Sheehy Ellen, Conrad Suzanne L, Brigham Lori E, Luskin Richard, Weber Phyllis, Eakin Mark, Schkade Lawrence, Hunsicker Lawrence
Association of Organ Procurement Organizations, McLean, Va 22101, USA.
N Engl J Med. 2003 Aug 14;349(7):667-74. doi: 10.1056/NEJMsa021271.
As the need for transplantable organs increases, waiting lists of patients become longer. We studied the size and composition of the national pool of brain-dead organ donors during a three-year period and, on the basis of these data, considered ways to increase the rate of donation.
We reviewed hospital medical records of deaths occurring in the intensive care unit from 1997 through 1999 in the service areas of 36 organ-procurement organizations to identify brain-dead potential organ donors. We examined data on characteristics of the potential donors, the processes of referral to organ-procurement organizations and of requesting donations, and the hospitals.
We identified a total of 18,524 brain-dead potential organ donors during the study period. The predicted annual number of brain-dead potential organ donors is between 10,500 and 13,800. The overall consent rate (the number of families agreeing to donate divided by the number of families asked to donate) for 1997 through 1999 was 54 percent, and the overall conversion rate (the number of actual donors divided by the number of potential donors) was 42 percent. Hospitals with 150 or more beds were more likely than smaller hospitals to have potential donors and actual donors (P<0.001); 19 percent of hospitals accounted for 80 percent of all potential donors. Calculations of the number of donors per million persons in the general population did not correlate well with the performance of organ-procurement organizations as measured by the conversion rate.
Lack of consent to a request for donation was the primary cause of the gap between the number of potential donors and the number of actual donors. Since potential and actual donors are highly concentrated in larger hospitals, resources invested to improve the process of obtaining consent in larger hospitals should maximize the rate of organ recovery. The performance of organ-procurement organizations can be assessed objectively through the comparison of the number of actual donors with the number of potential donors in the given service area.
随着对可移植器官需求的增加，患者等待名单越来越长。我们研究了三年期间全国脑死亡器官捐献者库的规模和构成，并基于这些数据探讨了提高捐献率的方法。
我们回顾了1997年至1999年期间36个器官获取组织服务区域内重症监护病房发生的死亡病例的医院病历，以确定脑死亡潜在器官捐献者。我们研究了潜在捐献者的特征、转介至器官获取组织及请求捐献的过程以及医院的数据。
在研究期间，我们共识别出18524名脑死亡潜在器官捐献者。预计每年脑死亡潜在器官捐献者数量在10500至13800之间。1997年至1999年的总体同意率（同意捐献的家庭数量除以被请求捐献的家庭数量）为54%，总体转化率（实际捐献者数量除以潜在捐献者数量）为42%。拥有150张或更多床位的医院比规模较小的医院更有可能拥有潜在捐献者和实际捐献者（P<0.001）；19%的医院占所有潜在捐献者的80%。按每百万人口计算的捐献者数量与器官获取组织以转化率衡量的表现相关性不佳。
对捐献请求缺乏同意是潜在捐献者数量与实际捐献者数量之间差距的主要原因。由于潜在和实际捐献者高度集中在较大的医院，投入资源改善较大医院获取同意的过程应能使器官回收率最大化。通过比较给定服务区域内实际捐献者数量与潜在捐献者数量，可以客观评估器官获取组织的表现。
