Moral injury in health care is characterized as the lasting psychological, biological, and social impact on providers that occurs following an adverse patient outcome. Moral injury can contribute to second victim syndrome and lasting psychological harm. Although many surgeons face moral injury due to patient acuity and the potential for intraoperative or postoperative complications, the transplant ecosystem compounds the impact of moral injury. Institutional blame placed on the transplant surgeon following a posttransplant death or graft loss is magnified by public reporting. Centers whose outcomes fall below threshold levels are subject to regulatory citation and financial loss. Moral injury can also result in risk aversion, limiting access to transplants for higher-risk candidates and reducing acceptance of marginal organs hurting donor families. Strategies to increase resilience, reduce accusation and blame, and focus on system quality improvement are vital to mitigate the impact of moral injury on transplant professionals. The transplant community must proactively work to reduce moral injury to protect surgeons, ensure access to life-saving transplant procedures, and avoid unnecessary organ offer declines.

中文翻译：

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道德伤害：移植手术的不言而喻的负担


医疗保健中的道德伤害的特点是在患者不良结果后对提供者产生持久的心理、生物和社会影响。道德伤害会导致第二受害者综合症和持久的心理伤害。尽管许多外科医生由于患者的敏锐度以及术中或术后并发症的可能性而面临道德伤害，但移植生态系统加剧了道德伤害的影响。移植后死亡或移植物丢失后，移植外科医生受到的机构指责被公开报道放大。结果低于阈值水平的中心将受到监管引用和经济损失。道德伤害还可能导致风险厌恶，限制高风险候选人获得移植的机会，并减少对伤害供体家庭的边缘器官的接受度。提高弹性、减少指责和责备以及专注于系统质量改进的策略对于减轻道德伤害对移植专业人员的影响至关重要。移植界必须积极努力减少道德伤害，以保护外科医生，确保获得挽救生命的移植手术，并避免不必要的器官报价拒绝。