Hibberd A D, Pearson I Y, McCosker C J, Chapman J R, Macdonald G J, Thompson J F, O'Connell D L, Mohacsi P J, McLoughlin M P, Spratt P M
John Hunter Hospital, Newcastle, New South Wales, Australia.
BMJ. 1992 May 23;304(6838):1339-43. doi: 10.1136/bmj.304.6838.1339.
To measure the potential for cadaver organ retrieval in New South Wales and to determine the reasons for potential donors failing to become actual donors.
Prospective audit of all patients dying in five hospitals in New South Wales between 1 December 1989 and 30 November 1990; quality assurance of the data by independent medical specialist and if disagreement by study committee.
2879 patients (100% of all deaths) yielding 364 patients with coma and 181 potential donors.
Realistic medically suitable potential donor rate, missed potential donor rate, rate of potential donors with permission refused, donor rate, reasons for realistic medically suitable potential donors failing to become actual donors.
2879 deaths yielded 73 medically suitable potential donors, resulting in 19 actual donors, 30 missed potential donors, 19 potential donors with permission refused, and five in whom adequate resuscitation failed. The most common reason for a potential donor failing to become an actual donor was a decision by the senior medical practitioner to withdraw or not to institute ventilatory or haemodynamic support (26/73). The second major obstacle was refusal of permission by the next of kin (17/73). Assuming that the potential donor rate was that implied by the observed donor rate (13/million population/year) the projected missed potential donor rate was 9/million population/year (95% confidence interval 4 to 15) and the projected rate of potential donors with permission refused was 13/million population/year (95% confidence interval 5 to 22). Assuming that the rate of potential donors in the study hospitals was the same as in the other New South Wales hospitals, the projected donor rate for New South Wales was 18/million population/year (10 to 26); the projected missed potential donor rate was 15/million population/year (7 to 23); and the projected rate of potential donors with permission refused was 18/million population/year (10 to 27).
The donor rate could be increased 70%-80% by overcoming the reluctance of medical practitioners to resuscitate missed potential donors and increased further by gaining permission for organ retrieval from the next of kin.
评估新南威尔士州尸体器官获取的可能性，并确定潜在捐赠者未能成为实际捐赠者的原因。
对1989年12月1日至1990年11月30日期间在新南威尔士州五家医院死亡的所有患者进行前瞻性审计；由独立医学专家对数据进行质量保证，如有分歧则由研究委员会处理。
2879例患者（占所有死亡人数的100%），其中364例昏迷患者，181例潜在捐赠者。
实际医学上合适的潜在捐赠者率、错过的潜在捐赠者率、同意被拒绝的潜在捐赠者率、捐赠者率、实际医学上合适的潜在捐赠者未能成为实际捐赠者的原因。
2879例死亡病例中有73例医学上合适的潜在捐赠者，产生了19例实际捐赠者、30例错过的潜在捐赠者、19例同意被拒绝的潜在捐赠者以及5例复苏失败的患者。潜在捐赠者未能成为实际捐赠者的最常见原因是高级医生决定停止或不进行通气或血流动力学支持（26/73）。第二个主要障碍是近亲拒绝同意（17/73）。假设潜在捐赠者率为观察到的捐赠者率所暗示的水平（每年每百万人口13例），预计错过的潜在捐赠者率为每年每百万人口9例（95%置信区间4至15），预计同意被拒绝的潜在捐赠者率为每年每百万人口13例（95%置信区间5至22）。假设研究医院的潜在捐赠者率与新南威尔士州其他医院相同，新南威尔士州的预计捐赠者率为每年每百万人口18例（10至26）；预计错过的潜在捐赠者率为每年每百万人口15例（7至23）；预计同意被拒绝的潜在捐赠者率为每年每百万人口18例（10至27）。
通过克服医生对复苏错过的潜在捐赠者的不情愿，捐赠者率可提高70%-80%，通过获得近亲对器官获取的确切同意可进一步提高。
