Division of Organ Transplantation, Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue North, S6-426, Worcester, MA 01655, USA.
World J Surg. 2012 Dec;36(12):2909-13. doi: 10.1007/s00268-012-1748-0.
Organ shortage is the greatest challenge facing the field of organ transplantation today. Use of more organs of marginal quality has been advocated to address the shortage.
We examined the pattern of donation and organ use in the United States as shown in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database of individuals who were consented for and progressed to organ donation between January 2001 and December 2010.
There were 66,421 living donors and 73,359 deceased donors, including 67,583 (92.1%) identified as donation after brain death and 5,776 (7.9%) as donation after circulatory death (DCD). Comparing two periods, era 1 (01/2001-12/2005) and era 2 (01/2006-12/2010), the number of deceased donors increased by 20.3% from 33,300 to 40,059 while there was a trend for decreasing living donation. The DCD subgroup increased from 4.9 to 11.7% comparing the two eras. A significant increase in cardiovascular/cerebrovascular disease as a cause of death was also noted, from 38.1% in era 1 to 56.1% in era 2 (p<0.001), as was a corresponding decrease in the number of deaths due to head trauma (48.8 vs. 34.9%). The overall discard rate also increased from 13,411 (11.5%) in era 1 to 19,516 (13.7%) in era 2. This increase in discards was especially prominent in the DCD group [440 (20.9%) in era 1 vs. 2,089 (24.9%) in era 2].
We detect a significant change in pattern of organ donation and use in the last decade in the United States. The transplant community should consider every precaution to prevent the decay of organ quality and to improve the use of marginal organs.
器官短缺是当今器官移植领域面临的最大挑战。为了解决短缺问题，提倡使用更多质量边缘的器官。
我们研究了美国的捐赠和器官使用模式，数据来自于 2001 年 1 月至 2010 年 12 月期间同意并进入器官捐赠程序的个人的器官获取和移植网络/器官共享联合网络数据库。
有 66421 名活体供者和 73359 名已故供者，其中 67583 名（92.1%）被确认为脑死亡后捐献，5776 名（7.9%）为循环死亡后捐献（DCD）。比较两个时期，第 1 时期（2001 年 1 月至 2005 年 12 月）和第 2 时期（2006 年 1 月至 2010 年 12 月），已故供者的数量从 33300 增加到 40059，增长了 20.3%，而活体捐赠呈下降趋势。DCD 亚组从两个时期的 4.9%增加到 11.7%。死亡原因中心血管/脑血管疾病的显著增加也得到了注意，从第 1 时期的 38.1%增加到第 2 时期的 56.1%（p<0.001），而因头部创伤导致的死亡人数相应减少（48.8 比 34.9%）。总的废弃率也从第 1 时期的 13411 例（11.5%）增加到第 2 时期的 19516 例（13.7%）。这种废弃率的增加在 DCD 组中尤为明显[第 1 时期为 440 例（20.9%），第 2 时期为 2089 例（24.9%）]。
我们发现美国在过去十年中器官捐赠和使用模式发生了显著变化。移植界应该考虑采取一切预防措施，防止器官质量下降，并提高边缘器官的利用率。
