Morris J A, Wilcox T R, Noreuil T, Frist W H
Division of Trauma, Vanderbilt University School of Medicine, Nashville, TN 37232.
South Med J. 1990 Aug;83(8):884-8. doi: 10.1097/00007611-199008000-00009.
To define the size of the donor pool among nontrauma patients and the role of physicians in the limited supply of organs available for transplantation, we reviewed the 1293 nontrauma deaths that occurred in Vanderbilt University Medical Center during a 31-month period. Computerized discharge abstracts showed that 111 adults died without contraindications to organ donation. Manual review of these 111 medical records yielded 68 records suitable for review by Tennessee Donor Services. From this group 10 eligible donors were identified. Physicians failed to ask the families of three patients, families of three patients refused organ donation, and one patient had cardiovascular collapse before the donation process could be completed. Organs were successfully donated from three patients. All eligible donors died of intracerebral hemorrhage or drug overdose. Failure of physicians to approach families for donation was not based on medical criteria, and it resulted in organ wastage. As a result of this study, we have developed a simplified audit process for hospitals to use in evaluating compliance with required request legislation.
为确定非创伤患者中供体库的规模以及医生在可用于移植的有限器官供应中所起的作用，我们回顾了范德比尔特大学医学中心在31个月期间发生的1293例非创伤性死亡病例。计算机化出院摘要显示，111名成年人死亡时没有器官捐赠的禁忌证。对这111份病历进行人工审查后，筛选出68份适合田纳西州捐赠服务中心审查的病历。从这一组中确定了10名合格供体。医生没有询问三名患者的家属，三名患者的家属拒绝器官捐赠，一名患者在捐赠过程完成前出现心血管衰竭。三名患者的器官成功捐赠。所有合格供体均死于脑出血或药物过量。医生未与家属沟通捐赠事宜并非基于医学标准，这导致了器官浪费。作为这项研究的结果，我们为医院制定了一个简化的审核流程，用于评估对强制要求法规的遵守情况。
