一位42歲男性因嚴重創傷性腦損傷已被合法宣告腦死。生命徵象為體溫 35.2°C，血壓 100/60 mmHg，心跳 85 次/分，目前仰賴呼吸器及血管收縮劑維持。病患皮夾內有一張簽署的器官捐贈卡。悲痛的妻子看著心電圖監視器說：「他的心跳還在跳！而且我絕不允許器捐，因為他們會把他的身體大卸八塊。」下列哪些處置符合現行的法律與倫理標準？（多選題）
A 42-year-old male with a severe traumatic brain injury has been legally declared brain dead. Vital signs are Temp 35.2°C, BP 100/60 mmHg, and HR 85 bpm, maintained on mechanical ventilation and vasopressors. The patient's wallet contains a signed organ donor card. The grieving wife observes the cardiac monitor and states, "His heart is still beating! Plus, I won't allow organ donation because they will mutilate his body." Which actions conform to current legal and ethical standards? (Select all that apply.)
- AExplain gently that the heart continues to beat only due to artificial life support and medications.✓ 正解溫和地解釋心臟持續跳動僅是因為人工生命支持系統和藥物作用。
- BInform the wife that the surgical recovery of organs is performed with respect and does not disfigure the body for open-casket viewing.✓ 正解告知妻子，手術取器官的過程充滿尊重，不會毀容，仍可進行開放式棺木瞻仰。
- CImmediately approach the wife to obtain her formal written consent for the organ procurement.立即接近妻子以取得她對器官摘取的正式書面同意。
- DAssure the wife that her refusal will be honored, completely canceling the procurement process.向妻子保證，她的拒絕將被尊重，並完全取消器官摘取程序。
- EContact the regional organ procurement organization (OPO) coordinator to facilitate the specialized family discussion.✓ 正解聯繫區域器官摘取組織（OPO）協調員，以協助進行專業的家属溝通。
本題測試腦死解讀與器官捐贈 (Organ Donation) 的照護。當宣告腦死後，病患在法律與醫學上皆已死亡。護理師應同理並澄清家屬的誤解：心跳的維持純粹是因為機器的供氧與藥物支持（選項A正確）。針對身體遭肢解的恐懼，護理師應衛教器官摘取如同一般外科手術，完成後可進行傳統的開棺瞻仰（選項B正確）。關於勸募流程，護理師或一般醫師不得主動向家屬要求器捐同意，必須由受過特殊訓練的器官勸募組織 (OPO) 協調師來主導討論，以避免利益衝突與情感壓迫（選項E正確，選項C錯誤）。此外，根據美國《統一解剖贈與法》(UAGA)，病患生前簽署的有效器官捐贈卡在法律上具備最高約束力，家屬不能隨意推翻病患本人的器捐遺願（選項D錯誤），OPO 將協助與家屬依法溝通。
This question tests the interpretation of brain death and the care surrounding organ donation. Once brain death has been declared, the patient is legally and medically dead. The nurse should respond empathetically and clarify any misunderstanding by the family: the maintenance of the heartbeat is solely due to mechanical oxygenation and pharmacologic support (Option A is correct). To address fears that the body will be disfigured, the nurse should educate the family that organ procurement is performed like any other surgical operation, after which a traditional open-casket viewing remains possible (Option B is correct). Regarding the request process, nurses and general physicians must not approach families directly to request consent for organ donation; the discussion must be led by a specially trained Organ Procurement Organization (OPO) coordinator to avoid conflict of interest and emotional coercion (Option E is correct; Option C is incorrect). In addition, under the Uniform Anatomical Gift Act (UAGA) in the United States, a valid organ donor card signed by the patient prior to death is legally binding, and family members cannot override the patient's documented wishes (Option D is incorrect); the OPO will assist in legally compliant communication with the family.
美國法規強烈保障註冊過的器捐意願，家屬幾乎無法推翻；但在台灣實務上（《人體器官移植條例》），縱使病患生前已於健保卡註記器捐意願，如果最近親屬在器官摘除前提出書面反對，醫院為避免醫療糾紛通常會終止器捐流程。