Transplantation, Tufts Medical Center, Boston, MA, USA.
Am J Transplant. 2011 Aug;11(8):1719-26. doi: 10.1111/j.1600-6143.2011.03634.x. Epub 2011 Jul 12.
The Joint Commission requires all hospitals have a policy regarding donation after cardiac death. To this date however, a quantitative analysis of adult hospital donation after cardiac death (DCD) policies and its impact on transplantation outcomes has not been reported. Specific characteristics for DCD polices were identified from 90 of the 164 (54.9%) hospitals within the New England Organ Bank's donor service area. Forty-five policies (50.0%) allow family members to be present during withdrawal of life-sustaining therapy (WLST) whereas eight (8.9%) prohibit this. Seventeen policies (18.9%) require WLST to occur in the operating room (OR); 20 (22.2%) specify a location outside of the OR. Fifty-six (62.2%) policies fail to state the method of determining death; however, some require arterial line (15 policies, 16.6%) and/or EKG (10 policies, 11.1%). These variables were not associated with organ recovery, utilization or donor ischemia time. Our regional analysis highlights the high degree of variability of hospital DCD policies, which may contribute to misunderstanding and confusion among providers and patients that may influence acceptance of this mode of donation.
联合委员会要求所有医院都制定有关心脏死亡后捐献的政策。然而，迄今为止，尚未对成人医院心脏死亡后捐献（DCD）政策及其对移植结果的影响进行定量分析。从新英格兰器官银行供体服务区内的 164 家医院中的 90 家确定了 DCD 政策的具体特征。45 项政策（50.0%）允许家属在停止生命维持治疗（WLST）期间在场，而 8 项（8.9%）则禁止家属在场。17 项政策（18.9%）要求 WLST 在手术室（OR）中进行；20 项（22.2%）指定 OR 以外的地点。56 项（62.2%）政策未说明确定死亡的方法；但是，有些政策需要动脉线（15 项政策，16.6%）和/或心电图（10 项政策，11.1%）。这些变量与器官恢复、利用或供体缺血时间无关。我们的区域分析突出了医院 DCD 政策高度的可变性，这可能导致提供者和患者之间的误解和混淆，从而影响对这种捐献模式的接受。
