Pugliese Maria Rosa, Degli Esposti Daniela, Dormi Ada, Venturoli Nicola, Mazzetti Gaito Paolo, Buscaroli Andrea, Petropulacos Kyriakoula, Nanni Costa Alessandro, Ridolfi Lorenza
Transplant Reference Centre, Emilia Romagna Region, Sant' Orsola Hospital, Clinica Chirurgica 2, Via Massarenti 9, 40138 Bologna, Italy.
Transpl Int. 2003 Jan;16(1):21-5. doi: 10.1007/s00147-002-0497-7. Epub 2002 Dec 10.
The increasing demand for organs for transplantation entails a consensual need for enhancement of organ procurement activity. As organ donors reside mainly in hospital intensive care units (ICUs), the Donor Action programme is aimed at identifying critical areas in ICUs, in order to improve the first step of organ donation. The purpose of this paper is to analyse the problem of identification of potential donors by means of a chart revision of patients who died in 14 ICUs in the Emilia-Romagna region between 1 July 1998 and 31 December 2000. All deaths and patients with severe brain insult (score on Glasgow Coma Scale (GCS) = 3/15) were assessed by the local transplant coordinators together with a professional at the Transplant Reference Centre. Brain death diagnoses and potential donor referrals were therefore assessed in the study period, which was subdivided into five semesters. Of the 3,056 deaths reported in 30 months, 1,248 were due to severe brain damage (GCS score = 3). Brain death diagnosis (BD) was performed in 509 patients (40.8%). Although we applied the same parameters over the whole length of the study, we observed a significant increase in BDs (from 87 in the first semester to 125 in the last, 30.5% to 53.0% of the patients with GCS 3 ( P=0.003, chi(2) for trend=16.072), in spite of a slight decrease in the total number of deaths and in the total number of patients with GCS score = 3 (from 649 to 587, and from 44% to 41%, respectively). Study population characteristics could have contrasted with rather than facilitated our results: age and gender did not change significantly, whilst cause of death showed a significant reduction in trauma and an increase in cerebrovascular incidents over the whole length of the study. We can conclude that the more careful assessment of patients dying in ICUs, by the Donor Action programme, significantly contributed to the improvement of BDs observed in the study period. Therefore, Donor Action seems to be an efficient quality control programme to improve identification of potential donors, the first stage of organ procurement.
对移植器官需求的不断增加使得人们一致认为有必要加强器官获取活动。由于器官捐献者主要住在医院重症监护病房（ICU），“捐献者行动”计划旨在确定重症监护病房中的关键领域，以改进器官捐献的第一步。本文的目的是通过对1998年7月1日至2000年12月31日期间在艾米利亚 - 罗马涅地区14个重症监护病房死亡患者的病历进行审查，分析潜在捐献者的识别问题。所有死亡患者和严重脑损伤患者（格拉斯哥昏迷量表（GCS）评分 = 3/15）均由当地移植协调员与移植参考中心的一名专业人员进行评估。因此，在研究期间对脑死亡诊断和潜在捐献者转诊情况进行了评估，研究期分为五个学期。在30个月内报告的3056例死亡病例中，1248例是由于严重脑损伤（GCS评分 = 3）。509例患者（40.8%）进行了脑死亡诊断（BD）。尽管在整个研究期间我们应用了相同的参数，但我们观察到脑死亡诊断数量显著增加（从第一学期的8例增加到最后一学期的125例，GCS评分为3的患者中从30.5%增加到53.0%，P = 0.003，趋势的卡方值 = 16.072），尽管死亡总数和GCS评分为3的患者总数略有下降（分别从649例降至587例，从44%降至41%）。研究人群的特征可能与我们的结果形成对比而非提供便利：年龄和性别没有显著变化，而在整个研究期间，死因显示创伤显著减少，脑血管事件增加。我们可以得出结论，“捐献者行动”计划对重症监护病房中死亡患者进行的更仔细评估，对研究期间观察到的脑死亡诊断的改善做出了重大贡献。因此，“捐献者行动”似乎是一个有效的质量控制计划，可改善潜在捐献者的识别，这是器官获取的第一阶段。
