一例心脏死亡供体无偿捐献供肝行原位肝移植的经验和体会

目的 总结心脏死亡供体器官捐献具体流程和经验.方法 对1例潜在器官捐献者经脑死亡评估和供体器官功能评估后,纳入心脏死亡器官捐献(Donation after Cardiac Death,DCD)程序,并严格按照心脏死亡器官捐献程序进行工作.结果 本例供体成功完成了肝脏捐献及获取流程,所获取供肝成功植入受体.结论 成功获取心脏死亡供体捐献的器官,为推广心脏死亡供体器官的捐献积累了经验.     

器官捐赠重症监护室的护理管理

当今,器官捐献成为器官移植供体的唯一合法来源。器官捐赠重症监护室(DICU)的建设在捐献器官质量的维护、边缘供体的挽救都有重要作用。本文就DICU的制度建设、场地建设、护理人员组成及护理工作流程进行探讨。     

中国心脏死亡捐献器官评估与应用专家共识

1 中国心脏死亡器官捐献与心脏死亡诊断标准 1.1 中国心脏死亡器官捐献 中国心脏死亡器官捐献,属于中国公民逝世后器官捐献(China donation after citizen's death,CDCD)三大类中的“中国二类(C-Ⅱ)”,即国际标准化心脏死亡器官捐献(donation after cardiac death,DCD注)或称无心跳器官捐献(non-heart beating donation,NHBD)[1]. 近年来,DCD在我国已发展成为移植器官来源的重要组成部分.中华医学会器官移植学分会、中华医学会外科学分会移植学组和中国医师协会器官移植医师分会,联合制定本专家共识,以规范DCD器官的评估与应用,保障移植疗效.     

潜在器官捐赠供体的转运及器官维护经验总结

目的总结潜在器官捐赠供体的转运流程和器官维护经验。方法回顾性分析2014年1月~2015年1月我院接手的52例潜在供体临床资料、当地医院病情、转运途中紧急处理、入院后接诊及如何行器官维护等资料。结果有46例供体实行成功捐献,一共实行移植115台,其中捐献肝移植34台,捐献肾移植81台。其中2例供体在ECMO下成功实行器官捐赠术。结论正确的供体评估及安全的转运是成功捐献的前提。对极危重供体,ECMO能提高器官捐献成功率。     

公民逝世后器官捐献肝质量研究进展

国际规范性器官移植的供体主要来源于公民逝世后器官捐献(donation after citizen's death)。近年国际国内有关公民逝世后器官捐献肝脏质量的研究取得了长足的进展,大量降低术后早期原发性无功能、肝功能延迟性恢复等相关并发症的新疗法涌现。脑死亡捐献(donation after brain death,DBD)及心死亡器官捐献(donation after cardiac death,DCD)成为公民逝世后器官捐献肝脏的基础,DBD与DCD供体肝移植并发症及其预后成为新的关注点。     

请您收藏——心脏死亡器官捐献理念

心脏死亡器官捐献(DCD)是指心脏停止跳动后的器官捐献。与脑死亡器官捐献(DBD)不同,DCD的捐献者具有严重的中枢神经损伤和/或不可逆转的脑损伤,但又没有达到脑死亡标准,此时身体其他器官的功能受损程度因缺氧耐受能力不同而各有不同。经过医生确定患者已经没有复苏的机会,并且亲属已经决定撤除患者的生命支持后,捐献者的家人可以选择DCD,为等待器官捐献的患者提供了另一种选择。DCD供者选择标准:年龄一般不超过65岁;无活动的人类免疫缺陷病毒(HIV)感染;无药物滥用史,或者无如下高危活动:静脉注射毒     

体外循环技术在移植器官保护中的应用

心脏死亡后捐献（donation after cardiac death,DCD）是指在宣告供体心脏死亡（不可逆性心脏功能丧失）后切取器官进行移植。在这个过程中,热缺血（warm ischemia,WI）损伤使得器官存活能力降低。传统的冷藏（cold storage,CS）方法对于DCD供体器官保护效果不理想,     

器官捐献失败105例原因分析

目的 探讨提高器官捐献成功率的途径.方法 回顾分析有器官捐献意愿的105例患者的捐献失败及器官维护不力原因.结果 (1)61例因严重器官功能不全或衰竭不能捐献,其中因维护不力在器官获取组织(OPO)到达前心跳停止38例,因肝肾功能衰竭未能捐献23例;(2)未达脑死亡标准24例,其中植物状态19例,高位截瘫并缺氧性脑病未达脑死亡标准2例,肌无力致严重呼吸衰竭3例;(3)其他原因20例,其中家中老人反对12例,要求有偿4例,家属要求捐献后与受者见面2例,百草枯中毒1例,中介介入1例.(4)61例严重器官功能不全或衰竭者中,严重低血容量58例,严重内环境紊乱35例,应用大剂量升压药61例,无一例应用T4.结论 相关人员对脑死亡的判定和脑死亡后器官功能维护等知识的不足是最终捐献失败的主要原因.     

心脏死亡器官捐献肾移植及顶层设计的初步经验

目的:总结近年来开展的心脏死亡器官捐献(donation after cardiac death,DCD)肾移植的临床经验,探讨终末期肾病患者接受移植的疗效及顶层设计与实施。方法:回顾性分析2011年10月至2013年9月接受DCD肾移植终末期肾病患者的临床资料。结果:23例患者均顺利完成DCD肾移植术。其中17例患者术后第5~7天肾功能恢复正常(73.91%);4例患者术后第8~10天肾功能恢复正常(17.39%);2例患者肾功能延迟恢复(8.69%),其中1例规律血透2周后肾功能恢复正常,另1例(最近1例)血透2月后肌酐维持在190μmmol/L并出院。在DCD肾移植后的随访过程中,随访时间为3个月~2年,1例患者术后第5个月死于重症肺部感染。结论:DCD供肾肾移植效果好,是我国尚无脑死亡法条件下,有效解决肾移植面临肾源短缺的重要途径;良好的顶层设计及组织实施是心脏死亡器官捐献肾移植工作开展的有力保障。     

我国ICU医务人员对心脏死亡器官捐献认知度的调查

目的了解当前ICU医务人员对心脏死亡器官捐献(DCD)的参与和认知情况,促进我国心脏死亡器官捐献的良性发展。方法研究者采问卷调查形式,在2014年度重症医学学术会议上对参加会议的ICU医务人员进行调查,信息完整的问卷回收后纳入研究分析。问卷自行设计,内容包括一般信息、对DCD的参与及认知情况,以及对DCD工作的参与意愿。结果共分析1079份问卷,参与调查的ICU医务人员中,90.05%不曾参与DCD工作而且对DCD认知明显欠缺,虽然88.47%了解DCD相关信息,但熟悉潜在的DCD捐献者及相关流程仅8.79%。但他们对DCD工作参与意愿强烈,96.3%愿意了解并学习DCD相关信息。结论尽管当前ICU医务人员对DCD的认知欠缺,参与度不高,但大多数对该项工作参与意愿强烈,乐意了解和投身DCD工作。     

医务人员器官捐献意愿及其影响因素探讨

目的 了解医务人员器官捐献意愿及其影响因素.方法 以北京市一级、二级、三级医院医务人员为研究对象,采用调查问卷方法,分别调查7所医院医护人员的基本资料,及其对器官捐献认知、态度及意愿,并对影响因素进行分析.结果 共调查男性149人(20％),女性596人(80％),受访者平均年龄为(34.6±8.8)岁,75.8％的受访者已婚,98.4％的受访者具有专科以上学历,65.9％的受访者收入在5 000元以上,76.1％的受访者来自三级医疗机构,77.7％的受访者来自内科,54.6％的受访者为医师.影响因素分析结果显示,文化程度、对脑死亡了解程度、对遗体器官捐献态度、是否担心同意捐献后医生为获得器官不尽力医治成为影响捐献意愿的主要因素.结论 应加强器官捐献的宣传工作,提高医务人员对器官捐献的认识.     

Attitudes toward organ donation in China

Background  Organ transplantation represents an important advance in modern medical science, and it has benefited many patients with organ failure; however, the severe deficiency of organ sources has been a bottleneck that has limited the benefits this technology can bring. The aim of this study was to show the results of a survey on Chinese people’s awareness and attitudes toward organ donation.

Methods  We designed a questionnaire regarding organ donation consisting of 20 short questions, which were distributed to 10 groups. Most of the questions were multiple-choice; the core question related to people’s attitudes to organ donation and the development of organ donation. The survey was held in the outpatient hall of Beijing Chao-Yang Hospital, a commercial district, and four professional colleges. Participants were randomly selected, and answered questions about gender, age, educational background, profession, and study major.

Results  In all, 2930 valid responses were received. Male:female ratio was nearly 1:1.2 (mean age 38 years). Over 90.0% of participants knew about organ transplantation and which organs could be transplanted; more than 95.0% knew about organ donation, but the time they had been aware of it varied. Nearly 90.0% of the participants approved of deceased organ donation; 73.0% indicated they would like to donate their organs post mortem. Participants who knew more about organ failure and organ transplantation were more likely to support organ donation. College students were very positive about organ donation, though as they gain professional knowledge their attitudes may change. Altogether, 65.3% of participants approved of living organ donation, which was obviously lower than the figure for deceased organ donation (P <0.05). In all, 85.7% of participants approved of compensation to the deceased donor’s family. To promote organ donation in China, 62.9% of participants indicated that the public’s knowledge about organ donation should be increased via the media and various kinds of education. Only 20.0% of the participants believed that legislation was required.

Conclusions  We conclude that at present the Chinese public has a basic understanding about organ transplantation and donation. The majority respondents were in favor of deceased organ donation and were willing to donate their own organs after death.

     

婴幼儿心死亡后捐献肾行肾移植术：2 例病例报告并文献复习

目的：加深针对扩大标准供肾的心脏死亡器官捐献(donation aer cardiac death，DCD) 肾移植手术术中、
术后管理的认识。方法：2 例供肾来自于诊断为脑死亡的2 例低龄儿童供者，年龄分别为11 个月和1 岁7 个月，脑
死亡的原因分别是重症婴儿肝综合征和重症颅脑外伤。2 例供者出现心死亡后，切取双肾整块，并分别整块移植给了
2 位受者。2 例受者的年龄分别是37 岁和41 岁。结果：术后随访6 个月，2 例受者移植肾功能基本正常。2 例受者术
后都出现大量血性引流液，在给予相应治疗后停止，未出现急性排斥反应和其他手术并发症。结论：采用改进的技
术可以安全采用年龄<3 岁的婴幼儿DCD 供肾；手术后短期效果满意，有助于扩大供体池，但血管并发症值得重视。     

Optimal management of brain-dead organ donor

Maintaining a brain stem–dead (BSD) donor is specialized science. It is a daunting task as they are fragile patients who need to be handled with utmost care owing to extreme haemodynamically instability and need the best of monitoring for maintenance of organs. To ensure a successful transplant, a BSD donor first needs to be identified on time. This requires scrupulous monitoring of neurologically compromised patients who tend to be the most frequent organ donors. Once the donor is identified, an all-out effort should be made to legally obtain consent for the donation. This may require numerous sessions of counselling of the relatives. It needs to be performed tactfully, displaying the best of intentions. It is important to understand the physiology of a brain-dead individual. A cascade of changes occurs in BSD donor which result in a catastrophic plummeting of the clinical condition of the donor. All organ systems are involved in this clinical chaos, and best possible clinical support of all organ systems should be available and extended to the donor. Organ support includes cardiovascular, pulmonary, temperature, glycaemic, metabolic and hormonal. This article has been written as a follow-up article of previously published article on identifying an organ donor. It intends to give the reader a concept of what the BSD donor undergoes after brain death and as to how to maintain and preserve various organs for donation for successful transplantation of maximum organs.     

Potential for organ donation in Victoria: an audit of hospital deaths

OBJECTIVE: To determine the potential for organ donation in 12 Victorian hospitals. DESIGN AND SETTING: Prospective audit of all deaths in 12 major public hospitals in the state of Victoria between January 2002 and October 2004. MAIN OUTCOME MEASURES: Number of organ donors and potential organ donors (patients with brain death or likely to progress to brain death within 24 hours if supportive treatment continued), requests for organ donation and consents. Unrealised potential donors (organ donation not requested) were categorised by an independent panel of intensivists as category A (brain death formally diagnosed); B (brain death not formally diagnosed but criteria likely to be fulfilled); and C (potential to progress to brain death within 24 hours). RESULTS: There were 17,230 deaths, 280 potential organ donors and 220 requests for organ donation. The 60 unrealised potential organ donors were classified as category A (3), B (17) and C (40). Consent rate was 53% to 65%, depending on the definition of potential donor (categories A, B and C or category A only). Consent rate was lower when discussions about organ donation were held by trainees or registrars (21%) than when specialists were present (57%) (P = 0.004). A maximum practically achievable organ donation rate for Victoria was estimated to be 15 to 17 donors per million population (current rate, 9 per million population). CONCLUSIONS: The potential for organ donation in Victoria is limited by a small organ donor pool. There is potential to increase the number of organ donors by increasing the consent rate (lower than expected from public surveys), the identification of potential organ donors (particularly those likely to progress to brain death if supportive treatment is continued), and requests for organ donation.     

Non-heart-beating organ donors as a source of kidneys for transplantation: a chart review

BACKGROUND: Organ transplantation is the treatment of choice for patients with end-stage organ failure, but the supply of organs has not increased to meet demand. This study was undertaken to determine the potential for kidney donation from patients with irremediable brain injuries who do not meet the criteria for brain death and who experience cardiopulmonary arrest after withdrawal of ventilatory support (controlled non-heart-beating organ donors). METHODS: The charts of 209 patients who died during 1995 in the Emergency Department and the intensive care unit at the Foothills Hospital in Calgary were reviewed. The records of patients who met the criteria for controlled non-heart-beating organ donation were studied in detail. The main outcome measure was the time from discontinuation of ventilation until cardiopulmonary arrest. RESULTS: Seventeen potential controlled non-heart-beating organ donors were identified. Their mean age was 62 (standard deviation 19) years. Twelve of the patients (71%) had had a cerebrovascular accident, and more than half (10 [59%]) did not meet the criteria for brain death because one or more brain stem reflexes were present. At the time of withdrawal of ventilatory support, the mean serum creatinine level was 71 (29) mumol/L, mean urine output was 214 (178) mL/h, and 9 (53%) patients were receiving inotropic agents. The mean time from withdrawal of ventilatory support to cardiac arrest was 2.3 (5.0) hours; 13 of the 17 patients died within 1 hour, and all but one died within 6 hours. For the year for which charts were reviewed, 33 potential conventional donors (people whose hearts were beating) were identified, of whom 21 (64%) became donors. On the assumption that 40% of the potential controlled non-heart-beating donors would not in fact have been donors (25% because of family refusal and 15% because of nonviability of the organs), there might have been 10 additional donors, which would have increased the supply of cadaveric kidneys for transplantation by 48%. INTERPRETATION: A significant number of viable kidneys could be retrieved and transplanted if eligibility for kidney donation was extended to include controlled non-heart-beating organ donors.     

Communication strategies for organ donation

A country, state or hospital may have the latest medical technology and infrastructure as well as qualified professionals for organ transplantation, but unless there is an adequate donor population the waiting lists for transplants will continue to be long and for some patients, hopeless. Public and professional awareness programmes are key factor in the donation process. Social education that explains the life-saving benefits of organ transplantation, the enormous need for organ donation, the concept of brain death and religious teachings related to these issues is vital for creating a conducive environment for the organ transplant co-ordinator or physician soliciting the donation. The education of hospital medical, nursing and administrative personnel is also essential to both miximise opportunities for donation, as well as to prevent loss of potential organs after donor consent. Other target populations are medical examiners or coroners, and police personnel under whose jurisdiction the donations occur, as their co-operation and guidance is necessary for meeting statutory requirements. The involvement of government officials and politicians is also valuable, as their active intervention is essential for the introduction and amendment of rules and laws to promote the donation and transplantation of organs. The present paper describes communication strategies for the development of an efficient education plan that will provide information about organ transplantation, explain the desired outcome, address potential queries, misconceptions or obstacles, and identify potential sources of support.     

The potential supply of organ donors. An assessment of the efficacy of organ procurement efforts in the United States.

OBJECTIVES--To estimate the potential supply of organ donors and to measure the efficiency of organ procurement efforts in the United States. METHODS--A geographic database has been developed consisting of multiple cause of death and sociodemographic data compiled by the National Center for Health Statistics. All deaths are evaluated as to their potential for organ donation. Two classes of potential donors are identified: class 1 estimates are restricted to causes of death involving significant head trauma only, and class 2 estimates include class 1 estimates as well as deaths in which brain death was less probable. RESULTS--Over 23,000 people are currently awaiting a kidney, heart, liver, heart-lung, pancreas, or lung transplantation. Donor supply is inadequate, and the number of donors remained unchanged at approximately 4000 annually for 1986 through 1989, with a modest 9.1% increase in 1990. Between 6900 and 10,700 potential donors are available annually (eg, 28.5 to 43.7 per million population). Depending on the class of donor considered, organ procurement efforts are between 37% and 59% efficient. Efficiency greatly varies by state and organ procurement organization. CONCLUSIONS--Many more organ donors are available than are being accessed through existing organ procurement efforts. Realistically, it may be possible to increase by 80% the number of donors available in the United States (up to 7300 annually). It is conceivable, although unlikely, that the supply of donor organs could achieve a level to meet demand.     

Psychosocial variables associated with willingness to donate organs.

Questionnaires were administered to 108 university psychology students to investigate attitudes and behaviour related to organ donation. Three groups (committed, uncommitted and opposed) were identified. A multivariate analysis of variance showed that, compared with uncommitted donors, committed donors felt better informed about organ donation, had discussed donation more often with family members and knew more people who had signed donor cards. The subjects in the opposed group and those in the uncommitted group cited different reasons for not signing a donor card. Empathy, religious beliefs and attitudes about death did not affect willingness to donate. Analyses of the interaction between willingness to donate one's own organs and willingness to donate those of a family member revealed a monotonic increase in willingness to donate the organs of a family member as the type of recipient became more personally relevant. Our findings indicate that when health care professionals request donor organs the potential recipients must be presented to the potential donors in a personally relevant manner. Educational programs must be developed to train medical personnel in how to effectively ask for organs without coercing the potential donor or invading the privacy of the potential recipient.