, the incidence of organ donation is still considerably low and organ donation by brain death is 3.5 people per million people, which is only 20% of that of the U.S.A and Germany. Recently, Cardinal Kim Su-Hwan's organ donation renewed people's perception on organ donation. However, it is true that a special occasion can draw people's attention on organ donation but it is not remain consistently unless people's consciousness on organ donation is kept permanently. Even if there are brain death cases, in order to activate the level of organ donation, not only we should form social sympathy that people recognize brain death as a death but also we should simplify the process of organ donation for brain-dead people. Thus, this study aims at providing basic data on organ donation by analyzing knowledge and attitudes on brain death, organ donation and transplantation and the effect of general characteristics on brain death and organ donation, and further at improving people's consciousness on organ donation, subject to citizens of Busan City. This study includes general public residing in Busan Metropolitan City and the data was collected for 47 days from 14 July to 31 August, 2009. The data collected firstly by educating research assistants, and by explaining purposes of the research to participants, and then collecting questionaries as soon as participants answered the questionaries directly when they agreed to do so. Among a total of 2200 cases of the questionaries, only 2042 cases were used for final analysis except for 158 cases which are not perfectly answered. Based on previous researches, the questionary as a tool of this study was reorganized for the purposes of this study, which contains a total of 101 questions including 11 questions for general characteristics, 20 for knowledge of brain dead, organ donation and transplantation, 33 for attitudes towards organ transplantation and donation, and 20 for attitudes towards brain death. For data analysis, SPSS 17.0K was used, and for the specific analysis method frequency analysis to understand general characteristics of the participants. In addition, examination on mean, standard deviation and X2-test, T-test and ANOVA analysis were conducted after analyzing the factors for participants' consciousness and attitudes on brain dead and organ transplantation, and logistic regression analysis for understanding of relations between participants' will to donate organs and general characteristics. The results of this study are summarized as follows; First, among the participants, those who have heard about organ donations were 71.6% and the first route contacting the information was 73.7% broadcasting. Second, among 54.6% the participants who are willing to donate their organs, for the motive that they became to decide to donate organs, the majority of the answer was 35.0% after watching PR activities by Organ Donation Center, followed by the answers 23.1%, after watching personages' organ donations. Third, recognition on brain death was significantly high, which was 92.8% for men and 89.5% for women. In regard to diagnosis of brain death, 83.7% of male respondents and 77.5% of female respondents recognized diagnosis of brain death. About the process of organ donation, 49.7% of male respondents and 40.6% of female respondents understood the process of organ donation. Forth, about the knowledge on organs that are possible to be transplanted, both male and female had high understanding of transplanting the kidney, cornea, liver, heart and marrow but low understanding of transplantation of the lung, pancreas, and stomach. Fifth, about the knowledge on brain death, organ donation and transplantation according to the will of organ donation, in the case of male respondents, those with high will of organ donation show high results in all the questions and there was significant differences in all the questions. In the case of female respondents, those with will to donate their organs showed high results, but they did not show significant differences statistically in all the questions as men did. Sixth, in regard to attitudes towards organ donation and transplantation according to general characteristics, when the respondents have the will to donate their organs, the results appeared as follows; for acceptive attitude factor, there were statistic significant differences when the respondents are old. For exclusive attitude, there were statistic significant differences when they are old, married and have religion. In the case of positive attitude factors, there were statistic significant differences when they are men, old, married, and have religion. Seventh, in the attitude towards brain death according to general characteristics, when they have will to donate their organs, the results appears as follows; in the factor of attitudes of recognizing death, there were statistic significant differences when they are men, old, married, and not have religion. For the factor of acceptive attitude, there were statistic significant differences when they are men, old and married. For exclusive attitude, there were statistic significant differences when they are men, old and married. For religious attitude factor, there were statistic significant differences when they are not have religion. Eighth, the factors that general characteristics influence on the attitudes towards organ donation include gender, age, chronic diseases or incurable diseases in the respondents or their family, religion, and acceptive, exclusive and positive attitudes towards organ donation. Ninth, the factors that general characteristics influence on attitudes towards brain death include gender, chronic diseases or incurable diseases in the respondents or their family, religion, and recognizing death, acceptive and exclusive attitudes towards organ donation. Based on the results, in order to raise people's consciousness on organ donation and form social sympathy, more than anything else, public mass media like broadcasting is important. Organ donation and transplantation through mass media may lead to conversion of recognition on organ donation since it can increase many and unspecified persons' the frequency of exposure to organ donation. In addition, as organ donation centers and related institutions prepare nationwide events, we should endeavor to prepare the opportunities in various ways to converse people's consciousness on organ donation and further put organ donation into practice.

뇌사자 장기기증에 대한 장기이식 코디네이터의 태도 분석

최정아 연세대학교 보건대학원 2009 국내석사

Organ transplant coordinators play an important role in the whole process of organ donation. This study attempted to provide materials for public relations, education, and policies to facilitate the process of organ donation. The study investigated organ transplant coordinators’ attitudes toward brain death donor organ donations and analyzed factors affecting their attitudes. The subjects for the present study were 99 organ transplant coordinators working for 71 nationwide organ transplant medical centers. The participants were asked to complete questionnaires. The questionnaire consisted of 46 inquiries, which were 13 questions about general characteristics, 6 questions about experience of organ donations and transplanting, 25 questions about attitudes toward brain death donor organ donations, and 2 questions about other attitudes toward brain death donor organ donations. The questionnaires were returned from October 2nd to 10th of 2008 by email, mail, and fax. A total of 90 copies were collected, reaching a 91 collection rate. program SAS was used to analyze the collected data and obtain frequency, percentages, averages, and standard deviation. T-test, the Analysis of Variance (ANOVA), and the Factor Analysis were run.The results are summarized as follows:1) Positive attitudes toward brain death donor organ donation ranged from 1 point to 5 points with higher points positive. The average and standard deviation of positive attitudes was 4.21±0.56. Especially the highest (4.71±0.56) in positive attitudes was the inquiry ‘I think that the organ donation is important in that it helps terminal patients of malfunctioning organs.’ The next (4.66±0.64) is the inquiry ‘I think that the organ donation is doing good for others.’2) Negative attitudes toward brain death donor organ donation ranged from 1 point to 5 points with higher points negative. The average and standard deviation of negative attitudes was 2.50±0.51. The highest (3.64±1.08) in negative attitudes was the inquiry ‘I feel a burden when I recommend the organ donation to others.’ The next negative inquiries were ‘I am afraid that I might take lawful responsibility for organ donations’ (3.23±1.19) and ‘I am willing to recommend the organ donation, but I do not bother doing so if the patient’s doctor advises not to donate.’ (2.96±1.08).3) Attitudes toward brain death donor organ donations segmented into general characteristics: being married (p=0.0314); academic careers with graduate schools and more (p=0.0096); signing up for an organ donation before in case the subject himself/herself is brain-dead (p=0.0002); signing up for an organ donation when a family member is brain-dead (p=<.0001); being a 1 to 5 year coordinator (p=<.0001); being satisfied with the present task (p=0.0140), whose respondents showed significantly positive attitudes. Being aged 30 to less than 35 (p=0.0123); being unmarried (p=0.0147); no signing up for an organ donation when a family member is brain-dead (p=0.0010); being a less than 1 year coordinator (p=0.0480); no being satisfied with the present task (p=0.0284), whose respondents showed significantly negative attitudes. The respondents’ negative attitudes were also significant in academic careers, even though differences among groups were not significant.4) Experience of the organ donation and transplanting segmented into: recommending the organ donation to a brain death donor family (p=<.0001); managing a brain death donor for the organ donation (p=0.0173); recommending the organ donation or making a brain death donor to the organ donation operation(p=0.0189); a patient who was ever transplanted from other brain-dead donors (p=0.0199); having a patient who ended up dead while waiting for the organ donation (p=0.0008); being trained in organ donations and transplanting (p=0.0046), whose respondents showed significantly positive attitudes. No recommendation of an organ donation to a brain death donor family (p=0.0047), whose respondents showed significantly negative attitudes.5) Factor of opposition to organ donations depending on qualifications of the organ donation and transplant medical centers segmented into: Seoul region transplant medical center, whose respondents showed significantly negative attitudes(p=0.0106). Factor of the burden of recommending organ donations depending on qualifications of the organ donation and transplant medical centers segmented into: Seoul region transplant medical center, whose respondents showed significantly positive attitudes(p=0.0209).6) Factors affecting attitudes toward brain death donor organ donation segmented into four positive and four negative ones. The positive factors were usefulness in organ donations, perception of organ donations, roles played in the process of organ donations, and willingness to donate organs. The negative ones were disbelief in the process of organ donations, opposition to organ donations, cooperation with the medical staff, and the burden of recommending organ donations.In conclusion, organ transplant coordinators’ attitudes toward brain death donor organ donations are positive compared to other groups such as nurses, but the coordinators were hesitant about organ donations by subjects themselves and their family members. They felt burdened in the process of organ donations and negatively approached brain death donor worrying about possible legal responsibilities. Attitudes toward brain-dead patents’ organ donations were significantly different between the coordinators’ general characteristics and experience of an organ donation and transplanting. Factors affecting the coordinators’ attitudes were significantly different among general characteristics, experience of organ donation and transplanting, and qualifications of medical centers the subjects work for.The results in the present study will function as materials for public relations, education, and policies to facilitate the process of organ donation. It is considered that the results will also contribute to training organ transplant coordinators and establishing policies in order to change coordinators’ attitudes towards organ donations in a positive way. 이 연구는 장기이식 코디네이터의 뇌사자 장기기증에 대한 태도를 조사하고, 태도에 영향을 미치는 요인을 분석함으로써 장기기증과정을 촉진시키기 위한 홍보, 교육 및 정책의 기초 자료를 제공하고자 하였다. 대상은 전국 71개 장기이식의료기관에 근무하는 99명의 장기이식 코디네이터로, 일반적 특성을 묻는 13문항, 장기기증 및 이식에 관한 경험을 묻는 6문항, 뇌사자 장기기증에 대한 태도를 묻는 25문항, 기타 뇌사자 장기기증에 대한 의견을 묻는 2문항을 포함한 총 46개 문항의 구조화된 설문지를 이용하였으며, 전자메일, 우편, 팩스로 2008년 10월 2일에서 10월 20일까지 자료를 수집하였다. 총 90부의 설문지를 회수하였으며(회수율 91%), 수집된 자료는 SAS 프로그램을 이용하여 빈도, 백분율, 평균, 표준편차를 구하고, t-test, ANOVA, factor analysis를 시행하였다.본 연구를 통하여 얻은 결론은 다음과 같다.1) 뇌사자 장기기증에 대한 긍정적인 태도는 1점부터 5점 사이의 점수로 계산되며 점수가 높을수록 태도가 긍정적임을 의미한다. 긍정적인 태도의 전체 평균점수는 4.21±0.56점이었으며, ‘나는 장기기증은 말기부전 상태의 환자를 돕는 중요한 일이라고 생각한다'(4.71±0.56)는 항목이 가장 긍정적으로 나타났고, 다음이 ’나는 장기기증은 타인에게 선을 행하는 것이라고 생각한다‘(4.66±0.64)는 항목이었다.2) 뇌사자 장기기증에 대한 부정적인 태도는 1점부터 5점 사이의 점수로 계산되며 점수가 높을수록 태도가 부정적임을 의미한다. 부정적인 태도의 전체 평균과 표준편차는 2.50±0.51점이었으며, ‘나는 장기기증을 권유할 경우 정서적인 부담을 느낀다'(3.65±1.08)는 항목이 가장 부정적으로 나타났고, 다음이 ’나는 장기이식과 관련된 법적 책임에 대해 우려가 된다‘(3.23±1.19), ’나는 기증을 권하고 싶으나 주치의가 장기기증을 권하지 않으면 굳이 하지 않는다‘(2.96±1.08)는 항목이었다.3) 뇌사자 장기기증에 대한 태도 요인 분석에서 긍정적인 태도는 장기기증의 유익, 장기기증에 관한 인식, 장기기증과정에서의 역할, 장기기증에 관한 의지의 4개 요인으로 나누어졌으며, 부정적인 태도는 장기기증과정에 관한 불신, 장기기증에 관한 반대 인식, 의료진과의 협조, 장기기증권유에 관한 부담의 4개 요인으로 나누어졌다.4) 장기이식 코디네이터 본인이 뇌사상태가 되었을 때 장기기증을 하겠다고 장기기증 희망 등록을 한 경우는 52.2%였고, 일반적 특성에 따른 뇌사자 장기기증에 대한 태도는 장기이식 코디네이터로서의 경력이 1년 미만인 경우 긍정적인 태도가 가장 낮았고(p=0.0123)와 부정적인 태도가 가장 높았으며(p=0.0480), 현재 자신의 업무에 만족하는 경우에 긍정적인 태도가 높았고(p=0.0140), 만족하지 않는 경우에 부정적인 태도가 높았다(p=0.0284).5) 장기기증 및 이식에 관한 경험은 부정적인 태도보다 긍정적인 태도에 더 많은 영향을 미쳤다. 특히 긍정적인 태도 요인 중 장기기증과정에서의 역할에서 뇌사자가 발생했을 때 뇌사자의 가족에게 장기기증 권유를 해본 경험이 있고(p=0.0047), 장기기증을 하기 위하여 뇌사 기증자를 간호하거나 관리해본 경험이 있으며(p=0.0028), 대상자가 장기기증을 권유하거나 관리한 뇌사자가 장기기증까지 이루어진 경험이 있고(p=0.0008), 대상자가 관리하는 환자가 뇌사자 장기이식을 받은 경험이 있는 경우(p=0.0119)에 더 태도가 긍정적이었다. 또한 뇌사자의 가족에게 장기기증을 권유를 해본 경험이 있는 경우 긍정적인 태도를 보였고(p=<.0001), 장기기증을 권유해본 경험이 없는 경우 부정적인 태도를 보였다(p=0.0047).6) 장기기증 및 이식에 관한 의료기관의 자격요건에 따른 뇌사자 장기기증에 대한 태도는 부정적인 태도의 요인 분석에서 유의한 차이를 보여, 대상자가 근무하는 의료기관이 1권역(서울, 경기, 인천, 강원, 제주)에 위치한 경우 장기기증에 관한 반대 인식에서 가장 부정적인 태도가 높았고(p=0.0106), 장기기증권유에 관한 부담에서 가장 부정적인 태도가 낮았다(p=0.0209).결론적으로 장기이식 코디네이터의 뇌사자 장기기증에 대한 태도는 다른 간호사군보다 긍정적이었으나, 장기기증과정에서 정서적인 부담을 느끼고 있었으며, 법적 책임에 대해 우려하여, 뇌사자 발생시 소극적으로 접근하는 경향을 보였다. 장기이식 코디네이터의 뇌사자 장기기증에 대한 태도는 일반적 특성과 장기기증 및 이식에 관한 경험, 대상자가 근무하는 의료기관의 자격요건에 따라 유의한 차이를 보였다.본 연구의 결과는 뇌사자의 장기기증과정을 촉진시키기 위한 홍보, 교육 및 정책의 기초 자료로 활용할 수 있을 것이며, 특히 장기이식 코디네이터의 태도를 긍정적으로 변화시키기 위한 교육 및 정책의 수립에 도움이 될 것으로 생각된다.

腦死와 臟器移植에 對한 基督敎 倫理學的 理解

박희찬 明知大學校 社會敎育大學院 1998 국내석사

The writer has reviewed issues on the brain death to be determined as 'death' based op the dignity of human kind and ethical review of organ transplantation, and the purpose of this study is to surmount their problems and to present alternative resolution in Christian ethics. First of all, in Christian ethics the writer investigated whether the brain death cap be determined as death. I am proposing 'possible acceptance of the brain death as death' after reviewing two parties; one who support op the brain death as death and the other who disagree. This is different atartinia point from possible partial acceptance of brain death that teleoloiaists insist op. Originally, the writer does pot agree to the brain death while teleoloiaists insist op possible partial brain death on the basis of utilitariapistic demand and understanding. Just as the problem of interpretation in ethics, 'How to understand God's command' is being a matter of copseguence and attitude of positive opposition to the 'brain death' which might be copfipded. By balancing Christians ethics towards life's total approaching methods and 'the responsible self' f Refold Niebuhr, the writer is presenting a scheme for a reluctant acceptance of the brain death. Acceptance of the brain death is to be limited to only if dignity of life is highly considered as activity of love and necessary conditions are all fulfilled. The following are conditions of determining the brain death as death. 1) Agreement by the person who is facing brain death 2) Clarity of judgement on the brain death 3) Agreement in social controversy 4) Fair selection of patients who will receive organs The conditions above are to secure dignity of human lives. Next, as the transplantation of organs is an activity of love in Christian ethics, the writer is recommending justifiable steps toward possible organ transplantation. Currently, the government is in the process of setting up legal regulations on the organ transplantation. In Christian ethical point of view there might be problems. In a situation of organ transplantation from a person alive reguires protection systems for minors. Name of organ donor should be kept strictly in confidential. Transplantation from the dead body should only be executed based on the agreement made prior to the death. Corpse should not be ignorantly handled and organ transplantation from a brain dead is restricted until finalizaton of precise definition of the brain death and its process of medical analysis that meet the standard of Christian ethics. In closing of this study of Christian ethical understanding of the brain death and the transplant of organs, the writer is proposing few points as follows. First, God has given human life. Since an era of life belongs to God, life has sanctity and dignity, so human cannot control over life. Thus, we must value dignity of human lives whether we disagree or agree on the brain death. Second, life fo human has sanctity and dignity, man behaves himself what should be done with God's permission. In christian ethics the brain death is not considered as death within the philosophy of human dignity. However, rather than completely disagreeing on the brain death I am considering to admit reluctantly to save someone who can extend his life by translpanting organs. Determination of the brain death should be selective and thorough diagnosis is necessary prior to execution. Third, the organ donation is regarded as the precious love of all that man can extend. Although organ transplantation is one of the greatest modern medical studies, currently there are many problems. Particularly, in case of legal regulations in regards to the organ transplantation is implemented, we should be ready to prevent side effects and/or over does well in advance. Fourth, full review of 'legal regulations on the organ transplantation' that the government is going to issue is necessary. Therefore, prior to finalization of the law, Churches are required to put constant efforts on reviewing and pointing out possible problems to meet the standard of Christian ethics. Fifth, current law does not define the brain death as death: however, in the medical science field this has been defined as death and organ transplantation has been practically performed. The organ transplantation should be banned as long as the law does not permit. The medical science field who deals with life of mankind should not violate legal regulations. Now in conclusion, it is insufficient for limited number of persons to discuss over the subject, and Christians as prophets with high standard of ethics need to lead the society to right determination of the 'brain death' and 'organ transplantations'.