孝文化与器官捐献

随着器官移植技术的日臻成熟和完善,器官衰竭的患者可以得到救治,延长生命.器官移植手术的实施离不开可供移植的器官,也即供体器官.目前,从整个世界的范围来看,供体器官严重短缺是一个普遍问题,这直接制约着器官移植挽救更多患者的生命[1].就我们国家而言,这一问题尤为突出.据悉,目前我国等待肾移植的患者有 28万～30万,等待...     

器官保存的现状

器官保存的现状中国医科大学第一临床学院（１１０００１）刘永锋器官保存的目的是使离体器官损伤减小到最小程度，为临床提供充分时间完成器官运送及手术，并在循环重建后立刻恢复功能．器官损伤源于以下四种因素：①生命终末期的低血压损伤，②心跳停止到器官取出期间的...     

福建省单中心器官捐献转化率和器官产出率及其影响因素研究

目的  探讨福建省单中心器官捐献转化率和器官产出率及其影响因素。方法  回顾性分析2018年11月至2021年6月福建医科大学附属协和医院182例潜在器官捐献者的基本信息,分析器官捐献转化率、器官捐献成功者的基本情况及器官捐献失败者捐献失败的原因。分析器官捐献产出情况及器官捐献数量的影响因素。结果  182例潜在器官捐献者中,捐献成功46例,捐献转化率为25.3%;失败136例,失败原因包括家属不同意（58.1%）、无充足时间评估（24.3%）和未达到捐献状态标准（17.6%）。46例器官捐献者共捐献大器官和组织212个,包括肾脏88个、肝脏42个、肺脏15个、心脏19个和角膜48个,人均捐献大器官和组织4.6个,人均捐献大器官3.6个。年龄、性别、籍贯、捐献辖区和血型是大器官捐献数量的影响因素;捐献辖区是组织捐献数量的影响因素。结论  福建省单中心器官捐献转化率偏低,家属不同意是最主要的原因。应针对性地选择合适的潜在器官捐献者开展器官捐献工作,提升器官捐献转化率和器官产出率。     

腹部实质器官的切取与保存

供体器官的质量在某种程度上取决于器官切取手术与保存技术，完美的供体手术技术，不但可以减少原发性供体功能衰竭的发生，还可放宽供体选择指征，最大限度地解决供体器官短缺的现状，挽救更多濒临死亡的病人。在脑死亡法尚未通过的国家，或者在供体生命指标不易维持的情...     

呼吸衰竭并多器官功能障碍综合征68例临床分析

目的探讨呼吸衰竭并多器官功能障碍综合征的临床特点,降低病死率。方法本研究回顾性分析笔者所在医院1990～2010年收治的呼吸衰竭并多器官功能障碍综合征68例患者的临床资料。结果本组呼吸衰竭并多器官功能障碍综合征累及器官为肺、心、脑、胃肠、肾、肝、血液等;器官功能障碍受累器官数目为2个器官39例,3个器官18例,4个及4个以上器官11例;Ⅰ型呼吸衰竭4例,Ⅱ型呼吸衰竭64例;68例中,死亡41例,病死率60.29%,年龄越大、受累器官越多、病死率越高。结论严密监测病情变化、早检查、早诊断、及时的综合治疗是抢救高危患者生命的关键措施。     

2例脑死亡无偿器官捐献供体的维护体会

目的探讨脑死亡器官移植供体的维护要点。方法我院于2011年12月至2012年1月期间共完成2例脑死亡器官捐献(DBD)供体的无偿器官捐献工作。供体确诊为脑死亡,应用机械通气、血管活性药物及其他相关药物维持供体,监测有创动脉压、中心静脉压、心率、血气交换、尿量、电解质酸碱平衡、体温、血细胞比容、白蛋白水平等,维持供体器官灌注。结果 2例DBD供体维持生命体征平稳,捐献的器官功能稳定正常。其中,供体1在入ICU后6 h确诊脑死亡,到实施器官捐献共维护33 h;供体2在入ICU后8 h确诊脑死亡,到实施器官捐献共维护31 h。捐献的肝脏、肾脏和角膜均成功移植于受体。结论 DBD供体维护是确保潜在供体器官成功捐献和捐献器官移植手术成功的关键因素之一,对有效提高捐献器官的利用率及缓解目前器官短缺状况起到很重要的作用。     

脓毒症液体复苏与器官支持

脓毒症引起的多器官功能障碍是死亡的重要原因,早期液体复苏是脓毒症治疗的重要组成部分。不同阶段液体复苏策略对器官功能的影响不同,液体复苏可分为4个阶段：早期积极复苏以挽救生命;维持组织最佳灌注状态;稳定阶段着重于器官功能支持,减少并发症;液体开始负平衡后,须降低补液强度,清除体内累积的多余液体。目前认为使用晶体或胶体并不影响临床结局,但可能影响治疗的起效时间。人工胶体导致肾功能损伤的风险高于白蛋白,而平衡盐溶液较有利于肾功能及内环境稳定。     

国外捐献器官获取质量管理与控制进展

器官移植是二十世纪以来有效挽救终末期器官衰竭患者生命的一项突破性技术,显著改善了患者生存质量。器官捐献作为器官移植的重要来源,提升捐献器官获取质量是促进捐献器官转化、改善器官移植预后的关键。美国、西班牙等国家在捐献器官获取质量管理与控制方面提出了系列政策和标准,并取得了积极成果。本文通过探讨医疗质量管理与控制有关概念、国际捐献器官获取质量管理先进策略及模式,研究器官获取组织、捐献者、捐献器官质控举措,以期为形成具有“中国特色”的捐献器官获取质量管理与控制体系、推进捐献器官获取高速度高质量发展提供参考。     

器官捐献可持续发展策略探讨

器官捐献是解决器官来源问题的有效途径。为了保证器官捐献工作的可持续发展,必须赢得公民的广泛支持与理解。3年多的实践经验证明,死亡标准、器官分配和财务制度的规范与统一是器官捐献工作健康、稳步推进的基础。当前迫切需要统一思想,做好顶层设计,加强监管,重点做好潜在捐献者入选标准和程序的统一,明确心脏死亡判定方法;全面推行人体器官分配与共享系统,公开器官分配标准与流向;重新审定器官移植收费标准,规范捐献者家庭困难救助行为。     

器官捐献协调员劝捐协调现状及影响因素研究

目的  探讨影响器官捐献协调员器官捐献意愿和器官捐献协调效果的重要影响因素。方法  采用方便抽样方式对349名全国器官捐献协调员进行问卷调查,其中男145名,女204名,年龄27(23,36)岁。利用多重线性回归和无序logistic回归探讨捐献意愿和协调效果的影响因素。结果  349名器官捐献协调员中,愿意捐献器官的人数有146名,占41.8%,其中已签署器官捐献同意卡的101名,占28.9%。器官捐献法律认知充分、文化程度高、有婚姻经历、自感健康状况好均对器官捐献协调员器官捐献意愿具有积极影响(均为P < 0.05); 收入高、器官捐献协调员工龄长、聘用方式为专职、捐献意愿高、捐献条件认知和捐献程序认知充分均对器官捐献协调员协调效果具有积极影响(均为P < 0.05)。结论  本研究发现器官捐献协调员对器官捐献的法律认知程度越高,器官捐献意愿越强,而增强器官捐献协调员自身捐献意愿对提高器官捐献协调效果有积极影响。因此,应搭建全方位器官捐献协调员培养体系,以提高器官劝捐成功率,推动器官捐献事业的发展。     

美国器官捐献和移植立法主要事件

1968年哈佛大学提出“脑死亡定义”1968年《人体器官捐献法》对以移植为目的的器官和组织捐献进行了法律规范 1971年修订《人体器官捐献法》，赋予器官捐献卡片法律效力     

Current techniques of organ procurement and organ conservation

Since organ transplantation became a standard procedure in medicine, some interdisciplinary discussion has evolved around the availability of organs for transplantation. The shortage of available donors leads to numerous deaths on waiting lists where heart, lung and liver disease is concerned. Patients on dialysis spend years waiting for a suitable cadaveric graft. The shortage of organs has widened not only the selection criteria for cadaveric donors and the optimization of procurement but also has led to the increased acceptance of relatives and friends as living donors for kidneys, parts of the liver and maybe in the future of the lung. It has to be decided in which direction one wants to influence the discussion about the retrieval of an adequate number of organs for our waiting patients.     

Determination of the factors affecting organ donation: Voluntary organ donors

IntroductionIn Turkey, even if a person wishes to be an organ donor while alive, approval from the family is required after brain death. Therefore, many potential organ donations are lost as approval cannot be obtained from the family of the deceased. The aim of this study was to determine the factors affecting organ donation.MethodA total of 219 organ donation documents of Voluntary Organ Donors (VOD) were examined in a public hospital. The information examined included the age, gender, occupation, marital status, and place of birth of the donor, the number of organs donated, and the person from whom permission should be requested after brain death.ResultsOf the total organ donors, 62.6% were aged 19–25 years, 67.6% had a high level of education, 35.6% stated that permission should be sought from their father, and 69% were born in the Mediterranean region. A significant relationship was determined between age and the number of organs donated (p < 0.05).ConclusionIt can be recommended that education about organ transplantation and donation is given in regions where donor rates are low and there are groups with a high mean age, and a low education level of nurses. It could also be effective for nurses to lead organ donation campaigns to be able to increase the number of donations.     

Extended criteria for organ acceptance. Strategies for achieving organ safety and for increasing organ pool

The terms extended donor or expanded donor mean changes in donor acceptability criteria. In almost all cases, the negative connotations of these terms cannot be justified. Factors considered to affect donor or organ acceptability have changed with time, after showing that they did not negatively affect graft or patient survival per se or when the adequate measures had been adopted. There is no age limit to be an organ donor. Kidney and liver transplantation from donors older than 65 years can have excellent graft and patient actuarial survival and graft function. Using these donors can be from an epidemiological point of view the most important factor to esablish the final number of cadaveric liver and kidney transplantations. Organs with broad structural parenchyma lesion with preserved functional reserve and organs with reversible functional impairment can be safely transplanted. Bacterial and fungal donor infection with the adequate antibiotic treatment of donor and/or recipient prevents infection in the latter. The organs, including the liver, from donors with infection by the hepatitis B and C viruses can be safely transplanted to recipients with infection by the same viruses, respectively. Poisoned donors and non-heart-beating donors, grafts from transplant recipients, reuse of grafts, domino transplant and splitting of one liver for two recipients can be an important and safe source of organs for transplantation.     

Care of organ donors

In summary, anesthesiologists play a pivotal role in maintaining adequate organ function in the donor. Anesthesiologists are responsible for integrating the needs of all transplant services involved in donor organ retrieval. In addition, anesthesiologists can play critical roles in expediting preparation of the patient for surgery, and they can lend emotional support to operating room personnel during the surgery. The care of the organ donor is really the care of several patients--the donor and the fortunate recipients of the donated organs--and can afford great personal satisfaction.     

Principles of organ preservation

Hypothermia remains the basic principle of all organ preservation. This review shows some main cellular mechanisms involved with normo and hypothermia, particularly during ischemia. Different pathways and target sites concerned in preservation are explained. Commonly used preservation techniques and cold storage solutions are also discussed. Cryopreservation especially vitrification seems to be promising perhaps in the near future; it allows a state of almost a cellular metabolic arrest and consequently a theoretically unlimited preservation time.     

人类器官移植供体来源的发展历程

移植器官来源模式是科学技术发展和人文精神升华完美结合的产物.移植器官来源经历了异种动物、死刑遗体、亲属活体、脑死亡供体、亲属活体+非亲属活体、心死亡供体、多种来源这7个不同的历史阶段.异种移植离临床应用遥远;死刑来源倍受批评;活体移植伤害健康人.器官捐献移植发展史证明,公民逝世后器官捐献值得大力推广.以美国全脑死亡器官捐献和英国脑干死亡器官捐献为代表的美-欧模式,均为生前自愿同意,且绝对无偿.公民认为任何形式的补偿都会改变捐献行为本来的性质.心死亡器官捐献是脑死亡器官捐献的补充,适用于既不符合脑死亡标准又无法救治,同时家属又有强烈捐献意愿者.