McCunn Maureen, Mauritz Walter, Dutton Richard P, Alexander Charles, Handley Christopher, Scalea Thomas M
Department of Critical Care Medicine, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, 21202, USA.
J Trauma. 2003 May;54(5):995-9. doi: 10.1097/01.TA.0000022461.76930.4E.
The similarities and differences in organ donation policies, consent rates, and number of organs transplanted from patients declared "brain dead" after traumatic injury in different countries has not been previously reported.
An international trauma survey questionnaire was developed. Analysis of two responding centers with regard to organ donation practices between urban, free-standing adult trauma hospitals is presented: the R Adams Cowley Shock Trauma Center (STC) in Baltimore, Maryland, and the Lorenz Böhler Hospital (LBH) in Vienna, Austria.
Hospital admissions resulting from traumatic brain injury (TBI) account for a significantly greater number of admissions at the STC than at the LBH (761 vs. 276), and the STC has a higher number of patients admitted with severe TBI (Glasgow Coma Scale score < 8). Of 39 medically suitable brain-dead patients at the STC, 18 went to organ donation. At the LBH, 16 patients were declared brain-dead, 7 were considered to be medically suitable, and all 7 went to donation. A "presumed consent" organ donation policy in Austria resulted in 100% of medically suitable patients going to donation at the LBH. With a volunteer donation policy at the STC, 46% of patients went to donation. Of those families who refused donation at the STC, 9 of 16 eligible African Americans (56%), 10 of 21 eligible Caucasians (48%), 1 Hispanic, and 1 Native American Indian family declined donation.
"Presumed" organ donation in Austria led to 4 organs transplanted per trauma brain-death at the LBH, as compared with 3.8 organs per brain-death at the STC. The greater number of patients with severe TBI at the STC accounts for a similar organ donation rate compared with the LBH, despite the fact that the consent at the STC is voluntary and at the LBH is "presumed." A higher organ donation rate in the United States would result in a greater number of organ transplants from patients who die after traumatic injury and a resultant increase in potential lives saved. There does not appear to be a significant difference in ethnicity between families who accept and those who refuse organ donation after traumatic brain death declaration at the STC.
不同国家在器官捐赠政策、同意率以及创伤后被宣布“脑死亡”患者的器官移植数量方面的异同此前尚未见报道。
编制了一份国际创伤调查问卷。本文分析了两家有回复的机构，即马里兰州巴尔的摩的R·亚当斯·考利休克创伤中心（STC）和奥地利维也纳的洛伦兹·伯勒医院（LBH），这两家均为城市独立成人创伤医院的器官捐赠实践情况。
创伤性脑损伤（TBI）导致的住院人数在STC显著多于LBH（761例对276例），且STC收治的重度TBI患者（格拉斯哥昏迷量表评分<8分）数量更多。在STC的39例医学上适合的脑死亡患者中，18例进行了器官捐赠。在LBH，有16例患者被宣布脑死亡，7例被认为医学上适合，且这7例均进行了捐赠。奥地利的“推定同意”器官捐赠政策使得LBH医学上适合的患者100%进行了捐赠。STC采用自愿捐赠政策，46%的患者进行了捐赠。在STC拒绝捐赠的家庭中，16名符合条件的非裔美国人中有9名（56%）、21名符合条件的白种人中有10名（48%）、1名西班牙裔以及1名美国原住民印第安家庭拒绝了捐赠。
在奥地利，“推定”器官捐赠使得LBH每例创伤性脑死亡患者有4个器官被移植，而STC每例脑死亡患者为3.8个器官。尽管STC是自愿同意，LBH是“推定”同意，但STC重度TBI患者数量更多导致其器官捐赠率与LBH相近。在美国提高器官捐赠率将使创伤后死亡患者的器官移植数量增加，并有可能挽救更多生命。在STC，脑死亡宣布后接受和拒绝器官捐赠的家庭在种族方面似乎没有显著差异。
