Number of deaths by neurological criteria, and organ and tissue donation rates at three critical care centres in Canada

PURPOSE: Comparative organ donation rates are expressed per million population and by this measurement, Canada lags behind other countries. These estimates do not account for differing demographics and health patterns of populations which can result in different rates of death by neurological criteria and subsequent donation rates. We sought to measure directly the number of deaths by neurological criteria, the associated donation rates, and the reasons for the differences. METHODS: A prospective evaluation of deaths by neurological and cardiorespiratory criteria in the critical care areas of three major adult Canadian tertiary care centres over a seven month period was undertaken. Patients were assessed for eligibility for organ and tissue donation and ultimate disposition. RESULTS: Annualized rates of death by neurological criteria varied from 2.3%-7.5% (8.6-28 patients) of all deaths. Conversion to actual donors ranged from 20-86%, with family refusal rates accounting for most of this variation. There were only three cases of suspected death by neurological criteria where a complete examination was not performed. CONCLUSIONS: There is substantial geographic variability in the rate of neurological death and actual organ donation rates in these Canadian tertiary care centres. These variations are principally related to regional differences in demographics of brain injury, referral patterns and donation consent rates, rather than lack of identification of potential donors.     

Estimating the organ donor potential in Denmark: a prospective analysis of deaths in intensive care units in northern Denmark

To estimate the organ donor potential in Denmark we conducted a prospective registration of deaths in all intensive care units (ICUs), counting 15 ICUs and two neurosurgical ICUs in the four northern Danish counties, which cover a population of 1.64 million inhabitants or 30% of the Danish population. From September 1, 2000 till August 31, 2002, all deaths in the ICUs in 15 hospitals were recorded. Each case was evaluated locally postmortem with respect to medical suitability to organ donation. A total of 1655 deaths were recorded, corresponding to 504 deaths per million population per year (PMP). Median age was 70 years (0 to 99 years), 52% were more than 70 years, and 22% more than 80 years of age. The cause of death was cerebral lesion in 18% of the cases (neurosurgical ICUs: n = 182; ICUs: n = 110). By thorough medical record examination, the number of potential donors was estimated to be 169, corresponding to 51 PMP. The cause of death was cerebral lesion in 96% of the potential donors. Organ donation was performed in 43 cases (32 from neurosurgical ICUs and 11 from ICUs) or 13.1 PMP. Thus, 25% of the potential became organ donors. The major reason for nondonation was refusal from the relatives. Out of 127 questioned, the relatives refused in 62 cases (49%). By comparison, 74% of the general Danish population are willing to donate organs after death. The rate of nondetection of potential donors by the hospital staff could be estimated to 22%. In conclusion, the organ donor potential may allow for improvement in donation rates. An increased effort for donor hospitals is warranted. The motives for refusal by the relatives need elucidation.     

Benchmarking performance in organ donation programs: Dependence on demographics and mortality rates

PURPOSE: Donors whose diagnosis of death is based upon neurologic criteria are the primary source of organs for human transplantation. The current measure of effectiveness of organ donation programs is the crude statistic, donors per million population (DPMP). This statistic represents the number of available donors, divided by the potential donor population. Comparisons between transplantation programs are done using the DPMP statistic. We sought to determine if variance in organ donation rates, reported as DPMP could be accounted for by differences in population demographics, specifically age and gender-specific mortality rates. METHODS: We obtained the population distribution and deaths for the year 2000 for the Calgary Health Region (CHR) and the country of Spain. Expected deaths were then calculated by standardizing the sample, based upon weighted averages of age, gender and cause-specific mortality rates. RESULTS: In 2000, Spain reported a crude organ donation rate of 33.9 DPMP. Standardizing the observed deaths in Spain using the CHR population distribution and calculating expected deaths based on the CHR rates, resulted in an adjusted rate of 19.2 DPMP (P < 0.05). CONCLUSIONS: These results bring into question the reliability of using crude DPMP as a measure of organ and tissue donation program performance. Alternative measures of benchmarking performance in organ donation programs should be considered.     

Brain death diagnoses and evaluation of the number of potential organ donors in Québec hospitals

PURPOSE: Faced with our inability to respond to the growing number of Quebec patients waiting for organ transplants, we sought to determine the number of potential organ donors (OD) in acute care hospitals. METHODS: A retrospective chart review of all acute care, in-hospital deaths in Quebec in the year 2000 was undertaken. Hospital record librarians provided statistics and completed questionnaires on each chart after applying exclusion and inclusion criteria. RESULTS: There were 24,702 acute care in-hospital deaths reported by 83 hospitals participating in the study on a voluntary basis. Analyzing 2,067 files meeting inclusion criteria, we identified 348 potential OD (1.4% of deaths). In hospitals not providing tertiary adult trauma care, the potential donor rate was 0.99% of all deaths. There were 4.5 times more potential donors in tertiary care adult trauma centers. Brain death was formally diagnosed in 268/348 patients, and organ donation discussed as an option with 230/268 families. Consent for donation was given in 70% of cases, although not all these patients proved to be suitable after evaluation. There were 125 actual donors in Quebec in the year 2000 (18 per million population). CONCLUSIONS: The gap between used and potential donors can be explained by several factors including failure to approach families for organ donation, family refusal, incomplete neurological assessment of patients, and medical unsuitability of some consented donors. There is room for improvement in the identification of potential donors and in the presentation of organ donation as an end of life option to families.     

An analysis of critical care staff's attitudes to donation in a country with presumed-consent legislation

CONTEXT: Lack of knowledge and confidence among critical care staff in identifying potential donors and communicating with donor families may explain missed organ and tissue donations. OBJECTIVES: To elucidate attitudes of critical care staff toward donation and their knowledge, involvement, and self-reported skills and confidence levels with donation-related tasks. METHODS: Between January 2004 and May 2006, Donor Action Foundation's Hospital Attitude Survey was used to collect data from staff members in critical care units in our university hospital (study group) and 2 other Belgian university hospitals (control group). In total, 92 physicians, 433 nurses, and 26 other staff members participated. RESULTS: The 2 groups did not differ significantly with regard to donation-related attitudes. The study group had a significantly lower perception of the public's approval of organ donation than did the control group (P < .001). Nurses reported significantly less involvement than did physicians (P < .001) in caring for potential donors, communicating severe brain damage, explaining brain death, requesting donation, and contacting procurement staff. Probably because of previous training, physicians in the study group reported less need for additional training on donation-related issues than did control physicians. However, compared with physicians, nurses in the study group requested significantly more training on a number of donation tasks. Nurses with more than 5 years of critical care experience were consistently more confident with donation-related tasks. CONCLUSION: Support rates for donation are high overall, and previous training is associated with improved attitudes and decreased educational needs. Educational efforts tailor-made for nurses should increase nurses' confidence levels when confronted with potential donors and their next of kin.     

A practical approach to evaluate the potential donor pool and trends in cadaveric kidney donation

BACKGROUND: The potential supply of transplantable cadaver kidneys is often expressed as donors per million population (pmp), which ignores some essential factors governing organ donation. METHODS: We performed a modeled analysis of kidney donor extraction rates by age, gender, race, cause of death, geographic region, and year in a cohort of evaluable deaths and actual cadaver donors between the ages of 1 and 65 years (1988-1993). Evaluable death was defined as an in-hospital death in patients between the ages of 1 and 65 years whose ICD-9-CM cause of death was not an obvious contraindication to kidney donation. The main outcome measures were the crude donation rate and an adjusted donor extraction rate (DER) per 1000 evaluable deaths. RESULTS: A total of 1.4x10(6) in-hospital deaths produced 300,502 evaluable deaths and 20,575 actual donors. Between 1989 and 1993, DER increased from 61.1 to 75 per 1,000 evaluable deaths. DERs were highest among the youngest age groups, declining significantly with age from 405.0 to 16.7/1,000 evaluable deaths for age groups 1-10 and 56-65 years, respectively. There was a small difference in donors pmp between blacks and whites (15 vs. 18). In contrast, DER was seven times higher in whites compared with blacks (112.5 vs. 16.5/1,000 evaluable deaths; P<0.001). The crude donation rate (per 1,000 evaluable deaths) was high for stroke (604.8) and trauma-related deaths (230.6), resulting in highly efficient donor extraction from these deaths. Region-specific DERs ranged from 49.4 to 83/1,000 evaluable deaths and differed significantly from the corresponding donors pmp. CONCLUSIONS: Estimating kidney donation relative to in-hospital evaluable deaths is a meaningful measure of organ procurement efficiency. Efforts to enhance cadaveric kidney donation should seek to understand and reduce the marked demographic and regional disparity in donor extraction rates.     

Changing Metrics of Organ Procurement Organization Performance in Order to Increase Organ Donation Rates in the United States

The shortage of deceased‐donor organs is compounded by donation metrics that fail to account for the total pool of possible donors, leading to ambiguous donor statistics. We sought to assess potential metrics of organ procurement organizations (OPOs) utilizing data from the Nationwide Inpatient Sample (NIS) from 2009–2012 and State Inpatient Databases (SIDs) from 2008–2014. A possible donor was defined as a ventilated inpatient death ≤75 years of age, without multi‐organ system failure, sepsis, or cancer, whose cause of death was consistent with organ donation. These estimates were compared to patient‐level data from chart review from two large OPOs. Among 2,907,658 inpatient deaths from 2009–2012, 96,028 (3.3%) were a “possible deceased‐organ donor.” The two proposed metrics of OPO performance were: (1) donation percentage (percentage of possible deceased‐donors who become actual donors; range: 20.0–57.0%); and (2) organs transplanted per possible donor (range: 0.52–1.74). These metrics allow for comparisons of OPO performance and geographic‐level donation rates, and identify areas in greatest need of interventions to improve donation rates. We demonstrate that administrative data can be used to identify possible deceased donors in the US and could be a data source for CMS to implement new OPO performance metrics in a standardized fashion.     

Changes in notification and demographics of deceased donors during the past decade in the state of Michigan, USA

From 1993 to 2003 there have been significant changes in the number and demographics of deceased donors referred to the organ procurement organization (OPO) in the state of Michigan (USA). It was the aim of this study to document the magnitude of these changes and attempt to explain them. There has been a 26-fold increase in the number of reported in-hospital deaths from 1993 to 2003. Most of these calls (96%) concerned patients who were already dead and thus not suitable for organ donation. There has also been a 72% increase in the number of antemortem calls, but there has been only a 30% increase in the number of organ donors, primarily because the majority of the deceased individuals referred for donation (57% in 2003) do not meet the criteria for brain death. The median age of donors over the past 10 years has increased from 31 to 45. The proportion of African-American donors increased from 9.8% in 1993 to 21.3% in 2003. An increase in the age of donors and the increased frequency of cerebrovascular accidents as the cause of death of donors may be a reflection of changes in criteria for donation. Mandatory reporting of hospital deaths has resulted in an increase in notification to the OPO but has not had a major impact on the number of organ donors. On the other hand, increased donation from African-Americans indicates that public information programs may be contributing to the increased donation from this segment of the population.     

Utilization of trauma-related deaths for organ and tissue harvesting.

A randomized retrospective analysis of patients who suffered trauma-related deaths over 36 months (May 1987-April 1990) was performed to study their utilization as candidates for organ and tissue harvesting. There were a total of 108 patients: 79 males, 29 females. The average age was 46.2 years; 38 (36%) of these patients were 65 years of age or older. Over 50% of fatalities were the result of motor vehicle crashes. There were 61 potential tissue donors. Forty-three were lost without documentation of a request for organ procurement. There were 23 patients with potentially salvageable organs: one candidate was lost without documentation of a request for organ procurement. Twenty-eight (26%) of the patients had support withdrawn; 16 were 65 years old or older. Brain death protocol was instituted in 17 (20%); organs were obtained from 70% of these patients. Reasons for failure of procurement after request by a physician included family refusal in seven cases, cardiopulmonary arrest during brain death protocol in two cases, and religious bias in one candidate. Twelve patients were organ donors: 10 patients were tissue donors. We conclude that the greatest source of underutilization lies in the failure to request tissue for harvesting, since there were no isolated tissue donors. Pertinent information should be more widely distributed to physicians regarding candidacy for tissue donation. Further consideration of the adequacy of organs or tissue in relation to the candidates' age should be given, since patients aged 65 years and older can be a significant source of potential donor candidates.(ABSTRACT TRUNCATED AT 250 WORDS)     

Organ donation in Hawaii: impact of the final rule

BACKGROUND: In an effort to increase organ donation, the Department of Health and Human Services issued the Final Rule in 1998. The Health Care Financing Administration (HCFA) later required hospitals to notify organ procurement organizations (OPO) of all deaths and imminent deaths in order to remain eligible for Medicare and Medicaid reimbursement. We set out to determine the impact of the Final Rule on organ donation in Hawaii. METHODS: Medical records of all deaths between January 1999 and December 2000 at 17 acute-care hospitals were reviewed to determine the number of medically suitable, potential organ donors. RESULTS: Of 9427 deaths, 144 were potential organ donors. In 1999, before the Final Rule, 60 of 75 (80%) potential donors were identified and 40 (53%) were referred to the OPO. In 2000, after the Final Rule, the identification rate was 83% and the referral rate was 70%. CONCLUSIONS: Although, the Final Rule increased the referral rate slightly, medical centres must continue to improve their identification of potential donors and prompt referral. This is not only to comply with the Final Rule, but ultimately to increase organ donation to meet the needs of the ever-expanding list of patients waiting for organs.     

Activity of Hospital Transplant Coordinators in Malopolskie Province (Poland)

Background

In Poland as well as in other European countries, the number of organs from deceased donors is too small to meet the needs of transplantation therapy.

Methods

This situation can be improved by increasing the number of hospital transplant coordinators in hospitals with potential of donation. Since 2010, 200 Polish hospitals have employed coordinators whose role is to recruit deceased organ donors, to monitor the potential of donation (quality assurance program), and to run the training courses. In Malopolskie Province, there are 26 hospitals in which organ procurement from brain-dead donors is possible. In 13 hospitals, donor transplant coordinators have been employed. The objective of this study was to evaluate the activity of hospitals in Malopolskie Province in the field of donor recruitment before and after employment of coordinators (19 months before and after). For the purpose of the study, the number of hospitals with positive effects and with no effects of coordinator employment was calculated, and several donation rates were compared in the period before and after employment of the coordinator. We also compared the number of deceased organ donors in 13 hospitals employing a coordinator and in 13 hospitals without a coordinator.

Results

The desired impact of employment of coordinators in Malopolskie Province measured by improvement of organ donation rates was observed in half of the hospitals (7 of 13; 54%) with a transplant donor coordinator. The number of potential organ donors increased by 100% (from 24 to 48), and the number of actual organ donors increased by 113% (from 16 to 34). The percentage of family objections to organ donation decreased (from 17% to 8%). The best result of employing coordinators was observed at university hospitals and multidisciplinary hospitals and at hospitals in which the coordinator was a physician. The worst effect was recorded at county hospitals.

Conclusions

The employment of hospital transplant coordinators in Malopolskie Province has a global impact on the increase of the number of actual organ donors in that region and improvement of organ donation rates, but it is effective only in half of the hospitals with coordinators. It indicates that other measurements should also be undertaken to run donation programs.     

Deaths with acute cerebral lesion and heart-beating potential organ donors in the Veneto region

BACKGROUND: The study was aimed at describing the clinical characteristics of dead patients with acute cerebral lesion and analyzing reasons of the shortage of heart-beating potential organ donors in the Intensive Care Units (ICUs) in the Veneto Region. METHODS: Data have been prospectively recorded in 23 ICUs over six months for deceased patients with acute cerebral lesion (clinical data, death diagnosis) and for any potential organ donor (medical suitability, family interview, organ retrieval). RESULTS: In the ICUs of the Veneto Region in 1998 deceased patients with acute cerebral lesion were 187 per million population (p.m.p.); 317 cases have been studied. Median age was 64 years (range 7-93). Heart-beating death was legally confirmed only in 98/317 cases (31%) against a clinical diagnosis of brain death in 203/317 (64%). Only 82/317 (26%) were considered eligible donors and 48/317 (15%) became real donors (22.8 p.m.p.). Among the remaining 235 cadavers, 105 were over 70 years old. In the group of 130 under 70 years absolute contraindications were present only in 30 and problematical clinical situations were reported in 100. CONCLUSIONS: The number of deaths with acute cerebral lesion represents a sensible index and a key factor for evaluating the potential organ donor pool in small regions and in the single intensive care unit. Collected data demonstrate that in the Veneto Region the efficiency of solid organ retrieval can be improved and that organ donor shortage may depend, beyond family refusal, on clinical and cultural factors that hamper stabilized heart-beating deaths. Most potential donors with age over 70 or problematical clinical situations are preventively excluded by ICUs physicians. To improve organ donation all the patients who die in spite of neuro-intensive treatment should be prevented from circulatory arrest to permit legal declaration of death. Thus more potential organ donors without absolute contraindications could be recovered and time would exist for discussing any problematical situation with experts in organ procurement, particularly in respect to existing urgencies in the waiting list.     

互联网微信平台功能模块微信群在器官捐献协调中的应用分析

目的探讨互联网微信平台功能模块微信群在器官捐献协调中的促进作用及应用价值。 方法回顾性分析2016年1月至2019年12月江西省人民医院4个器官捐献分管片区共446例潜在器官捐献案例,根据器官捐献协调方法不同,分为传统协调模式组(135例,2016年1月至2017年12月捐献案例)与微信平台应用组(311例,2018年1月至2019年12月)。共设置潜在捐献者信息确认、潜在捐献者病情评估、死亡判定、伦理审核以及器官获取与分配5个功能模块微信群,并将相关工作内容和协调要求分别嵌入这5个功能模块微信群。采用成组t检验比较传统协调模式组与微信平台应用组潜在器官捐献者和完成器官捐献者年龄以及每例捐献平均转化时间。采用卡方检验比较两组潜在捐献者转化为器官捐献者比例以及潜在捐献者和完成器官捐献者年龄段、性别和地区分布。P<0.05为差异有统计学意义。 结果传统协调模式组与微信平台应用组潜在器官捐献者年龄分别为(38±14)和(44±16)岁,差异有统计学意义(t＝-3.391,P<0.05);两组年龄段、性别及各片区捐献数量差异均无统计学意义(P均>0.05)。传统协调模式组与微信平台应用组潜在器官捐献者分别成功实施器官捐献39(28.9%)和132(42.4%)例,差异有统计学意义(χ²＝7.316,P<0.05)。两组完成器官捐献者年龄分别为(37±15)和(42±13)岁,每例捐献平均转化时间分别为(3.44±0.51)和(2.03±0.24)d,差异均有统计学意义(t＝-2.284和24.090,P均<0.05);两组完成器官捐献者年龄分布、性别及各片区捐献数量差异均无统计学意义(P均>0.05)。传统协调模式组与微信平台应用组分别获取大器官115个和390个,分别弃用2个和6个。 结论将互联网微信平台功能模块应用于器官捐献协调中,有利于增加潜在捐献案例转化成功捐献案例数,提高每例捐献协调时效,促进了器官捐献工作的发展。     

Non-utilization of hearts and lungs after consent for donation: a Canadian multicentre study

PURPOSE: To identify reasons why hearts and lungs from consented adult organ donors are not transplanted and identify changes in practice aimed at increasing their utilization rates. A greater potential may exist in Canada to improve utilization rates for hearts and lungs given their comparatively suboptimal rates (kidneys 85%, livers 84%, hearts 35% and lungs 23% reported in 2001). METHODS: Four Canadian organ procurement organizations participated. All adult organ donation cases for the calendar year 2002 were reviewed and included if consent for organ donation was obtained. An organ donation framework was established to highlight key areas where organs are lost from the transplantation stream. Organ donor cases were analyzed through this framework. RESULTS: A utilization rate of 39% (42/107) for heart and 28% (29/105) for lung donors was found, comparable to Canadian and international rates. Organ function was the most frequently cited reason for non-utilization, followed by donor characteristics and logistical issues. Suggestions for alternate management, potentially resulting in organ utilization, were made in 20 of 65 (31%) hearts and 28 of 156 (18%) lungs. Variable practices, around consent for individual organs and offering of organs consented, remained significant barriers to successful transplantation. CONCLUSION: Target areas for changes in practice included consenting and offering of all organs. Management of "marginal" organs should include resuscitation and reevaluation thus allowing potential organ rescue and utilization. Although there is considerable pressure to increase organs for transplantation, any such mechanism will not be judged successful unless recipient graft survival rates remain acceptable.     

Organ donation and utilization in the United States, 2004

This article discusses issues directly related to the organ donation process, including donor consent, donor medical suitability, non-recovery of organs, organs recovered but not transplanted, expanded criteria donors (ECD), and donation after cardiac death (DCD). The findings and topics covered have important implications for how to evaluate and share best practices of organ donation as implemented by organ procurement organizations (OPOs) and major donor hospitals in the same donation service areas (DSAs). In 2002 and 2003, US hospitals referred more than one million deaths or imminent deaths to the OPOs of their DSA. Referrals increased by nearly 10% from 2002 to 2003 (1,022,280 to 1,121,392). Donor consents have increased by about 5% and the number of total deceased donors has risen from 6,187 to 6,455. Since multiple organs are recovered from most donors, this increase allowed more than 500 additional wait-listed candidates to receive an organ transplant than in the prior year. Non-traditional donor sources have experienced a large rate of increase; in 2003 the number of ECD kidney donors increased by 8% and the number of DCD donors increased by 43% , from 189 donors in year 2002 to 271 donors in 2003.     

Evaluation of verification of brain death and coordination with hospital organ procurement at the University Hospital at Lille

OBJECTIVES: To determine the incidence of brain death (BD) and to evaluate the registration of potential organ donors (PD) by the organ procurement team (OPT). STUDY DESIGN: Two-year prospective audit in the French university hospital of Lille. PATIENTS AND METHODS: All deaths occurring in the intensive care units or the emergency department were studied. If death was consecutive to brain damage, on-site review of medical records and charts was performed. Death cause, presence of criteria for brain death and reference to the OPT were recorded for each death. A medical expert staff evaluated the incidence of and reasons for unsuitability for organ donation. After 12 months of observation, a protocol for "systematic alert of the OPT when brain death is suspected" was broadcast and evaluated during the next 12 months. RESULTS: During the first period, 277 BD occurred and 119 PD were suitable for organ donation. The OPT recorded 80 PD (67.2% of all PD) and 45 multi-organ procurements (MOP) were performed. Physicians opposed two major reasons for not calling OPT: anticipation of a non-validated medical contraindication in 18 cases and approach of the family without the OPT team in 21 cases. After broadcast of the protocol, 110 PD were identified and the OPT was called in 93 cases (84.5% of all PD, p < 0.004 versus first period). Fifty-three MOP were performed. CONCLUSION: The OPT was not called to manage one-third of the PD. The protocol for "systematic alert of the OPT when brain death is suspected" improves the call of the OPT and increases MOP.     

Organ donation rates in a neurosurgical intensive care unit

OBJECT: The number of patients waiting for organ transplantation continues to grow, while organs are donated by very few of the thousands of potential donors who die every year. The authors' neurosurgical intensive care unit (NICU) has worked closely with coordinators from the local organ procurement organization (OPO) for many years. In this study, the authors analyze donation rates in the NICU and discuss factors that may be important in maximizing these rates. METHODS: All referrals from the NICU to the OPO from 1996 to 1999 were analyzed. Of the 180 referrals, 98 patients were found to be medically suitable as potential donors. Another 15 patients died of hemodynamic collapse shortly after admission to the NICU. If one assumes that all 15 patients would have been suitable donors, the unsuccessful resuscitation rate becomes 15 (13.3%) of 113. Of the 98 eligible donors, consent was obtained and organs or tissue were recovered in 72, yielding a successful organ procurement rate of 73.5%. CONCLUSIONS: Close working relationships among physicians, nurses, and OPO coordinators can result in higher donation rates than have been reported previously. Aggressive resuscitation and stabilization of all patients, early identification of potential organ donors, prompt declaration of brain death, and attempts by the OPO coordinator to build rapport with families are all important factors that may increase donation rates. Because most organ donors have sustained catastrophic intracranial events, neurosurgeons are uniquely positioned to influence organ donation policies at their hospitals and thus to salvage some benefit from tragic cases of overwhelming brain injury.     

公民逝世后器官捐献及利用的单中心数据分析

目的  了解无锡地区公民逝世后器官捐献及利用现状,为促进局部地区器官捐献工作的进一步开展提供思路和依据。方法  回顾性分析151例器官捐献者的临床资料,其中器官捐献成功者37例,潜在捐献者114例。分析潜在捐献者捐献失败的原因;收集器官捐献成功者的一般资料;分析器官捐献成功者的器官捐献情况和器官利用情况。结果  151例器官捐献者中,器官捐献成功者37例,捐献转化率为24.5%。器官捐献失败者114例,捐献失败的原因分别为家属不同意、未达到捐献状态标准、无充足时间评估和工伤纠纷未解决。器官捐献类别包括34例脑-心双死亡器官捐献（DBCD）,3例脑死亡器官捐献（DBD）,无心脏死亡器官捐献（DCD）。捐献者死亡原因包括19例颅脑外伤、14例脑卒中和4例其他。37例器官捐献成功者中,以流动人口为主。捐献者共捐献大器官和组织154个,其中大器官124个。人均大器官和组织捐献个数（4.2± 1.6）个,人均大器官捐献个数（3.4± 1.1）个。154个捐献器官中,利用率为96.7%（149/154）,器官分配前4位城市为南京、无锡、苏州、常州。结论  无锡地区公民逝世后器官捐献成功率及捐献转化率偏低,应建立局部地区器官捐献工作网络、加大器官捐献宣传力度以及开展协调员技能培训。     

Factors influencing the potential organ donation: a 6-yr experience of the New Jersey Organ and Tissue Sharing Network

The demand for organ transplants in the United States is increasing by 16% every year. Unfortunately, organ donation figures are not increasing at the same rate. Factors that influence the process of organ donation in New Jersey were analyzed. METHODS: A retrospective study in which the charts of actual and potential organ donors identified by the New Jersey Organ and Tissue Sharing Network (OTSN) between January 1990 and December 1995 were reviewed. Potential donors who were not identified by the OTNS or the United Network for Organ Sharing (UNOS) were not considered because no data relative to these cases were available. The conversion ratio (CR) between actual donor from potential donor was determined. A statistical analysis of the data was performed using multivariate regression logistic analysis. RESULTS: Organ donation increased, both in the male and female population, by 14% over the last 6 yr. The 0-5-yr age group experienced an increment in CR from 7.7 to 37.7% (p < 0.001). All other age groups had a continuous improvement, but a statistically significant increase over time was not observed. The CR of all races increased over the 6-yr study period. The Afro-American population donated significantly less than the white population (32.1 vs. 59.9%) (p < 0.001). The three transplant centers in New Jersey had a CR less than that seen in the non-transplant centers (38.1 vs. 44.1%). The number of total donations (78.7 vs. 21.3%) was significantly greater in the non-transplant centers (p < 0.001). Moreover, the number of lost donors was higher at transplant centers (p < 0.001). Over the 6-yr period, the difference between donations coming from non-urban (70.8%) versus urban areas (29.27%) was highly significant (p < 0.001). Traumatic deaths were associated with a greater CR (55.3%) than all other causes of death. The CR for donors dying as a result of motor vehicle accidents (MVA) (p < 0.001), penetrating trauma, and child abuse all increased. Level II trauma centers had a better CR (53.7%) than level I centers (48.4%) and non-trauma centers (51.1%). The donation rate was similar for level II and non-trauma centers (60%). CONCLUSIONS: The organ donation rate in New Jersey is not sufficient to meet the needs of organ recipients in New Jersey. Pediatric donations increased considerably, specifically from child abuse. MVA deaths are associated with the greatest CR. Urban areas have a worse CR than non-urban areas, even if they are associated with transplant or trauma