华东地区某三甲医院人体器官获取组织100例器官捐献经验总结

Experience of 100 cases of organ donation from organ procurement organization in a third class hospital in East China

目的概括及分析复旦大学附属中山医院人体器官获取组织(organ procurement organization,OPO)实现的100例公民逝世后器官捐献案例并总结相关经验。方法回顾性分析2014年7月至2021年3月复旦大学附属中山医院OPO办公室实现的全部100例公民逝世后器官捐献案例资料,分析捐献者的年龄、性别、主要原发病、籍贯及捐献率、产出比、利用率等器官捐献数据。结果自2014年7月至2021年3月,复旦大学附属中山医院OPO片区的每百万人口捐献率分别为1.7(2014年)、4.1(2015年)、4.5(2016年)、8.6(2017年)、5.2(2018年)、3.1(2019年),5.9(2020年),与同期上海市的PMP数据基本持平。医院OPO共成功利用捐献肝脏88个(利用率96.6%)、肾脏200个(利用率93.5%)、心脏6个(利用率100%),总产出比1∶2.94。捐献者平均年龄44.7岁;男性(80%)远多于女性;上海户籍人口占20%;平均住院天数6.1 d。主要原发病构成比为脑出血48%、颅脑损伤44%、脑梗死5%、缺血缺氧性脑病3%。本中心91%的器官捐献案例产生于各重症监护室。中山医院OPO片区上报潜在器官捐献者线索的转化率为32%,未转化案例中家属明确拒绝70%、病情未达标21%、患者死亡9%。结论随着上海城镇化逐步完成,人口的日益老龄化,以及国家对工作环境防护的改善和交通的治理,器官捐献者中的外伤性病因逐步减少,而内科性病因(如脑出血、脑梗死、缺氧缺血性脑病等)则逐步增多,高龄捐献者也并不鲜见。如何提高本地居民的器官捐献意愿、提高潜在捐献者的转化率、提高捐献器官的产出比(多器官联合捐献),是OPO面对的现实课题和长期工作。ICU是器官捐献的主战场,提高临床一线的医务人员参与器官捐献工作的积极性和主动性,并正确认识器官捐献者的病情,尽早开始器官维护的重症医学治疗,是器官移植成功的开始。

Objective To review and analyze the 100 DCD cases conducted by the organ procurement organization(OPO)of Zhongshan Hospital,Fudan University.Methods Data of the 100 DCD cases conducted by the OPO of Zhongshan Hospital from July 2014 to March 2021 were retrospectively collected.Medical record included age,gender,primary disease and region.Parameters including potential donation rate,production ratio and utilization rate were also calculated.Results From 2014 to 2021,the annual PMP of our OPO working area were 1.7,4.1,4.5,8.6,5.2,3.1,and 5.9,respectively.The PMP data were in accordance with the general PMP of Shanghai.Our OPO has successfully conducted donation of 88 livers,200 kidneys and 6 hearts with a production ratio of 2.94.The utilization rate was 96.6%,93.5%and 100%for liver,kidney and heart,respectively.The average age of donors was 44.7 years old,with male exceeding female(80%vs 20%).Only 20%of the donors were local resident.The average hospitalization day was 6.1 d.The constituent ratio of the primary disease was 48%for cerebral hemorrhage,44%for cranial injury,5%for cerebral infarction and 3%for ischemic hypoxic encephalopathy.91%of the cases raised from ICU.The donation rate of potential donors was 32%in our cases.Reasons for failed donation included rejection from relatives(70%),inappropriate health condition(21%)and premature death before donation(9%).Conclusions Intrinsic factors,including cerebral hemorrhage and infarction,has exceeded trauma and cranial injury and have become the leading primary disease of the donors.Elder donors are also not rare cases.To increase the donation willingness of the local resident,increase the donation rate of potential donors and elevate the production ratio are the main tasks OPO have to challenge in the future.ICU hospitalized the most donors,therefore ICU doctors and nurses should pay full proactive to identify potential donors and strengthen the ability to maintain organs.