Gore S M, Hinds C J, Rutherford A J
Medical Research Council, Biostatistics Unit, Cambridge.
BMJ. 1989 Nov 11;299(6709):1193-7. doi: 10.1136/bmj.299.6709.1193.
To audit all deaths in intensive care units (excepting coronary care only and neonatal intensive care units) in England to assess potential for organ procurement.
An audit in which 14 regional health authorities and London special health authorities each designated a regional liaison officer to identify intensive care units and liaise with Department of Health and the Medical Research Council's biostatistics unit in distribution, return, and checking of audit forms. Audit took place from 1 January to 31 March 1989 and will continue to 31 December 1990.
278 Intensive care units in England.
Colleagues in intensive care units (doctors, nurses, coordinators, and others), who completed serially numbered audit forms for all patients who died in intensive care.
The estimated number of deaths in intensive care units was 3085, and validated audit forms were received for 2853 deaths (92%). Brain stem death was a possible diagnosis in only 407 (14%) patients (about 1700 cases a year) and was confirmed in 282 (10%) patients (an estimated 1200 cases a year). Half the patients (95% confidence interval 45% to 57%) in whom brain stem death was confirmed became actual donors of solid organs. Tests for brain stem death were not performed in 106 (26%) of 407 patients with brain stem death as a possible diagnosis, and general medical contraindication to organ donation was recorded for 48 (17%) of 282 patients who fulfilled brain stem death criteria before cessation of heart beat. The criteria were fulfilled before cessation of heart beat and in the absence of any general medical contraindication to organ donation in 234 patients, 8% of those dying in intensive care (an estimated 1000 cases a year). Consent for organ donation was given in 152 (70%) of 218 cases (64% to 76%) when the possibility of organ donation was suggested to relatives. In only 14 out of 232 families (6%; 3% to 9%) was there no discussion of organ donation with relatives. Corneal suitability was recorded as "not known" in a high proportion (1271; 45%) of all deaths and intensive care units reported only 123 corneal donors (4% of all audited deaths).
When brain stem death is a possible diagnosis tests should always be carried out for confirmation. Early referral to the transplant team or coordinator should occur in all cases of brain stem death to check contraindications to organ donation. There should be increased use of asystolic kidney donation, and patients should be routinely assessed for suitability for corneal donation. Finally, more publicity and education are necessary to promote consent.
审核英格兰重症监护病房（不包括仅冠心病监护病房和新生儿重症监护病房）的所有死亡病例，以评估器官获取的可能性。
一项审计，14个地区卫生当局和伦敦特别卫生当局各指定一名地区联络官，以确定重症监护病房，并就审计表格的分发、回收和核查与卫生部及医学研究理事会生物统计学部门进行联络。审计于1989年1月1日至3月31日进行，并将持续至1990年12月31日。
英格兰的278个重症监护病房。
重症监护病房的工作人员（医生、护士、协调员及其他人员），他们为所有在重症监护病房死亡的患者填写连续编号的审计表格。
重症监护病房的估计死亡人数为3085人，收到有效审计表格的死亡病例为2853例（92%）。仅407例（14%）患者（约每年1700例）可能诊断为脑干死亡，其中282例（10%）患者（估计每年1200例）得到确诊。在407例可能诊断为脑干死亡的患者中，有106例（26%）未进行脑干死亡检测，在282例在心跳停止前符合脑干死亡标准的患者中，有48例（17%）记录有器官捐赠的一般医学禁忌证。在234例患者（占重症监护病房死亡患者的8%，估计每年1000例）中，在心跳停止前符合标准且无器官捐赠的任何一般医学禁忌证。当向亲属提及器官捐赠可能性时，218例病例中有152例（70%；64%至76%）获得了器官捐赠同意。在232个家庭中，只有14个（6%；3%至9%）未与亲属讨论器官捐赠问题。在所有死亡病例中，很大一部分（1271例；45%）角膜适宜性记录为“未知”，重症监护病房仅报告了123例角膜捐赠者（占所有审计死亡病例的4%）。
当可能诊断为脑干死亡时，应始终进行检测以确诊。对于所有脑干死亡病例，应尽早转诊至移植团队或协调员处，以检查器官捐赠的禁忌证。应增加对心脏停搏后肾脏捐赠的利用，并且应常规评估患者角膜捐赠的适宜性。最后，需要加强宣传和教育以促进同意捐赠。
