Aggressive organ donor management significantly increases the number of organs available for transplantation
Aggressive organ donor management significantly increases the number of organs available for transplantation
复制标题
DOI：
10.1097/01.ta.0000168708.78049.32
复制
发表时间：
2005-05-01
影响因子：
--
通讯作者：
Demetriades, D
中科院分区：
文献类型：
--
作者：
Salim, A;Velmahos, GC;Demetriades, D
背景：可移植器官短缺已成为国家危机。尽管有各种扩大捐赠者库的尝试，但器官供应和器官需求之间的差距继续扩大。由于没有可预见的捐助者的数量增加，有必要最大限度地利用现有的donor pool.Methods器官：所有患者的记录提到区域器官采购组织可能的器官捐赠超过8年的时间（1995-2002年）进行了审查。1999年1月，由专职医生制定了积极的供体管理（ADM）政策，包括入住重症监护室、肺动脉导管插入术、积极的液体复苏、早期使用血管加压药、预防和治疗与脑死亡相关的并发症，以及在血流动力学不稳定的供体中自由使用甲状腺激素。关于器官捐赠，实际器官捐赠者，器官回收，捐赠者失去了由于心血管衰竭器官捐赠前的数据进行了比较之前（1995年1月至1998年12月）和之后（1999年1月至2002年12月）ADM。结果：有878例患者在8年期间提到器官捐赠。其中，469人（53.4%）被确认为潜在供体，但只有161人（34.3%）成为实际供体。与ADM前相比，ADM后的总转诊人数增加了57（p < 0.001），潜在供体增加19%（p = 0.01），实际捐助者增加82%（p < 0.001），因血流动力学不稳定而丢失的供体数量减少87%（p < 0.001），并且回收的器官数量增加了71%（p < 0.001）。结论：ADM政策增加了器官捐献的转诊池，并减少了因心血管衰竭而失去的器官捐献者数量。最终结果是可用于移植的器官数量显著增加。
Background: The shortage of transplantable organs has become a national crisis. Despite various attempts to expand the donor pool, the difference between organ supply and organ demand continues to widen. With no foreseeable increase in the number of donors, it is necessary to maximize the utilization of organs from the existing donor pool.Methods: Records of all patients referred to the regional organ procurement organization for possible organ donation over an 8-year period (1995-2002) were reviewed. A policy of aggressive donor management (ADM) by dedicated physicians was instituted in January 1999 involving intensive care unit admission, pulmonary artery catheterization, aggressive fluid resuscitation, early use of vasopressors, prevention and treatment of complications associated with brain death, and liberal use of thyroid hormone in hemodynamically unstable donors. Data regarding referrals for organ donation, actual organ donors, organs recovered, and donors lost due to cardiovascular collapse before organ donation were compared before (January 1995-December 1998) and after (January 1999-December 2002) ADM.Results: There were 878 patients referred for organ donation during the 8-year period. Of those, 469 (53.4%) were confirmed as potential donors, but only 161 (34.3%) became actual donors. When compared with the period before ADM, the period after ADM showed a 57% increase in total referrals (p < 0.001), 19% increase in potential donors (p = 0.01), 82% increase in actual donors (p < 0.001), 87% decrease in the number of donors lost due to hemodynamic instability (p < 0.001), and a 71 % increase in the number of organs recovered (p < 0.001).Conclusions: A policy of ADM increases the referral pool for organ donation and reduces the number of organ donors lost due to cardiovascular collapse. The net result is a significant increase in the number of organs available for transplantation.