潜在器官捐献者家属捐献意愿现状及影响因素分析

目的探讨潜在器官捐献者家属捐献意愿现状并探讨其影响因素。方法选取2015年1月-2018年12月我院危重患者家属404名,根据其是否有意向进行器官捐献及是否最终捐赠分为有意向最终捐献组(49名)、有意向未捐献组(41名)及无意向组(314名)。分析可能影响3组家属进行器官捐献的相关因素。结果 (1)单因素分析结果显示,学历、年收入、宗教信仰、医学专业、接受器官捐赠宣教、接受组织协调、担忧自身权益、担心分配不均及对机构不信任是家属捐献意愿的影响因素,差异有统计学意义(P0.05)。(2)有序Logistics分析结果显示,高收入且为医学专业是促进器官捐赠的影响因素,而低学历、未接受器官捐赠宣教、担心自身权益得不到保障、无组织协调及对机构不信任则是潜在人群拒绝器官捐赠的影响因素。结论对潜在器官捐献家属进行宣教和出台相关政策保证器官捐赠人群自身权益,并将相关事宜透明化,是促进潜在器官捐赠家属捐赠的有效手段,其中保障器官捐赠者自身权益是捐赠者主要关心问题。     

我国器官捐献存在的问题及促进措施

介绍了器官捐献的起源、我国器官捐献的现状、影响器官捐献的因素、促进器官捐献发展的措施.     

国际标准化心脏死亡器官捐献家属器官捐献前的评估及干预

<正>器官捐献在我国尚属新生事物,也是世界敏感的社会问题[1]。目前临床上器官捐献有国际标准化脑死亡器官捐献(DBD)、国际标准化心脏死亡器官捐献(DCD)、中国过渡时期脑-心双死亡标准器官捐献(DBCD),但由于国情、习惯等,我国器官捐献量较少。人体器官捐献协调员由人体器官捐献办公室聘任、培训和管理。协调员由相关机构的专业人员担任,主要职责为开展人体器官捐献宣传、发现潜在捐献者、组织协调登记等。     

器官移植供体短缺之解决途径:器官捐献

○器官移植体的现状:没有供体,就没有器官移植,国内器官移植供需矛盾日益突出.○亲属器官移植的利弊:亲属活体供体是最好的器官,但亲属活体移植仍存在诸多困难.○供体短缺的主要原因:伦理道德、医疗技术、立法?○器官移植供体短缺解决途径:减少需求、避免浪费、扩展来源,解决立法,推动器官捐献体系工作的开展     

心死亡捐献供体器官保护中体外膜肺氧合技术的应用研究进展

本文综述体外膜肺氧合（ECMO）在心死亡器官捐献（DCD）中的应用，讨论了“不触碰”时间、ECMO置管及开启时机、ECMO灌注温度、肝素化时机、ECMO支持过程中的炎症反应等相关问题。心死亡器官捐献器官获取过程中，ECMO在改善DCD器官的可用性方面取得了非常好的效果。ECMO的使用可以使器官热缺血时间明显减少，减少热缺血对器官的损伤。但在伦理、法律、ECMO管理技术等方面还存在诸多的争议。     

心脏死亡器官捐献供者家属应对压力的探讨

目的：探讨压力理论对心脏死亡器官捐献供者家属面临的伦理问题的指导性意义,缓解供者家属焦虑状态,争取可供移植器官的来源。方法收集我院54例潜在捐献者资料,分析捐献者家属心理压力的来源,探讨压力理论对缓解压力,加强供者家属对伦理问题应对的作用。结果54例潜在捐献者中同意捐献者35例,成功捐献22例。结论压力理论可应用于今后心脏死亡器官捐献供者家属管理中,为争取更多可移植器官提供保障。     

构建国内器官捐献救助体系的思考

背景：进入21世纪,器官移植事业飞速发展,器官移植供体的短缺极大的限制了这项技术在临床领域的充分运用,而中国1：30的数量比更是阻碍中国器官移植事业发展的“瓶颈”。目的：探讨建立人体器官捐献救助体系的意义、内容及途径,分析目前中国器官捐献救助存在的问题,提出器官捐献救助的措施。方法：在CNKI和PubMed通过关键词“器官捐献、器官移植、救助”查阅相关文献,对来源于核心期刊的文章进行综合分析。同时,深入临床,通过交谈法了解器官捐献者和医务人员的呼声,为文章救助措施的提出提供了具有现实意义的依据。结果与结论：为了器官移植事业的快速发展,从社会、经济、心理等方面对器官捐献者给予一定的人道主义救助乃大势所趋,同时,从法律援助、制度设计、组织构建、工作人员配置几个方面提出构建符合中国国情的器官捐献救助体系,确保救助措施落到实处。     

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。     

非医学人员器官捐献意愿调查及原因分析

目的 了解没有医学背景的人群对器官捐献的意愿,并分析其原因.方法 采取便利抽样的方法,随机抽取兰州市没有医学背景者共540名,进行问卷调查,并对问卷结果进行分析.结果 非医学人员捐献器官的意愿在7.7％ ～ 35.9％,其中愿意为家人捐献活体器官者占35.9％,捐献尸体器官者占8.9％,愿意为家人捐献活体器官和尸体器官者占30.8％;愿意为陌生人捐献活体器官者占7.9％,捐献尸体器官者占29.2％,愿意为陌生人捐献活体器官及尸体器官者占7.7％.愿意捐献活体和尸体器官的原因主要是能够拯救生命、延长他人寿命,不愿意捐献活体器官的主要原因为对死亡的害怕和恐惧、担心身体的完整性受损、担心寿命缩短;不愿意捐献尸体器官的主要原因是担心身体的完整性受损、对死亡的害怕和恐惧、受到文化及风俗习惯的影响.结论 非医学人员因缺乏对器官捐献的认知而不愿意捐献器官,提高器官捐献率的有效措施为普及器官捐献及移植的相关知识,提高公众的认知.     

脑死亡患者家属器官捐献决策体验的Meta整合

目的 对脑死亡患者家属器官捐献决策的体验进行Meta整合。方法 检索PubMed、Cochrane Library、Web of Science、Embase、CINAHL、ProQuest、中国知网、万方数据库、维普数据库、中国生物医学文献数据库关于脑死亡患者家属器官捐献决策体验的质性研究,检索时限为建库至2022年6月。采用2016版澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准进行质量评价,对结果进行Meta整合。结果 共纳入12项研究,提炼出63个研究结果,归纳出10个新类别,3个整合结果。整合结果1为尊重患者及益处获得;整合结果2为矛盾且复杂的决策过程;整合结果3为渴望正向互动与社会支持。结论 脑死亡患者家属器官捐献决策体验复杂,与医护人员的互动质量影响最终的决策结果,医护人员应提供脑死亡相关知识并确保家属正确理解,不断提高器官捐献沟通的专业性,给家属相应的支持及人文关怀,帮助其渡过丧亲之痛,解决决策困境,作出符合其家庭情况的捐献决定。     

Care of the multiple organ donor

Successful organ transplantation offers patients with end stage organ failure the chance of a normal life. The recognition of brain death allowed the use of beating heart donors and this has enabled multiple organ procurement from a single donor. Suitable patients with severe brain injury resulting in brain death, who may be potential organ donors, are to be found on both neurosurgical and general intensive care units. The pathophysiological results of brain death are similar, irrespective of the underlying cause. Severe brain injury may result in the loss of temperature regulation, and the development of diabetes insipidus and cardiovascular instability. The management of brain injury before death often results in abnormalities of fluid balance, due to fluid restriction and diuretic therapy. Other problems such as acute endocrine failure and the impact of their correction on ultimate organ function remains to be elucidated. Good donor maintenance in the intensive care unit and operating theatre is essential if optimal function of the transplanted organ is to occur.     

Comparison of high- and low-dose corticosteroid regimens for organ donor management

Purpose

Corticosteroids are used to promote hemodynamic stability and reduce inflammatory organ injury after brain death. High-dose (HD) methylprednisolone has become the standard regimen based on comparisons to untreated/historical controls. However, this protocol may exacerbate hyperglycemia. Our objective was to compare a lower-dose (LD) steroid protocol (adequate for hemodynamic stabilization in adrenal insufficiency and sepsis) to the traditional HD regimen in the management of brain-dead organ donors.

Methods

We evaluated 132 consecutive brain-dead donors managed before and after changing the steroid protocol from 15 mg/kg methylprednisolone (HD) to 300 mg hydrocortisone (LD). Primary outcome measures were glycemic control, oxygenation, hemodynamic stability, and organs transplanted.

Results

Groups were balanced except for nonsignificantly higher baseline Pao₂ in the LD cohort. Final Pao₂ remained higher (394 mm Hg LD vs 333 mm Hg HD, P = .03); but improvement in oxygenation was comparable (+ 37 mm Hg LD vs + 28 mm Hg HD, P = .43), as was the proportion able to come off vasopressor support (39% LD vs 47% HD, P = .38). Similar proportions of lungs (44% vs 33%) and hearts (31% vs 27%) were transplanted in both groups. After excluding diabetics, median glucose values at 4 hours (170 mmol/L vs 188 mmol/L, P = .06) and final insulin requirements (2.9 U/h vs 8.4 U/h, P = .01) were lower with LD steroids; and more patients were off insulin infusions (74% LD vs 53% HD, P = .02).

Conclusions

A lower-dose corticosteroid protocol did not result in worsened donor pulmonary or cardiac function, with comparable organs transplanted compared with the traditional HD regimen. Insulin requirements and glycemic control were improved. High-dose methylprednisolone may not be required to support brain-dead donors.     

Two perspectives on organ donation: experiences of potential donor families and intensive care physicians of the same event

The aim was to explore how relatives and physicians understood cases where organ donation had been requested and what factors were salient for the decision on donation. Physicians of 25 deceased patients and 20 relatives were interviewed. The material was analyzed using qualitative methods. Eleven patients had declared their wishes on donation before death; in 14 cases the relatives had to decide. Half of these relatives accepted donation and half refused. The donation request was of secondary importance to the families; they were totally occupied by the death and initially tried to avoid the request by regarding “no” as a nonresponse. They needed support to relieve their immediate reactions of uneasiness, start rational thought processes, and reach well-grounded answers. The basis for requesting donation was good; relatives, with regard to circumstances, had been well prepared for the death by continuous information from the physicians and had confidence in staff, accepted that the question was raised, and understood the death criteria. However, about half the physicians experienced conflicts regarding prerequisites of procuring organs and dealing with relatives. Three different approaches were displayed: prodonation, neutral, and ambivalent. Only physicians with a prodonation approach received acceptance for donation.     

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.     

Psychosocial factors influencing nurses' involvement with organ and tissue donation

This paper focuses on the first phase of a 3-year study that explored the psychosocial factors that influence nurses' willingness to discuss post-mortem donation intentions with relatives of potential organ and tissue donors. The United Kingdom's donation system is dependent upon such discussions taking place. A cross-sectional survey of 776 randomly selected nurses, from two health regions in the United Kingdom, found that personal negative attitudes to aspects of donation and transplantation, fears and misconceptions about the donation process, clinical area of work, past experience, and socio-historical factors influence discussion behaviour. Knowledge deficits were discovered, together with requests for general information about the donation process and specific information about the organ and tissue donor exclusion criteria.     

急诊科护士心理健康状况及影响因素的调查分析

目的:调查急诊科护士的心理健康状况,分析影响其心理健康的因素。方法:采用SCL-90、SAS、SDS问卷调查122名急诊科护士的心理健康状况,同时分析其影响因素。结果:急诊科护士SCL-90有6个因子分和总均分、SAS和SDS评分均高于全国常模(P<0.05);单因素分析显示:专业水平、工作紧张状况、濒死或死亡现象的刺激、人身安全、对传染病的恐惧、自我调节和应对方式等6个因素可能是产生心理问题的原因;多因素Logistic回归显示:专业水平、濒死或死亡现象的刺激及自我调节和应对方式是产生心理健康问题的主要原因。结论:急诊科护士心理健康状况较差,可能存在一定的心理健康问题,应该积极应对。     

An underrecognized source of organ donors: patients with brain death after successfully resuscitated cardiac arrest

Objective To identify predictors of brain death after successful resuscitation of out-of-hospital cardiac arrest (OHCA), with the goal of improving the detection of brain death, and to evaluate outcomes of solid organs harvested from these patients. Design and setting Prospective observational cohort study in a medical and surgical unit of a nonuniversity hospital. Patients Patients with successfully resuscitated OHCA were prospectively included in a database over a 7-year period. We looked for early predictors of brain death and compared outcomes of organ transplants from these patients to those from patients with brain death due to head injury or stroke. Results Over the 7-year period 246 patients were included. No early predictors of brain death were found. Of the 40 patients (16%) who met criteria for brain death, after a median ICU stay of 2.5 days (IQR 2.0–4.2), 19 donated 52 solid organs (29 kidneys, 14 livers, 7 hearts, and 2 lungs). Outcomes of kidneys and livers did not differ between donors with and without resuscitated cardiac arrest. Conclusions Brain death may occur in about one-sixth of patients after successfully resuscitated OHCA, creating opportunities for organ donation. C. A. received a grant from the publicly funded organization Agence de Biomédecine which manages organ donor data in France.     

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.