心脏死亡捐献单中心工作实践与思考

Single-center experience of donation after cardiac death and its inspirations

背景:心脏死亡捐献是国内现阶段解决器官来源的科学决策。国内外对移植器官受者及其家属的相关指标探讨较多,其次为捐献态度及其影响因素调查和伦理相关问题的研究,基于心脏死亡捐献基础上的供者及家属情况分析探讨较少。目的:回顾性分析吉林大学第一医院自2011年被卫生部和中国红十字会指定为心脏死亡捐献工作第二批试点单位以来的工作经验,汇总供者及其家属的信息,及时审视工作进展并探讨需要改进的方面。方法:以单中心试点工作以来获得的组织经验为基础,结合所接触的供者及其家属的自然状况、社会属性、对心脏死亡捐献的认知等情况,予以统计学处理。结果与结论:吉林大学第一医院心脏死亡捐献工作已逐步正规化,取得了一定成果,工作中总结了现存问题及普遍误区,以指导下一步工作。总结改进要点如下:①采取具体措施协助供者家属应对传统观念、心理压力及伦理问题。②大力发展与地方医院的交流与合作。③不能疏忽伦理评估与审批。④认真准确及时地上报供者信息,并随时更新受者信息库中的资料。⑤遇到特殊案例应进行小组讨论,针对个案探讨成功或失败的经验。⑥培养心脏死亡捐献团队成员整体素养。

BACKGROUND： Donation after cardiac death is a scientific strategy for solving organ source in modern China. Numerous studies focused on the relevant indexes of transplant organ recipients and their family members in China and outside China, and donation attitude, influencing factor investigation and relevant ethical problems. Few studies addressed the donors for donation after cardiac death and their family members. OBJECTIVE： To etrospectively analyze experience, summarize the information of donor and their family members, check our work and find out the shortcomings we should correct since the First Hospital of Jilin University was appointed as the second pilot organization of Donation of Cardiac Death by Ministry of Public Health of China and Red Cross Society of China in 2011. METHODS： On the basis of experience of single center pilot, statistical treatment was done in combination with general data, social nature, and recognition of donation after cardiac death of donors and their family members. RESULTS AND CONCLUSION： The donation after cardiac death in the First Hospital of Jilin University has been gradually regularized and obtained a certain outcome, and some existing problems and common errors are summarized to guide further work. Improvements are as follows： （1） precise measures are used to overcome conventional idea, mental stress and ethical problems of donor’s family members. （2） Try to make vigorous expansion of communication and cooperation with local hospitals. （3） Cannot ignore ethical evaluation and approval. （4） Seriously, accurately, promptly upload donor’s information, and renew recipient’s data in information database at any time. （5） For special cases, group discussion is needed, and the successful or failed experiences of individual cases are explored. （6） It is necessary to train the literacy of team members.