新型冠状病毒肺炎疫情期器官捐献相关风险评估的经验总结

Risk assessments of organ donation and procurement during COVID-19 pandemic

目的:探讨新型冠状病毒肺炎(COVID-19)疫情期风险评估表对器官捐献和获取相关风险的临床评估效果,降低供者来源性感染和医务人员感染的风险。方法:2020年1月20日至2月29日南部战区总医院器官获取组织在COVID-19疫情期采用风险评估表对8例潜在供者进行2019新型冠状病毒(2019-nCoV)感染的临床评估,通过分析捐献医院风险等级、潜在供者的临床特点和接触史将潜在供者分为高风险、低风险、不确定风险。器官获取组织(OPO)协调员、器官评估和病区医护人员以及参加器官获取手术人员均加强防护。观察上述工作人员的2019-nCoV感染情况,观察对应移植受者术后移植物功能和2019-nCoV感染情况。结果:按照COVID-19风险评估结果,8例潜在供者中有高风险等级1例、低风险等级5例和不确定风险等级2例。对6例供者(低风险等级供者5例和不确定风险等级供者1例)进行了器官功能评估和器官获取,共获得肝脏、肾脏、胰腺和心脏19个移植物,均成功用于器官移植。OPO协调员、器官评估、获取和病区医护人员在观察期(14 d)中无疑似或确诊感染2019-nCoV的情况发生。19例移植受者术后移植物功能恢复顺利,随访4~30 d未见移植物功能低下或急性排斥反应,无术后疑似或确诊感染2019-nCoV,其中6例术后2019-nCoV核酸检测阴性。结论:在COVID-19疫情期间,利用COVID-19风险评估表对潜在供者进行风险评估并采取针对性器官评估和获取策略具有良好的安全性,主张开展低风险供者器官捐献,谨慎开展不确定风险供者器官捐献,不主张对高风险供者进行器官捐献。

Objective To explore the clinical evaluation outcomes of COVID-19 risk assessment scale on organ donation and procurement during the pandemic of novel coronavirus pneumonia(NCP)and reduce the incidence of donor-derived infection and medical staff infection.Methods From January 20 to February 29 in 2020,the organ procurement team adopted the COVID-19 risk assessment scale for evaluating 8 potential donors.They were classified into the levels of high/low/uncertain risk by analyzing the risk levels of donation hospitals,clinical characteristics and exposure history.The coordinators,organ evaluators and ward medical staff adopted essential protective measures.The infection status of 2019-nCoV in the above mentioned staff was examined and graft function in the corresponding recipients were observed.Results Based upon the COVID-19 risk assessment results,the risk level was high(n=8),low(n=5)and uncertain(n=2)and underwent organ procurement.A total of 19 grafts including liver,kidney,pancreas and heart were harvested and successfully utilized for organ transplantation.During the observation period of 14 days,there was no suspected or confirmed infection of 2019-nCoV among coordinators and medical staff.No graft dysfunction or acute rejection was observed during a follow-up period of 4 to 30 days.No recipient was suspected or confirmed to be infected with 2019-nCoV and 6 of them were negative for 2019-nCoV nucleic acid testing after organ transplantation.Conclusions During the COVID-19 pandemic,it is safe to proceed with donor organ evaluations and procurements according to the result with the COVID-19 risk assessment scale.Low-risk donor organ donation may be carried out,uncertain risk donor organ donation should be performed cautiously and high-risk donations discouraged.