Department of Surgery, University of California San Diego, San Diego, CA.
Liver Transpl. 2013 Sep;19(9):981-6. doi: 10.1002/lt.23684.
After the foundation of the National Transplant Organization, Spanish rates of deceased donor donation rapidly outpaced US growth over the decade from 1989 to 1999. An analysis of the following decade, 1999-2009, demonstrated a markedly flattened growth curve for Spanish deceased donor organ procurement, which increased only 2.4% from 33.6 to 34.4 donors per million population (pmp). In comparison, over the same decade in the United States, the rate of deceased donation increased from 20.9 to 26.3 donors pmp (25.8%). An age group comparison demonstrated a much higher donation rate among older donors in Spain. For example, the number of donors older than 70 years increased from 3.8 to 8.8 pmp (a 132% increase), and they now constitute 25.4% of all Spanish organ donors. In contrast, the number of US donors older than 70 years increased from 1.0 to 1.3 pmp, and they constitute only 4.4% of total deceased donors. Over the same decade, the number of younger donors (15-30 years old) decreased from 6.6 to 2.5 pmp (a 62% decrease) in Spain, and this contrasted with a slightly increased US donation rate for the same age subgroup (a 15.5% increase from 5.8 to 6.7 pmp). Although older donors were more rarely used in the United States, growth in donation over the 2 decades (1989-2009) was strongly associated with the utilization of donors aged 65 or older (P < 0.01). United Network for Organ Sharing regions demonstrated significant differences in utilization rates for older donors. In conclusion, strategies aimed toward achieving US donation rates equivalent to the Spanish benchmark should target improved utilization rates for older donors in the United States instead of emulating elements of the Spanish organ procurement system.
国家移植组织成立后，1989 年至 1999 年的十年间，西班牙的已故供体捐献率迅速超过美国。对随后十年（1999 年至 2009 年）的分析表明，西班牙已故供体器官获取的增长曲线明显趋于平缓，每百万人口仅增加了 2.4%，从 33.6 人增至 34.4 人（pmp）。相比之下，同期美国的已故捐献率从 20.9 人增至 26.3 人 pmp（增长 25.8%）。年龄组比较表明，西班牙老年供体的捐献率更高。例如，70 岁以上供体人数从 3.8 人增至 8.8 人 pmp（增长 132%），占西班牙所有器官捐献者的 25.4%。相比之下，美国 70 岁以上供体人数从 1.0 人增至 1.3 人 pmp，仅占已故捐献者的 4.4%。同期，西班牙 15-30 岁的年轻供体人数从 6.6 人降至 2.5 人 pmp（减少 62%），而美国同一年龄组的捐献率略有上升（从 5.8 人增至 6.7 人 pmp，增长 15.5%）。尽管美国老年供体的利用率较低，但过去 20 年（1989 年至 2009 年）的捐献量增长与 65 岁及以上供体的利用率密切相关（P<0.01）。器官共享联合网络（United Network for Organ Sharing）各区域老年供体利用率存在显著差异。总之，要达到西班牙的基准捐献率，美国应制定旨在提高老年供体利用率的策略，而不是效仿西班牙的器官获取系统。
