Salim Ali, Martin Matthew, Brown Carlos, Rhee Peter, Demetriades Demetrios, Belzberg Howard
Department of Surgery, Division of Trauma and Critical Care, University of Southern California Keck School of Medicine and the Los Angeles County + University of Southern California Medical Center, Los Angeles, CA 90033, USA.
J Trauma. 2006 Aug;61(2):429-33; discussion 433-5. doi: 10.1097/01.ta.0000228968.63652.c1.
The disparity between the number of people awaiting organ transplantation and the number of organs available has become a public health crisis. As many as 25% of potential donors are lost as a result of cardiovascular collapse (CVC) before organ harvest. A policy of aggressive donor management (ADM) may decrease the number of cadaveric donors lost as a result of CVC.
Retrospective analysis of potential brain-dead donors evaluated from January 1995 to December 2003 at nine American College of Surgeons-verified Level I trauma centers covered by a regional organ procurement agency. One center (Los Angeles County + University of Southern California Medical Center [LAC]) had an ADM protocol in place instituted January 1999; the remaining eight centers with no ADM protocol were grouped as Center A. The incidence of CVC and organ donation demographics were compared between centers and within LAC before (LAC-Pre) and after (LAC-Post) adoption of ADM. ADM consists of early identification of potential organ donors, a dedicated team that provides medical management, and aggressive fluid resuscitation as well as hormone replacement therapy with solumedrol and thyroxin.
The incidence of CVC was significantly higher in LAC-Pre (odds ratio [OR] 15.0, p < 0.001) and Center A (OR 5.8, p < 0.001) compared with LAC-Post. The number of organs harvested per potential donor for LAC-Post (2.4) was significantly higher than LAC-Pre (2.0, p = 0.02) and Center A (2.1, p < 0.01).
An aggressive donor management protocol decreases the number of donors lost as a result of cardiovascular collapse and increases the number of harvested organs per potential donor.
等待器官移植的人数与可用器官数量之间的差距已成为一场公共卫生危机。多达25%的潜在捐赠者在器官获取前因心血管衰竭（CVC）而流失。积极的捐赠者管理（ADM）政策可能会减少因CVC而流失的尸体捐赠者数量。
对1995年1月至2003年12月期间在一家区域器官采购机构覆盖的九家美国外科医师学会认证的一级创伤中心评估的潜在脑死亡捐赠者进行回顾性分析。其中一个中心（洛杉矶县+南加州大学医学中心[LAC]）于1999年1月制定了ADM方案；其余八个没有ADM方案的中心归为A组。比较了各中心之间以及LAC采用ADM之前（LAC-前）和之后（LAC-后）的CVC发生率和器官捐赠人口统计学数据。ADM包括早期识别潜在器官捐赠者、一个提供医疗管理的专门团队、积极的液体复苏以及使用甲泼尼龙和甲状腺素进行激素替代治疗。
与LAC-后相比，LAC-前（优势比[OR]15.0，p<0.001）和A组（OR 5.8，p<0.001）的CVC发生率显著更高。LAC-后每个潜在捐赠者获取的器官数量（2.4个）显著高于LAC-前（2.0个，p=0.02）和A组（2.1个，p<0.01）。
积极的捐赠者管理方案可减少因心血管衰竭而流失的捐赠者数量，并增加每个潜在捐赠者获取的器官数量。
