Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Crit Care Med. 2012 Oct;40(10):2773-80. doi: 10.1097/CCM.0b013e31825b252a.
Many organ procurement organizations have implemented critical care end points as donor management goals in efforts to increase organs transplanted per donor after neurologic determination of death. Although retrospective studies have demonstrated an association between meeting donor management goals and organ yield, prospective studies are lacking.
In June 2008, nine donor management goals were prospectively implemented as a checklist and every donor after neurologic determination of death was managed to meet them. The donor management goals represented normal cardiovascular, pulmonary, renal, and endocrine end points. Data were collected for 7 months. Donor management goals "met" was defined a priori as achieving any seven of the nine donor management goals, and this was recorded at the time of consent, 12-18 hrs later, and prior to organ recovery. The primary outcome measure was ≥4 organs transplanted per donor, and binary logistic regression was used to identify independent predictors of this outcome with a p<.05.
All eight organ procurement organizations in the five Southwestern United States (United Network for Organ Sharing Region 5).
All standard criteria donors after neurologic determination of deaths.
Prospective implementation of a donor management goal checklist.
There were 380 standard criteria donors with 3.6±1.7 organs transplanted per donor. Fifteen percent had donor management goals met at the time of consent, 33% at 12-18 hrs, and 38% prior to organ recovery. Forty-eight percent had ≥4 organs transplanted per donor. Donors with ≥4 organs transplanted per donor had significantly more individual donor management goals met at all three time points. Independent predictors of ≥4 organs transplanted per donor were age (odds ratio=0.95 per year), final creatinine (odds ratio=0.75 per 1-unit increase), donor management goals "met" at consent (odds ratio=2.03), donor management goals "met" prior to organ recovery (odds ratio=2.34), and a change in the number of donor management goals achieved from consent to 12-18 hrs later (odds ratio=1.13 per additional donor management goal).
Meeting donor management goals prior to consent and prior to organ recovery were both associated with achieving ≥4 organs transplanted per donor. However, only 15% of donors have donor management goals met at the time of consent. The donor hospital management of patients with catastrophic brain injuries, before the intent to donate organs is known, affects outcomes and should remain a priority in the intensive care unit.
许多器官获取组织已将关键的重症监护终点作为供者管理目标，以增加在脑死亡后每例供者的移植器官数量。虽然回顾性研究表明达到供者管理目标与器官收获之间存在关联，但前瞻性研究尚缺乏。
2008 年 6 月，作为检查表，前瞻性地实施了 9 项供者管理目标，对每例脑死亡后的供者进行管理以达到这些目标。供者管理目标代表了正常的心血管、肺、肾和内分泌终点。收集了 7 个月的数据。供者管理目标“达标”定义为达到 9 项供者管理目标中的任何 7 项，在同意时、12-18 小时后和器官获取前记录。主要结局指标为每例供者移植的器官数≥4 个，采用二项逻辑回归分析具有 p<.05 的独立预测因素。
美国西南部 5 个器官获取组织的所有 8 个（器官共享联合网络 5 区）。
所有脑死亡标准供者。
前瞻性实施供者管理目标检查表。
有 380 例脑死亡标准供者，每例供者移植的器官数为 3.6±1.7 个。15%的供者在同意时达到供者管理目标，33%的供者在 12-18 小时后达到，38%的供者在器官获取前达到。48%的供者每例供者移植的器官数≥4 个。每例供者移植的器官数≥4 个的供者在所有 3 个时间点达到的供者管理目标明显更多。每例供者移植的器官数≥4 个的独立预测因素为年龄（每增加 1 岁，比值比为 0.95）、终末期肌酐（每增加 1 单位，比值比为 0.75）、同意时达到供者管理目标（比值比为 2.03）、器官获取前达到供者管理目标（比值比为 2.34）以及从同意到 12-18 小时后达到的供者管理目标数量的变化（每增加 1 个供者管理目标，比值比为 1.13）。
在同意前和器官获取前达到供者管理目标与达到每例供者移植的器官数≥4 个有关。然而，只有 15%的供者在同意时达到供者管理目标。在已知器官捐献意向之前，对患有严重脑损伤的患者进行供者医院管理会影响结局，应继续作为重症监护病房的重点。
