心脏死亡器官捐献获取流程探讨

目的总结并进一步探讨心脏死亡器官捐献(DCD)获取流程的初步经验。方法回顾性分析2009年7月至2012年1月期间广州军区总医院28例DCD者的临床资料、供体入选标准及器官获取流程。结果 28例DCD供体均成功实施了器官捐献,其中MaastrichtⅢ类3例(10.7%),MaastrichtⅣ类1例(3.6%),脑-心双死亡捐献(DBCD)供体24例(85.7%)。3例MaastrichtⅢ类供体实施了标准DCD器官获取流程(简称DCD流程),1例MaastrichtⅣ类供体采用DBCD器官获取流程(简称DBCD流程)非体外膜肺氧合(ECMO)模式,24例DBCD采用了DBCD流程ECMO模式。供体器官热缺血时间:DBCD为0 min,MaastrichtⅣ类为18 min,MaastrichtⅢ类平均25 min(22～28 min)。本组共获取了28个肝脏、40个肾脏、2个心脏,分别成功用于肝移植、肾移植和心脏移植。结论我国DCD器官获取可分为DCD流程和DBCD流程,后者又分为ECMO模式和非ECMO模式。ECMO模式可避免器官热缺血损伤且没有伦理学争议,对我国公民DCD器官有着十分重要的作用。

Organ Procurement Process for Organ Donation after Cardiac Death

Objective To summarize and further investigate the initial experience of organ procurement process for organ donation after cardiac death(DCD).Methods The clinical data,the selected standard,and the organ procurement process of 28 cases of DCD from July 2009 to January 2012 in the liver transplantation center of Guangzhou General Hospital were reviewed and analyzed.Results Twenty-eight cases of DCD all had donated organs successfully.Among these cases,there were 3 cases(10.7%)of the Maastricht Ⅲ,and one case(3.6%)of the Maastricht Ⅳ,and 24 cases(85.7%)of the organ donation after brain death plus cardiac death(DBCD).Three cases of the Maastricht Ⅲ were practiced the organ procurement process of DCD.One case of the Maastricht Ⅳ was practiced the organ procurement process of DBCD without the extracorporeal membrane oxygenation(ECMO).Twenty-four cases of DBCD were practiced the organ procurement process of DBCD with the ECMO.The donator warm ischemic time was zero min in DBCD,18 min in Maastricht Ⅳ,and mean 25 min(22-28 min)in Maastricht Ⅲ.All the donated organs included 28 livers,40 kidneys,and 2 hearts.And all these organs had been practiced the liver transplantation,the kidney transplantation,and the heart transplantation.Conclusions The organ procurement process for organ DCD includes the DCD process and the DBCD process in China,and the later includes the organ procurement process with the ECMO and without the ECMO.The ECMO could well control the warm ischemia for protecting the donors just without ethics dispute.So,the using of the ECMO for the organ DCD of citizen in China has a very important contribution.