公民死亡器官捐献潜在供体转运通道建立及供体重症监护室器官维护

Establishment of transportation channel for potential cadaver organ donation and organ maintenance in donor's intensive care unit

目的探讨适合临床的公民死亡器官捐献(DCD)潜在供体转运通道及供体重症监护室供体维护机制。方法首都医科大学附属北京佑安医院自2012年1月开通转运通道,至2016年6月,器官获取组织(Organ Procurement Organization,OPO)共接到DCD相关信息152例,评估152例。临床判定为潜在捐献者合格84例,访谈84例,41例潜在供体家属同意捐献。建立DCD潜在供体转运通道,一般流程下直接转运潜在供体入供体重症监护室(DI-CU),并立即进行各重要器官的评估及维护。当潜在供体在转运过程中出现生命体征的恶化,紧急情况下启动应急流程。评价潜在供者进入DICU时和捐献前各项实验室检查指标的变化。结果自2012年首都医科大学附属北京佑安医院共接收潜在供体41例,其中男29例,女12例;年龄(35.17±19.51)岁。1例(2.4%)转运过程中出现呼吸心跳停止,3例(7.3%)因家属意愿改变而中止捐献,37例(90.2%)顺利完成器官捐献。按中国心脏死亡器官捐献分类标准进行分类,此37例中国际标准化脑死亡供体28例(75.7%),国际标准化心脏死亡供体3例(8.1%),国际标准化心脑死亡供体6例(16.2%)。其中31例供体捐献器官用于移植,6例供体的器官捐献后因损伤超出标准被弃用。潜在供体入DICU时和捐献前各项化验指标变化,AST、T-BIL、D-BIL、BUN的差异有统计学意义(P<0.05)。结论建立适合临床工作的公民死亡器官捐献潜在供体转运通道及供体重症监护室以维护器官功能、提高捐献成功率非常重要,保证了供体器官的数量及质量。

Objective To investigate the feasible mechanism of clinical transportation channel and donor＇s inten- sive care unit（DICU） maintenance for potential cadaver organ donation. Methods Transportation channel for potential DCD donor was established via optimization of processes, division and cooperation, Under the general flow, potential do- nor was transported into DICU, where the donor was assessed and maintained vital organs functions immediately. When vital signs deterioration being occurred during potential donor transportation, emergency procedures started immediately. Results From Jan. 2012, the transportation channel had been opened, upto Jun 2016, Beijing You＇ an Hospital had re- ceived a total of 41 cases of potential donors, including 29 males and 12 females, （35.17：i： 19.51） years old. One case （2.4%） of cardiopulmonary arrest occurred during transportation, 3 cases （7.3%） had been suspended due to the changed willingness of the families. A total of 37 patients （90.2%） had completed organ donation successfully. Classified by China cardiac death organ donation classification criteria, among these 37 cases, there were 28 cases （75.7%） of donation after brain death, 3 cases （8.1%） of donation after cardiac death potential donors, 6 cases （16.2%） of donation after brain and cardiac death. Thirty-one cases had donated organs for transplantation, 6 cases had been abandoned after organ donation because of injury beyond the standard. Changes in laboratory tests of potential donors between entering to DICU and before donating had been compared, AST, T-BIL, D-BIL and BUN were of statistically significant （P 〈 0.05）. Conclusion The clinical practice of transportation channel for potential DCD donor and DICU to maintain organ function, improve the success rate of donation is very important, which ensures the quantity and quality of donor organs.