Shafer Teresa J, Wagner Dennis, Chessare John, Schall Marie W, McBride Virginia, Zampiello Francis A, Perdue Jade, O'Connor Kevin, Lin Monica J-Y, Burdick James
LifeGift Organ Donation Center, Fort Worth, Texas 76107, USA.
Crit Care Nurs Q. 2008 Jul-Sep;31(3):190-210. doi: 10.1097/01.CNQ.0000325044.78904.9b.
More than 92000 Americans are on waiting lists for organ transplants, and an average of 17 of them die each day while waiting. The US Organ Donation Breakthrough Collaborative (ODBC), which began in 2003 at the request of the Secretary of the US Department of Health and Human Services, was a formal, concerted effort of the donation and transplantation community to bring about a major change to improve the organ donation system. The nationwide Collaborative was housed within a Health and Human Services agency, the Health Resources and Services Administration (HRSA) Division of Transplantation, and included participation of the organ procurement organizations (OPOs) throughout the United States and the American hospitals with the largest organ-donor potential. HRSA leaders used the Breakthrough Series Collaborative method, originally developed by the Institute for Healthcare Improvement, as the model for the intervention. Expert practitioners drawn from hospitals and OPOs that had already demonstrated their ability to achieve and sustain high organ donation rates were chosen as faculty for the collaborative and best practices were gleaned from their institutions. The number of organ donors in Collaborative hospitals increased 14.1% in the first year, a 70% greater increase than the 8.3% increase experienced by non-Collaborative hospitals. Moreover, the increased organ recovery continued into the post-Collaborative periods. Between October 2003 and September 2006, the number of total US organ donors increased 22.5%, an increase 4-fold greater than the 5.5% increase measured over the same number of years in the immediate pre-Collaborative period. The study did not involve a randomized design, but time-series analysis using statistical process control charts shows a highly significant discontinuity in the rate of increase in participating hospitals concurrent with the Collaborative program, and strongly suggests that the activities of the Collaborative were a major contributor to this increase. Given the stable nature of the historical increases over many years, the HRSA estimates that more than 4000 annual additional transplants have occurred in association and apparently as a result of these increases in organ donation.
超过92000名美国人在等待器官移植的名单上，平均每天有17人在等待过程中死亡。美国器官捐赠突破协作组织（ODBC）于2003年应美国卫生与公众服务部部长的要求成立，是捐赠和移植界为改善器官捐赠系统带来重大变革而进行的正式、协同努力。全国性的协作组织设在卫生与公众服务部的一个机构——卫生资源与服务管理局（HRSA）移植司内，参与的有美国各地的器官采购组织（OPO）以及具有最大器官捐赠潜力的美国医院。HRSA的领导人采用了最初由医疗保健改进研究所开发的突破系列协作方法作为干预模式。从已经证明有能力实现并维持高器官捐赠率的医院和OPO中挑选出专家从业者作为协作组织的教员，并从他们的机构中收集最佳实践经验。协作医院的器官捐赠者数量在第一年增加了14.1%，比非协作医院8.3%的增长率高出70%。此外，器官回收率的提高在协作期之后仍在持续。在2003年10月至2006年9月期间，美国器官捐赠者总数增加了22.5%，比协作期前相同年份内5.5%的增长率高出4倍。该研究没有采用随机设计，但使用统计过程控制图的时间序列分析显示，参与医院的增长率在协作项目实施期间出现了高度显著的不连续性，强烈表明协作组织的活动是这一增长的主要促成因素。鉴于多年来历史增长的稳定性质，HRSA估计，由于这些器官捐赠的增加，每年大约多进行了4000例移植手术。
