Grigoraş I, Blaj M, Florin G, Chelarescu O, Craus C, Neagu R
University of Medicine and Pharmacy, School of Medicine, Iasi, Romania.
Transplant Proc. 2010 Jan-Feb;42(1):141-3. doi: 10.1016/j.transproceed.2009.11.026.
To evaluate the rate of organ donation after brain death in 2 tertiary care medical centers of a Romanian city, the reasons for donation exclusion (donors or organs), and identification of potential strategies for improvement.
The study retrospectively evaluated potential organ donors with brain death (BD) who were identified between January 2006 and June 2009 in an university city of Romania. The potential donors were considered patients with severe intracranial pathology and clinical signs of brain death who were reported to the regional transplant team. The BD declaration was completed according to the Law of Transplant Procurement and Management in Romania: clinical signs of brain stem death, apnea test, and flat EEG, criteria that must be fulfilled twice at a 6 hour interval. According to Romanian law, family consent is mandatory for organ harvesting.
The study included 35 potential donors, of whom 22 had a declaration of BD. Failure of potential donors to be declared BD was caused by positive viral serology (n = 7), improvement in clinical status (n = 2), sudden cardiac arrest (n = 2), and refusal of physician in charge (n = 2). Among the 22 with a BD declaration, organ harvesting was performed in only 12 cases due to family refusal (n = 10). In 4 cases the planned organ harvesting was aborted owing to unexpected intraoperative findings.
Factors that generate the low rate of organ procurement include local organizational particularities, a high rate of viral infections, poor education, (both of lay persons and of medical personnel), restrictive criteria for BD declaration and the mandatory need for family approval.
The rate of donation in this university city of Romania is still low. Several strategies have been identified to improve the rate: better identification of potential donors, better management, and education of the public and of health care personnel.
评估罗马尼亚某城市两家三级医疗中心脑死亡后的器官捐赠率、捐赠排除（捐赠者或器官）原因，并确定潜在的改进策略。
本研究回顾性评估了2006年1月至2009年6月在罗马尼亚一个大学城确定的脑死亡潜在器官捐赠者。潜在捐赠者为患有严重颅内病变且有脑死亡临床体征并报告给区域移植团队的患者。脑死亡声明根据罗马尼亚《移植采购与管理法》完成：脑干死亡的临床体征、呼吸暂停试验和平坦脑电图，这些标准必须在6小时间隔内重复两次。根据罗马尼亚法律，器官摘取必须获得家属同意。
该研究纳入了35名潜在捐赠者，其中22人有脑死亡声明。潜在捐赠者未被宣布脑死亡的原因包括病毒血清学阳性（n = 7）、临床状况改善（n = 2）、心脏骤停（n = 2）以及主治医生拒绝（n = 2）。在22名有脑死亡声明的人中，由于家属拒绝（n = 10），仅12例进行了器官摘取。4例计划中的器官摘取因术中意外发现而中止。
导致器官获取率低的因素包括当地组织特点、病毒感染率高、教育程度低（包括普通人和医务人员）、脑死亡声明的严格标准以及家属批准的强制性要求。
罗马尼亚这个大学城的捐赠率仍然很低。已确定了几种提高捐赠率的策略：更好地识别潜在捐赠者、更好地管理以及对公众和医护人员进行教育。
