The Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, New South Wales, Australia.
Intern Med J. 2012 Aug;42(8):866-73. doi: 10.1111/j.1445-5994.2012.02792.x.
BACKGROUND/AIM: During the past two decades, Australian federal and state governments have funded many initiatives to bolster organ donation. Despite large investments of time, effort and money, Australia's deceased donation rate is in the bottom half of the Organisation for Economic Co-operation and Development countries and has only marginally increased from 11.9 donors per million people (pmp) in 1990 to 14.9 donors pmp in 2011. An often-cited explanation for this situation is that Australia's success in increasing levels of public health and safety through reduced traffic and stroke fatalities has reduced its number of potential deceased organ donors. We refer to this as the 'Failure Because of Success' hypothesis. Although commonly accepted, this hypothesis is largely untested.
By analysing data from international donation and transplantation organisations and international public health and safety organisations, we compared historical deceased organ donation rates with traffic and stroke fatality rates in Australia and the seven countries with the world's highest deceased organ donation rates (Spain, Portugal, France, USA, Belgium, Austria and Italy).
Traffic fatality rates across all countries in the study have fallen dramatically during the time period, with Spain having the lowest traffic fatality rates. Stroke fatality rates demonstrate similar reductions, with France showing the lowest cerebral vascular accident mortality rates.
When compared with countries with the world's highest deceased donation rates, Australia's improvements to public health and safety through reductions in traffic and stroke fatalities were neither unique nor exemplary and do not provide an adequate explanation for its low organ donor rates.
背景/目的：在过去的二十年中，澳大利亚联邦和州政府资助了许多举措来加强器官捐赠。尽管投入了大量的时间、精力和资金，但澳大利亚的已故捐赠率仍处于经济合作与发展组织（OECD）国家的后半部分，并且仅从 1990 年的每百万人中有 11.9 名捐赠者（dpm）略有增加到 2011 年的 14.9 dpm。这种情况的一个常被引用的解释是，澳大利亚通过减少交通事故和中风死亡率成功提高了公共卫生和安全水平，从而减少了潜在的已故器官捐献者数量。我们将这种情况称为“因成功而失败”假说。尽管这种假说被广泛接受，但在很大程度上尚未得到验证。
通过分析来自国际器官捐赠和移植组织以及国际公共卫生和安全组织的数据，我们比较了澳大利亚和世界上已故器官捐赠率最高的七个国家（西班牙、葡萄牙、法国、美国、比利时、奥地利和意大利）的历史上的已故器官捐赠率与交通事故和中风死亡率。
在所研究的所有国家中，交通事故死亡率在研究期间急剧下降，其中西班牙的交通事故死亡率最低。中风死亡率也出现了类似的下降，法国的脑血管意外死亡率最低。
与世界上已故捐赠率最高的国家相比，澳大利亚通过减少交通事故和中风死亡率来改善公共卫生和安全的做法既不独特也不典型，并且不能为其低器官捐赠率提供充分的解释。
