Bozzi G, Saviozzi A, De Simone P, Filipponi F
Coordinamento Locale alla Donazione Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Transplant Proc. 2008 Jul-Aug;40(6):1816-7. doi: 10.1016/j.transproceed.2008.05.032.
Constant monitoring is paramount in order to detect the criticalities and improve the results of the deceased donation process. Concomitant with the institution of a regional transplantation service authority--Organizzazione Toscana Trapianti--in 2003, Tuscany adopted a program of quality assurance of the deceased donation process by compulsory reporting of all encephalic deaths from local intensive care units to the regional transplant office in Florence. The indicators we adopted were the efficiency of deceased donor (DD) identification, expressed as the ratio of encephalic deaths (ED) to total deaths with encephalic lesions (EL) (ie, ED/EL); the efficiency of DD reporting, expressed as the ratio of reported potential DD (RPDD) to total ED (ie, RPDD/ED); the efficacy of the DD process, as the ratio between actual DD (ADD) to total ED (ie, ADD/ED); the conversion rate; the percent of opposition to donation; and the incidence of DD maintenance failures. Data were collected prospectively, stratified by regional hospital consortia (Aziende Sanitarie Locali) and compared with international benchmarks. In the period 2003-2006 the mean efficiency of DD identification was 48.3%+/-4.4% (range 42.6%-53.2%); the mean efficiency of DD reporting was 95.2%+/-2.5% (range 92.5%-98.5%); the mean efficacy of the deceased donation process was 51.8%+/-2.4% (range 48.6%-54.4%); the mean conversion rate was 59.6%+/-2.2% (range 57.6%-62.7%); the mean opposition rate was 31.9%+/-1.1% (range 30.6%-33.2%); and the incidence of DD maintenance failure was 5%+/-2.9% (range 2.2%-8.7%). The breakdown analysis revealed wide interhospital variability in terms of efficiency of DD identification (from a low of 25% to a high of 80%); efficacy of the donation process (from a low of 22% to a high of 79%); and conversion rate (from a low of 29% to a high of 79%). Our results highlight that the donation process gets started in about 50% of eligible cases. Further strategies are favored to address this critical area.
持续监测至关重要，以便发现关键问题并改善死亡器官捐献流程的结果。随着2003年地区移植服务机构——托斯卡纳移植组织（Organizzazione Toscana Trapianti）的设立，托斯卡纳通过了一项死亡器官捐献流程质量保证计划，要求当地重症监护病房将所有脑死亡病例强制上报至佛罗伦萨的地区移植办公室。我们采用的指标包括：死亡器官捐献者（DD）识别效率，以脑死亡（ED）与有脑部病变的总死亡数（EL）之比表示（即ED/EL）；DD上报效率，以报告的潜在DD（RPDD）与总ED之比表示（即RPDD/ED）；DD流程的效力，以实际DD（ADD）与总ED之比表示（即ADD/ED）；转化率；反对捐献的比例；以及DD维护失败的发生率。数据前瞻性收集，按地区医院联盟（Aziende Sanitarie Locali）分层，并与国际基准进行比较。在2003 - 2006年期间，DD识别的平均效率为48.3%±4.4%（范围42.6% - 53.2%）；DD上报的平均效率为95.2%±2.5%（范围92.5% - 98.5%）；死亡器官捐献流程的平均效力为51.8%±2.4%（范围48.6% - 54.4%）；平均转化率为59.6%±2.2%（范围57.6% - 62.7%）；平均反对率为31.9%±1.1%（范围30.6% - 33.2%）；DD维护失败的发生率为5%±2.9%（范围2.2% - 8.7%）。分类分析显示，在DD识别效率（从低至25%到高至80%）、捐献流程效力（从低至22%到高至79%）和转化率（从低至29%到高至79%）方面，医院间存在很大差异。我们的结果表明，在约50%的符合条件的病例中启动了捐献流程。需要采取进一步策略来解决这一关键领域的问题。
