Department of Management Affairs, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Transpl Int. 2012 Dec;25(12):1268-74. doi: 10.1111/j.1432-2277.2012.01567.x. Epub 2012 Oct 11.
A shortage of size-matched organs and tissues is the key factor limiting transplantation in children. Empirical data on procurement from pediatric donors is sparse. This study investigated donor identification, parental consent, and effectuation rates, as well as adherence to the national protocol. A national retrospective cohort study was conducted in all eight Dutch pediatric intensive care units. Records of deceased children were analyzed by an independent donation officer. Seventy-four (11%) of 683 deceased children were found to be suitable for organ donation and 132 (19%) for tissue donation. Sixty-two (84%) potential organ donors had been correctly identified; the parental consent and effectuation rate was 42%. Sixty-three (48%) potential tissue donors had been correctly identified; the parental consent and effectuation rate was 27%. Correct identification increased with age (logistic regression, organs: P = .024; tissues: P = .011). Although an overall identification rate of 84% of potential organ donors may seem acceptable, the variation observed suggests room for improvement, as does the overall low rate of identification of pediatric tissue donors. Efforts to address the shortage of organs and tissues for transplantation in children should focus on identifying potential donors and on the reasons why parents do not consent.
儿童器官和组织大小匹配的短缺是限制移植的关键因素。关于从儿科供体获取器官的经验数据很少。本研究调查了供体识别、父母同意和实施率，以及对国家方案的遵守情况。在所有 8 家荷兰儿科重症监护病房进行了全国性回顾性队列研究。一名独立的捐赠官员对已故儿童的记录进行了分析。在 683 名死亡儿童中，发现有 74 名（11%）适合器官捐献，132 名（19%）适合组织捐献。已正确识别出 62 名（84%）潜在的器官捐献者；父母同意和实施率为 42%。已正确识别出 63 名（48%）潜在的组织捐献者；父母同意和实施率为 27%。正确识别率随年龄增长而增加（logistic 回归，器官：P=0.024；组织：P=0.011）。尽管潜在器官捐献者的总体识别率为 84%，似乎可以接受，但观察到的差异表明仍有改进的空间，儿科组织捐献者的总体识别率也很低。解决儿童移植器官和组织短缺的努力应侧重于识别潜在的捐献者，以及父母不同意的原因。
