体外膜肺氧合辅助潜在捐献者院际转运专家共识

<正>2010年，我国正式启动了公民逝世后器官捐献试点工作，并从2013年2月开始在全国范围内推广。从2015年1月1日起，公民逝世后捐献器官成为尸体器官唯一合法来源。在伦理允许的范围内，围绕人体器官捐献的系列流程，开展规范化管理和不断创新器官捐献者器官保护、安全转运的方式方法，是改善捐献器官质量和器官移植受者预后的关键因素，也是实现器官捐献供者价值最大化的保障。     

在校医学生器官移植与捐献态度及认知的调查

背景：在校医学生对器官移植的认知与态度影响着整个社会对器官移植和捐献的认知,进而影响中国器官捐献移植工作的进程。目的：调查在校医学生对人体器官移植与捐献的态度与认知。方法：选择济宁医学院400名学生为被试进行问卷调查。内容主要包括：①对器官移植、器官（遗体）捐献知识的掌握程度。②器官移植、器官（遗体）捐献知识的来源。③对捐献器官（遗体）所持态度。结果与结论：69.8%在校医学生了解器官移植捐献概念,44.6%赞成捐献自己身后器官。说明在校医学生能较好认同器官移植作为治疗终末期器官功能衰竭的有效手段,但对器官捐献所持态度不很乐观,影响其捐献态度的主要因素为家属情感和捐献程序和传统观念。一年级赞同率最低,为26.6%,五年级最高,为61.4%,赞同率随着年级的升高而增加,55.6%的在校医学生认为应该给予器官捐献者一定的奖励或补偿。     

47例潜在儿童供体父母拒绝器官捐献的原因分析和对策

目的 调查拒绝器官捐献的潜在儿童供体父母的捐献态度,分析其拒绝捐献的原因,并针对原因提出对策。方法 采用方便抽样的方法,抽取2017年6月—2020年4月广州市某三级甲等妇儿医院儿童重症监护室、儿童急诊科、新生儿重症监护室、先天性心脏病重症监护室拒绝器官捐献的潜在儿童供体的父亲或母亲作为研究对象,采用潜在儿童供体父母的捐献态度问卷对其进行调查。结果 拒绝器官捐献的47例潜在儿童供体的父亲或母亲中,16例（34%）不能接受孩子的预后;33例（70%）认为患儿还有好转机会;16例（35%）认同“脑死亡即死亡”的观点;10例（21%）之前了解过器官捐献; 27例（57%）表示会因捐献孩子器官而愧疚;21例（45%）认为孩子的现状自己有过错;根据当地丧葬风俗,19例（40%）要带死者归家。潜在儿童供体父亲或母亲拒绝器官捐献原因的前3位为：担心手术会带来痛苦,不想孩子再受苦28例（60%）;不想破坏孩子身体的完整性,想让孩子完完整整的离开26例（55%）;当地丧葬风俗必须将死者身体完整带回去19例（40%）。结论 拒绝器官捐献的潜在儿童供体父母对患儿有较强烈的愧疚感,拒绝接受患儿预后不良;对脑死亡接受程度较低;器官捐献知晓率较低。其中,担心手术痛苦、不想破坏身体完整性、风俗习惯是潜在儿童供体父母拒绝捐献的主要原因。建议针对拒绝器官捐献原因,从哲学角度讨论生死观,加大对器官捐献和脑死亡的宣传,同时提高重症监护室医务人员的参与力度,以提高符合捐献标准的潜在供体捐献成功率。     

“第四届上海国际呼吸病研讨会（ISRD）暨第十五届亚太呼吸治疗学会（APARC）联合会议”在上海胜利闭幕

由复旦大学中山医院呼吸科、英国器官功能衰竭杂志（Journal of Organ Dysfunction）、亚太呼吸监护协会和上海医学会共同举办的第四届上海国际呼吸病研讨会（ISRD）暨第十五届亚太呼吸监护协会会议（APARC）于2007年11月3日在光大国际会议中心举行，并于11月5日成功落下帷幕。     

家属对亲属器官捐献决定的影响因素及对策研究

[目的]通过参与协调的潜在心脏死亡遗体器官捐献(DCD)案例,探讨影响家属决定亲属器官捐献的因素及解决对策.[方法]2010年3月至2011年3月,对51例潜在捐献者家属进行开放式访谈,探讨协调介入时间和环境、协调员的专业水平、家属对脑死亡及捐献流程信息的了解、家庭组成对家属捐献决定的影响.[结果]成功捐献的案例,协调...     

公民逝世后器官捐献肝移植保存液污染:基于78例单中心对照研究

目的分析公民逝世后器官捐献肝移植保存液（PS）污染情况。方法根据捐献肝脏PS培养结果将2016年3月~2017年10月广州某三甲医院78例公民逝世后器官捐献肝移植受者分为阳性组和阴性组。阳性组围手术期序贯应用厄他培南和亚胺培南,疗程为1周;阴性组停用亚胺培南。对保存液污染病原菌分布、术后3月感染和预后情况进行统计分析。结果78例肝移植患者中,32例PS培养阳性,阳性率41.03%,共分离出33株病原菌。分离出最常见的病原菌是革兰氏阴性杆菌（9株,27.27%）和凝固酶阴性葡萄糖球菌（9株,27.27%）。培养液阳性组和阴性组肝移植术后感染率分别为31.25%和13.04%（χ2=3.837,P=0.048）。感染例次最多的部位是下呼吸道和腹腔（5例,31.25%）,其次是手术切口（4例,25.00%）。不同肝功能CTP、MELD评分以及手术方式患者术后感染率差异无统计学意义（P>0.05）。1例（1.28%）术后3周发生与PS污染相同的病原菌感染,并因多脏器功能衰竭而死亡。在术后随访3月内,阳性组和阴性组患者急性排斥反应率和死亡率分别为3.13%（1例）、4.35%（2例）和6.25%（2例）、10.87%（5例）,差异均无统计学意义（P>0.05）。结论公民逝世后捐献肝脏PS经常受到污染,PS污染是受者术后感染的危险因素。早期针对性抗菌素治疗对降低公民逝世后捐献肝脏PS污染相关的感染有着积极作用。      

家属对亲属器官捐献决定的影响因素分析及应对措施

目的通过潜在心脏死亡人体器官捐献(DCD)案例的访谈工作,探讨家属对亲属器官捐献决定的影响因素分析及应对措施,为制定临床上缓解器官供应紧缺的应对方案提供依据。方法选取2015年1月~2016年1月参与本移植医学中心协调的潜在DCD案例62例,对潜在DCD者的家属通过专业调查人员进行访谈,通过对DCD案例成败分析、访谈时机、调查人员专业度、家属对器官捐献接受程度、家庭成员构造、家庭成员对DCD决定的影响等调查,探索家属对亲属器官捐献决定的影响因素分析及应对措施。结果捐献成功的主要因素:（1）与家属访谈的时机均为家属放弃治疗之后;（2）家属接受临床DCD的概念及流程,对DCD体制和使用情况不会质疑;（3）调查人员通过DCD访谈技巧培训;（4）患者家庭构造是核心家庭,DCD讨论参与者只有核心的家庭成员。结论家属对亲属DCD的决定受多种因素的影响,政府与医疗机构需要规范DCD 体制,加强调查人员的专业培训,宣传DCD知识,改良DCD的社会舆论,建立国家级DCD登记与分配平台,进而缓解器官供应紧缺的难题,提高我国DCD数量和捐献率具有重要的临床意义。      

我国公民对器官捐献的态度及其影响因素

目的了解我国公民对器官捐献态度的现状及其影响因素。方法检索中国生物医学文摘数据库CBMdisc（1978—2009年）、维普资讯中文科技期刊数据库（1989—2010年）、中国期刊全文数据库CNKI（1994—2009年）中关于器官捐献态度的调查性论文,同时筛检纳入论文的参考文献,并对检索收集的文献进行信息提取和分析。结果有关调查我国公民对器官捐献态度的研究不多,本研究共纳入9篇论文。9篇论文中调查对象以大学生、医护人员居多。各调查结果中公民赞成遗体器官捐献的有40％～70％,赞成活体器官捐献的有60％～80％。影响器官捐献的主要因素有对器官捐献知识和意义的认知程度、伦理道德、人生价值观、法律法规建设、器官捐献分配体系建设、社会支持力度、传统观念、宗教信仰和封建习俗、家庭利益及个人心理因素等。结论切实了解我国公民对器官捐献的真实态度及想法,可为器官移植和器官捐献事业的推进提供参考依据,有关部门应加大提高公民自愿捐献器官意识的力度,加快建设中国的器官捐献体系。     

儿童心脏死亡器官捐献与肾脏移植1例报告

背景：器官短缺是全球移植界共同面临的难题,为扩大供者来源,缓解日益紧张的器官短缺,回避因脑死亡立法及诊断标准缺位造成的困惑,卫生部和中国红十字会联合推动心脏死亡器官捐献。目的：探讨开展儿童心脏死亡器官捐献的可行性。方法：回顾性分析解放军南京军区福州总医院1例儿童心脏死亡肾脏捐献案例,结合文献进行分析。结果与结论：4岁男孩,心肺复苏后脑死亡,经过2次两组专家时隔24h按脑死亡判定标准（儿童）和脑死亡判定技术规范,以及阿托品试验结果独立作出判定。捐献者父母对捐献方案知情同意,书面表达捐献意愿,且得到医院伦理委员会批准。按中国心脏死亡器官捐献工作指南逐步完成捐献申请、审批、转运、器官维护,以及生命支持治疗撤除、器官切取过程,热缺血时间13min。按年龄、体质量和组织配型结果选择受者,2只肾脏分别植入2例尿毒症受者体内,左肾接受者为13岁女性,右肾接受者为35岁女性,术后未发生肾功能延迟恢复,无移植肾血管栓塞、尿瘘、输尿管梗阻等并发症。术后1年内移植肾由术前7cm增大至10cm,尿蛋白阴性,血肌酐≤60μmol/L,估算肾小球滤过率70-150mL/min。术后至今均未发生严重感染事件,血压正常,无糖尿病、高脂血症、肝功能损害等并发症,现生活自理,精神状态好,遵医行为佳。提示儿童心脏死亡器官捐献是过渡时期解决器官来源的方向之一。必须严格遵守患者救治利益高于一切的基本原则,积极探索儿童心脏死亡器官捐献规范化操作程序。     

护士对器官捐献协调知识、信念、行为现况及影响因素分析

[目的]了解护士对器官捐献协调的知识、态度、行为现况及影响因素。[方法]采用自行设计的一般资料调查表及器官捐献协调知识量表、态度量表、行为问卷对北京市某三级甲等综合医院35个科室的303名护士进行问卷调查。[结果]器官捐献协调工作知识量表均分为20.14分,态度量表均分为3.73分,器官捐献协调工作态度量表的动力维度均分4.01分、阻力维度均分2.47分;0.7%的研究对象表示有过器官捐献协调工作的经验;0.3%表示做过器官捐献专业协调员;器官捐献协调工作知识与态度得分呈正相关(r=0.171,P<0.05);逐步回归分析显示:职称、参加过公益活动以及接受过器官移植或捐献的相关培训是影响知识得分的因素(P<0.05);职称、学历、执业过程中遇到过潜在捐献者及身边的人捐献过器官是影响态度得分的因素(P<0.05)。[结论]护士对器官捐献协调工作的知识掌握程度处于中等水平;护士对器官捐献协调工作的态度比较积极,但同时拥有诸多顾虑担心,应加强对护士的相关培训,加快器官捐献协调工作的职业化建设,使护士消除顾虑,积极投身器官捐献协调工作。     

The incidence of potential missed organ donors in intensive care units and emergency rooms: a retrospective cohort

Purpose

There is a shortage of organ donors in Canada. The number of potential organ donors that are not referred to organ procurement organizations in Canada is unknown.

Methods

We conducted a retrospective cohort study of all deaths in ICUs and emergency rooms not referred to the Human Organ Procurement and Exchange Program in four hospitals between 1 January 2008 and 31 December 2010. The primary outcome was the number of normal and expanded criteria heart-beating donors and circulatory death (DCD) donors.

Results

Of 2,931 deaths, 64 patients were identified as having a high probability for progression to heart-beating donation (Glasgow Coma Score of 3 and three or more absent brainstem reflexes) and 130 patients were assessed for possible DCD donation. The number of potential abdominal and lung heart-beating donors ranged from 3.2 to 7.5 and 0.5 to 2.7 per million population. The number of potential DCD abdominal and lung donors ranged from 3.9 to 6.5 and 2.7 to 4.3 per million population. Potential heart-beating abdominal (p = 0.04) and lung (p = 0.06) donors increased after legislation mandating donation discussion. Non-pupillary brainstem reflexes were documented in fewer than 60 % of records. Life-sustaining treatment was withdrawn in 19 of 46 (41.3 %) cardiac arrest patients not requiring high doses of vasoactive drugs within 24 h.

Conclusion

The number of heart-beating or DCD organ donors represented by missed referrals may represent up to 7.5 donors per million population. Improved documentation of brainstem reflexes and encouraging referral of patients suffering cardiac arrest to ICU specialists may improve donor numbers.     

Why families deny consent to organ donation.

Advances in medical practice and technology and the success of organ transplantation over the past 2 decades have resulted in an increased demand for organ donors. However, the health care community and organ procurement organisations (OPO) are faced with a worldwide shortage of donor organs. The non-consent of families is the most common reason that organs of medically suitable potential donors are not recovered. A review of published research post 1990 was conducted to primarily determine the major factors that influence a family's decision to deny consent to donation. Other objectives included providing suggestions for health care personnel to facilitate the donation request experience and to suggest strategies that would increase donation consent rates to benefit the organ procurement process. Databases predominately used in the review included CINAHL and Medline. The world wide web (www) was also accessed. The literature review indicates that the significant factors associated with denial of consent include: the misunderstanding of brain death; cultural beliefs; the specific timing of the request; the setting in which the request is made; the approach of the individual making the request; and characteristics of the deceased. Organ donation and transplantation rates could be increased by the joint involvement of medical, nursing and OPO personnel to enhance the quality of hospital care and to ensure that requests for donation are handled in a way that meets the family's informational and emotional needs. Increased consent rates have the potential to save lives and improve the quality of life for organ recipients.     

Identifying the potential organ donor: an audit of hospital deaths

Objective To quantify the potential for organ donation in Victoria and identify missed opportunities for organ donation.Design and setting Prospective medical record audit of all deaths in 12 Victorian hospitals.Measurements Data on deaths, total potential donors, organ donors and outcome of requests for organ donation were collected. Patients in whom brain death was confirmed or likely to occur and in whom organ donation was not requested (unrealised potential donors) were classified by an independent panel. Rates of organ donation and unrealised donors were determined as a proportion of total potential donors and hospital deaths and the maximal potential organ donor rate was estimated.Results Of 5551 deaths, there were 112 potential donors, with 66 requests for organ donation resulting in 39 consents (consent rate of 59%) and 37 organ donors (33% of total potential donors; 0.7% of hospital deaths). Two consented potential donors did not donate due to failed physiological support (5%). There were 46 medically suitable unrealised potential donors; 3 with confirmed brain death. Approximately half of these patients had treatment withdrawn in the intensive care unit and half in the Emergency Department. The estimated maximal potential donor rate was 30 per million population.Conclusions The potential for organ donation in Victoria is relatively low compared with previous estimates in Australia and overseas. An increase in the organ donation rate may be possible through increasing consent and the identification and support of potential donors. This would require substantial changes in clinical practice that have resource and ethical implications.     

Exploring the unseen effect of COVID 19 pandemic on blood transfusion services in a tertiary care centre

BackgroundThe coronavirus pandemic confronted blood transfusion services with major challenges. The present study was conducted to explore the effect of the COVID-19 pandemic on blood transfusion services including seroprevalence of transfusion-transmitted infections.Material and MethodsA retrospective cross-sectional study was conducted and data on blood donation, utilization, camps, plateletpheresis and seroprevalence of transfusion-transmitted infections (TTI) was retrieved from software from March to September 2020 and 2021 and compared with corresponding time periods of three preceding non-pandemic years.ResultsThere was a decline of 53.79% and 34.4% in blood donations in 2020 and 2021 respectively with a significant reduction in voluntary donations from 91.8% in the pre-pandemic period to 72.2% in 2020 and 77.7% in 2021. Replacement donors increased by 60.81% and 72.89% in 2020 and 2021 respectively. There was a decline of 48.4% in the number of plateletpheresis procedures in 2020 which increased in 2021 during the dengue outbreak. The decline in total blood donations and issue of packed red blood cells was statistically significant but supply and demand were balanced with no deficit. TTI seroprevalence increased from 1.01% to 1.49%(p<0.001) and 1.51%(p<0.001) in 2020 and 2021 respectively. Replacement donors showed a significantly higher TTI prevalence as compared to voluntary donors(p<0.001). A significant increase in prevalence was observed for Syphilis (0.4%) in 2020 and HBsAg (0.54%), HCV(0.63%) and syphilis (0.25%) in 2021.ConclusionThe potential consequences of the COVID-19 pandemic on blood safety cannot be undermined. Developing a strong database of regular voluntary donors can be instrumental in dealing with future waves and surges in infections.     

ICU nurses’ perceptions of responsibilities and organisation in relation to organ donation—A phenomenographic study

Objectives

According to the Istanbul declaration, health services should create better routines for identifying potential donors. A previous study involving 702 intensive and critical care (ICU) nurses revealed that only 48% trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. The aim was to study ICU nurses’ perceptions of their experiences of professional responsibilities and organisational aspects in relation to organ donation and how they understand and perceive brain death.

Methods

A phenomenographic method was chosen. Data collection (interviews) took place in Sweden and included fifteen nurses; one man and fourteen women, from six hospitals serving different geographic areas.

Results

The findings pertain to three domains: ICU nurses’ perceptions of (1) their professional responsibility, (2) the role of the organisation regarding organ donation and (3) death and the diagnosis of brain death.

Conclusion

The ambiguity and various perceptions of brain death diagnosis seem to be a crucial aspect when caring for a brain dead patient. The lack of structured and sufficient organisation also appears to be a limiting factor. Both these aspects are essential for the ICU nurses’ opportunities to fulfil their professional responsibility during the organ donation process.     

Organ donation within the intensive care unit: A retrospective audit

BackgroundDespite many Australians supporting organ donation, national posthumous organ donation rates have not increased as expected over the last three decades. Little is known about the barriers to organ donation for patients in intensive care that meet the criteria for organ donation.ObjectiveThe aim of this study was to describe the characteristics of patients identified as potentially suitable for organ donation and to explore the variables associated with the success, or failure, of solid organ donation within the context of an Australian public hospital intensive care unit (ICU).MethodsA retrospective audit examined electronic records of 280 potential organ donors aged 18–80 years, admitted into the ICU between 1 July 2012 and 30 June 2016. Data extracted from three separate electronic hospital databases were amalgamated for analysis.ResultsOf the 280 potential organ donors identified, conversations with families of 182 (65%) patients resulted in their agreement to organ donation. Consent to organ donation was most often provided by the patient's spouse (65, 35.7%); however, only 63.7% (n = 116) were successful organ donors. The remaining 36.3% (n = 66) of patients did not donate organs for medical reasons. Compared with those who did not donate, the typical organ donor was significantly younger (M 49.9 years, p = 0.020), Australian-born (p = 0.031), and had a shorter length of ICU stay (M 64.9 h, p = 0.002). The most frequently donated organs were kidneys (103, 88.8%), lungs (59, 50.9%), and livers (52, 44.8%).ConclusionThis study provided insights into patient, family, and organisational factors contributing to the success of organ donation outcomes in the ICU. Two factors that adversely impacted donation outcomes were the following: (1) the family did not consent to organ donation on behalf of the patient and (2) consent was provided, but donation did not proceed for medical reasons. Although the focus on the consenting process has been raised, this study highlights the additional impact of medical suitability on rates of organ donation. Family members may experience significant disappointment after consent that may have repercussions on their health and also future donation considerations. This study also highlighted some deficiencies in the databases that, if addressed, could better inform organisational processes in the consent and support of those making decisions about consent.