Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
Transplantation. 2010 Dec 27;90(12):1506-10. doi: 10.1097/TP.0b013e3182007b33.
Organ donation after brain death (DBD) has declined in the United Kingdom, whereas donation after cardiac death (DCD) has increased markedly. We sought to understand the reasons for the decline in DBD and determine whether the increase in DCD was a major factor.
The UK Transplant Registry was analyzed to determine trends in organ donation. Data from the "Potential Donor Audit," an audit of all patients younger than 76 years who died in noncardiothoracic UK intensive care units, was analyzed to identify trends in clinical demographics and management and to determine whether potential donors (DBD and DCD) were identified and appropriate steps were taken to enable organ donation.
There were 7589 (12.8 per million of population [pmp]) deceased organ donors in the United Kingdom from 1999 to 2009. The total number of deceased donors increased by 16% (to 14.9 pmp), but DBD donors decreased from 744 to 612, and the overall increase in donors was due to an 8-fold increase in DCD donors (33 in 1999 to 2000, 288 in 2008 to 2009). Analysis of the Potential Donor Audit over the 5-year period 2004 to 2005 to 2008 to 2009 showed that the number of patients dying in intensive care units who were possibly brain stem dead (comatose, apparently apnoeic with unresponsive pupils) decreased from 1929 in 2004 to 2005 to 1495 in 2008 to 2009 (22.5% reduction). The proportion of potential DBD donors who became donors increased from 45% to 51%.
There is no evidence that the increase in DCD donors has contributed directly to the decline in DBD, which reflects a decrease in the number of patients with brain death.
在英国，脑死亡后器官捐献（DBD）的数量有所下降，而心死亡后器官捐献（DCD）的数量则显著增加。我们试图了解 DBD 数量下降的原因，并确定 DCD 数量的增加是否是一个主要因素。
对英国移植登记处进行了分析，以确定器官捐献的趋势。对所有年龄在 76 岁以下、死于英国非心胸重症监护病房的潜在捐献者的“潜在捐献者审核”进行了数据分析，以了解临床人口统计学和管理方面的趋势，并确定是否确定了潜在捐献者（DBD 和 DCD）并采取了适当的步骤来实现器官捐献。
1999 年至 2009 年期间，英国共有 7589 名（每百万人口 12.8 名）已故器官捐献者。已故捐献者总数增加了 16%（达到 14.9 名/百万），但 DBD 捐献者从 744 人减少到 612 人，捐献者总数的增加是由于 DCD 捐献者增加了 8 倍（从 1999 年至 2000 年的 33 人增加到 2008 年至 2009 年的 288 人）。对 2004 年至 2005 年、2008 年至 2009 年的潜在捐献者审核进行了 5 年分析，结果显示，在重症监护病房死亡、可能脑死亡（昏迷、明显无呼吸伴无反应性瞳孔）的患者人数从 2004 年至 2005 年的 1929 人减少到 2008 年至 2009 年的 1495 人（减少了 22.5%）。潜在 DBD 捐献者成为捐献者的比例从 45%增加到 51%。
没有证据表明 DCD 捐献者的增加直接导致了 DBD 的减少，这反映了脑死亡患者数量的减少。
