Caramiciu J A, Adams J P, McKown B T, French C D, Ruggieri E R, Heard S O
Department of Anesthesiology, University of Massachusetts Medical School, Worcester, Massachusetts.
Department of Anesthesiology, University of Massachusetts Medical School, Worcester, Massachusetts; The New England Organ Bank, Waltham, Massachusetts.
Transplant Proc. 2014 Jun;46(5):1274-80. doi: 10.1016/j.transproceed.2014.03.005.
Timely referral of patients following asystolic death to an organ procurement organization (OPO) may increase tissue donation rates. Lack of education of health care providers and nonphysicians (admitting department) about timely referral to the OPO following asystolic death may adversely affect tissue donation rates. We hypothesized that using an in-house donation coordinator for provider education and changing the responsibility for calling the OPO from the admitting department to the licensed independent practitioner (LIP) declaring death would increase timely referral and tissue donation rates.
An education program was developed in 2005 by a newly hired in-house coordinator to highlight the importance of tissue donation. In addition, to improve timely referrals to the OPO after death, the instructions accompanying the working copy of the death certificate were altered to require the patient's LIP to call the OPO within 1 hour of death (early 2007). Rates for both timely referrals and tissue donors were modeled by a Poisson regression model with a log link function.
Timely referral rates rose from 48% before the interventions to 72% after the intervention (P < .0001). The number of tissue donors per number of referrals also increased significantly (P = .025) over that period.
An in-house donation coordinator initiated education program and LIP referral rather than referral by other parties following asystolic death results in higher tissue donation rates.
心脏停搏死亡患者及时转诊至器官获取组织(OPO)可能会提高组织捐赠率。医护人员和非医师人员(入院科室)缺乏关于心脏停搏死亡后及时转诊至OPO的相关教育,可能会对组织捐赠率产生不利影响。我们推测,通过内部捐赠协调员对相关人员进行教育,并将联系OPO的职责从入院科室转至宣布死亡的执业独立医师(LIP),将会提高及时转诊率和组织捐赠率。
2005年,新聘请的内部协调员制定了一项教育计划,以强调组织捐赠的重要性。此外,为了提高死亡后及时转诊至OPO的比率,死亡证明工作副本所附说明被修改,要求患者的LIP在患者死亡后1小时内联系OPO(2007年初)。及时转诊率和组织捐赠者比率均采用带有对数链接函数的泊松回归模型进行建模。
及时转诊率从干预前的48%升至干预后的72%(P < .0001)。在此期间,每次转诊的组织捐赠者数量也显著增加(P = .025)。
由内部捐赠协调员发起的教育计划以及LIP转诊,而非心脏停搏死亡后由其他方进行转诊,可带来更高的组织捐赠率。