Dutch Transplant Foundation, Leiden, The Netherlands.
Nephrol Dial Transplant. 2010 Jun;25(6):1992-7. doi: 10.1093/ndt/gfp705. Epub 2010 Jan 18.
The Netherlands has a low number of deceased organ donors per million population. As long as there is a shortage of suitable organs, the need to evaluate the donor potential is crucial. Only in this way can bottlenecks in the organ donation process be detected and measures subsequently taken to further improve donation procedures.
Within a time frame of 4 years, 2005-08, medical charts of all intensive care deaths in 64 hospitals were reviewed by transplant coordinators and donation officers. Data were entered in a web-based application of the Dutch Transplant Foundation, both to identify the number of potential organ donors (including donation after cardiac death), as well as to analyse the reasons for potential donor loss.
In total, 23 508 patients died in intensive care units, of which 64% were younger than 76 years. The percentage of all potential organ donors out of the total number of deaths decreased from 8.2% in 2005 to 7.1% in 2008. Donor detection increased from 96% in 2005 to 99% in 2008. Of the potential donors, 17-21% recorded consent and 17-18% recorded objection in the national Donor Register. If the Donor Register was not decisive, the consent rate of families approached for organ donation was 35% in 2005, 29% in 2006, 41% in 2007 and 31% in 2008. The overall conversion rate (the number of actual donors divided by the number of potential donors) was 30%, 26%, 35% and 29% in these years. In the group of potential donor losses, objection by families accounted for about 60% during this study.
This study showed that the maximal number of potential organ donors is about three times higher than the number of effective organ donors. The main reason accounting for approximately 60% of the potential donor losses was the high family refusal rate. The year 2007 showed that a higher percentage of deceased organ donors can be procured from the pool of potential donors. All improvements should focus on decreasing the unacceptably high family refusal rates.
荷兰每百万人口中的已故器官捐献者人数较少。只要合适的器官短缺，评估捐献者的潜力就至关重要。只有这样，才能发现器官捐献过程中的瓶颈，并采取相应措施进一步改进捐献程序。
在 2005-08 年的 4 年时间内，由移植协调员和捐赠官员对 64 家医院所有重症监护死亡患者的医疗记录进行了回顾。数据被输入荷兰移植基金会的一个基于网络的应用程序中，目的是确定潜在器官捐献者的数量（包括心死亡后的捐献），并分析潜在捐献者流失的原因。
共有 23508 名患者在重症监护病房死亡，其中 64%年龄小于 76 岁。潜在器官捐献者在总死亡人数中的比例从 2005 年的 8.2%下降到 2008 年的 7.1%。捐献者的发现率从 2005 年的 96%上升到 2008 年的 99%。在潜在捐献者中，有 17-21%在国家器官捐献登记处表示同意，有 17-18%表示反对。如果国家器官捐献登记处的决定不具有决定性，那么在 2005 年、2006 年、2007 年和 2008 年，对被邀请进行器官捐献的家属的同意率分别为 35%、29%、41%和 31%。在这些年份，实际捐献者人数与潜在捐献者人数之比的总体转化率分别为 30%、26%、35%和 29%。在潜在捐献者损失组中，家庭反对约占 60%。
本研究表明，潜在器官捐献者的数量大约是有效器官捐献者的三倍。导致潜在捐献者流失的主要原因是家属拒绝率高。2007 年的数据表明，从潜在捐献者中可以获得更高比例的已故器官捐献者。所有的改进都应集中在降低不可接受的高家属拒绝率上。
