Saidi R F
Division of Organ Transplantation, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Int J Organ Transplant Med. 2012;3(4):149-56.
Organ transplantation has proven highly effective in the treatment of various forms of end-stage organ failure. However, organ shortage is still the greatest challenge facing the field of organ transplantation.
To assess the pattern of organ donation and utilization during the past decade in the USA.
We studied OPTN/UNOS database for organ donation between January 2000 and December 2009. The retrieved records were then categorized into two time periods-from January 2000 to December 2004 (era 1), and from January 2005 to December 2009 (era 2).
There were 65,802 living and 71,401 deceased donors in the US from 2000 to 2009, including 66,518 (93.2%) brain-dead donors and 4,883 (6.8%) donation after cardiac death. Comparing two periods-from January 2000 to December 2004 (era 1) and from January 2005 to December 2009 (era 2), the number of deceased donors increased by 25% from 31,692 to 39,709 and living donors decreased by 7.6%. Donation after cardiac death increased from 3.5% to 9.3%. The portion of donors older than 64 years increased from 6.9% in era 1 to 11.3% in era 2 (p=0.03). The number of donors with a body mass index of >35 kg/m(2) was also increased from 6.8% to 11.2%. A significant increase in the incidence of cardiovascular/cerebrovascular as 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 incidence of death due to head trauma (34.9% vs. 48.8%). The overall discard rate also increased by 41% from 13,411 in era 1 to 19,516 in era 2. This increase in discards was especially more prominent in donation after cardiac death group which rose by 374% from 440 in era 1 to 2,089 in era 2. The discard rate for livers and kidneys increased by 31% and 68%, respectively, comparing era 1 and era 2. We noted a 78% increase for discarded donation after cardiac death livers and 1,210% for discarded donation after cardiac death kidneys.
We detected significant changes in the make-up of the donor pool over the past decade in the US. Over time, donor characteristics have changed with increased numbers of elderly donors and donors with comorbidities, especially donors who died of cardiovascular/cerebrovascular disease. The incidence of donation after cardiac death has increased significantly; brain-dead donors have only increased slightly and living donors have decreased. As the result, the discard rates have increased. The transplant community and policy makers should consider every precaution to safeguard the donor pool and prevent the decay of organ quality in favor of quantity.
器官移植已被证明在治疗各种终末期器官衰竭方面非常有效。然而，器官短缺仍然是器官移植领域面临的最大挑战。
评估美国过去十年间器官捐赠和利用的模式。
我们研究了器官获取与移植网络/器官共享联合网络（OPTN/UNOS）数据库中2000年1月至2009年12月期间的器官捐赠情况。检索到的记录随后被分为两个时间段——2000年1月至2004年12月（时期1），以及2005年1月至2009年12月（时期2）。
2000年至2009年期间，美国有65802名活体捐赠者和71401名已故捐赠者，其中包括66518名（93.2%）脑死亡捐赠者和4883名（6.8%）心脏死亡后捐赠者。比较两个时期——2000年1月至2004年12月（时期1）和2005年1月至2009年12月（时期2），已故捐赠者数量从31692名增加到39709名，增长了25%，而活体捐赠者数量减少了7.6%。心脏死亡后捐赠从3.5%增加到9.3%。64岁以上捐赠者的比例从时期1的6.9%增加到时期2的11.3%（p = 0.03）。体重指数>35 kg/m²的捐赠者数量也从6.8%增加到11.2%。作为死亡原因的心血管/脑血管疾病的发生率也从时期1的38.1%显著增加到时期2的56.1%（p < 0.001），因头部创伤导致的死亡发生率相应下降（34.9%对48.8%）。总体废弃率也从时期1的13411例增加到时期2的19516例，增长了41%。这种废弃率的增加在心脏死亡后捐赠组中尤为突出，从时期1的440例增加到时期2的2089例，增长了374%。与时期1相比，肝脏和肾脏的废弃率分别增加了31%和68%。我们注意到心脏死亡后捐赠肝脏的废弃率增加了78%，心脏死亡后捐赠肾脏的废弃率增加了1210%。
我们发现美国过去十年间捐赠者群体的构成发生了显著变化。随着时间的推移，捐赠者特征发生了变化，老年捐赠者和患有合并症的捐赠者数量增加，尤其是死于心血管/脑血管疾病的捐赠者。心脏死亡后捐赠的发生率显著增加；脑死亡捐赠者仅略有增加，而活体捐赠者减少。结果，废弃率增加。移植界和政策制定者应采取一切预防措施来保护捐赠者群体，防止器官质量因追求数量而下降。
