重症监护病房脑死亡后器官捐献认知调查

Intensive care unit survey of cognition status of donation after brain death

目的 调查重症监护病房（ICU）医务人员和脑死亡潜在供体（PD）家属对脑死亡后器官捐献的认知态度,探讨脑死亡后器官捐献发展办法.方法 对2011年7月至2013年4月广东省89家ICU的149名医务人员和879名脑死亡PD家属对脑死亡后器官捐献的认知态度进行调查.结果 100％（149/149）的医务人员认同脑死亡后器官捐献意义,其中96.6％（144/149）赞同脑死亡后器官捐献,脑死亡标准知晓率为85.9％（128/149）,94.0％ （140/149）认可脑死亡=死亡.医务人员PD标准认知：捐献年龄知晓率为13.4％ （20/149）,肝肾功能捐献条件知晓率为40.9％（61/149）,对乙型肝炎捐献条件知晓率为44.3％（66/149）.对于脑死亡立法的必要性,79.2％ （118/149）的医务人员认为必要,14.8％（22/149）认为无所谓,6.0％ （9/149）认为不需要.对于应如何开展脑死亡后器官捐献工作,43.6％（65/149）的医务人员认为不知道,79.2％（118/149）不敢,30.9％（46/149）没想到.无一名PD家属知晓什么叫脑死亡,经解释后98.6％ （867/879）认可脑死亡=死亡,99.5％（875/879）认同脑死亡后器官捐献意义,47.0％（413/879）赞同脑死亡后器官捐献,认同脑死亡后器官捐献意义但是不赞同脑死亡后器官捐献的原因：80.5％（372/462）认为死要完尸,19.5％（90/462）原因未知;有捐献意愿但是拒绝器官捐献原因：50.1％（207/413）为家庭成员反对[其中非直系亲属反对占26.1％（54/207）],11.4％（47/413）担心邻居议论买卖器官,9.2％（38/413）希望有偿,8.0％（33/413）为其他原因.结论 ICU医务人员和家属对脑死亡后器官捐献认知不足、医生担心脑死亡尚未立法和传统思想对家属的影响是导致脑死亡转化率低的主要原因,需要一支专业的移植协调员队伍对全民进行器官捐献知识的宣教.

Objective To explore the development approach of donation after brain death through analyzing the cognition status of donation after brain death among medical staff and potential donor （PD）family members of intensive care unit （ICU）.Methods Analysis was conduced for the cognition of donation after brain death among 149 ICU professionals and 879 PD family members at 89 hospitals from July 2011 to April 2013.Results Medical staff：100% （149/149） recognized the significance of donation after brain death,96.6% （144/149）approved of donation after brain death,85.9% （128/149）knew about brain death criteria,94.0% （140/149）accepted the equivalence of brain death as death.Awareness of standard of potential donor：13.4% （20/149） were aware of donation age,40.9% （61/149） familiar with the donation criteria of liver and kidney function and 44.3% （66/149） knew the hepatitis B donation criteria.Necessity of brain death legislation：79.2% （118/149） considered it necessary,14.8% （22/149） unimportant and 6.0% （9/149）not necessary.How to manage donation after brain death：43.6% （65/149）did not know how,79.2% （118/149）were afraid and 30.9% （46/149）never considered.Family members：0/879 knew about brain death,98.6% （867/879） accepted the equivalence of brain death as death,99.5% （875/879） approved the significance of donation after brain death and 47.0% （413/879） agreed with donation after brain death.The reasons for approving the significance of donation after brain death but not agreeing with donation：80.5% （372/462）required a full corpse after death and 19.5% （90/462）for other reasons.Reasons for agreeing with donation but refuse：50.1% （207/413） were opposed by other family members,11.4% （47/413） beware of neighbors＆#39; chat about their organ trading,9.2% （38/413） hoped to be paid and 8.0% （33/413） for the others.Conclusions The cognitive deficits of donation after brain death for medical staff and family members,medical staff＆#39;s worries about brain death legislation and traditional thoughts of family members are the main reasons for a low conversion rate of PD.A professional transplant coordinating team should be built for national organ donation knowledge education.