Cheung C Y, Pong M L, Au Yeung S F, Chau K F
Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong.
Transplant Coordinating Service, Kowloon Central Cluster, Hospital Authority, Hong Kong.
Hong Kong Med J. 2016 Dec;22(6):570-5. doi: 10.12809/hkmj164930. Epub 2016 Oct 24.
The number of actual donors per million population is the most commonly used metric to measure organ donation rates worldwide. It is deemed inadequate, however, because it does not take into account the potential donor pool. The aim of this study was to determine the true potential for solid organ donation from deceased brain-dead donors and the reasons for non-donation from potential donors in the Chinese community.
Medical records of all hospital deaths between 1 January and 31 December 2014 at a large regional hospital in Hong Kong were reviewed. Those who were on mechanical ventilation with documented brain injury and aged ≤75 years were classified as possible organ donors. The reasons why some potential organ donors did not become utilised organ donors were recorded and evaluated.
Among 3659 patient deaths, 121 were classified as possible organ donors. The mean age of the possible organ donors was 59.4 years and 72.7% of them were male. The majority (88%) were from non-intensive care units. Of the 121 possible organ donors, 108 were classified as potential organ donors after excluding 13 unlikely to fulfil brain death criteria. Finally 11 patients became actual organ donors with an overall conversion rate of 10%. Reasons for non-donation included medical contra-indication (46%), failure to identify and inform organ donation coordinators (14%), failure of donor maintenance (11%), brain death diagnosis not established (18%), and refusal by relatives (11%).
It is possible to increase the organ donation rate considerably by action at different stages of the donation process. Ongoing accurate audit of current practice is necessary.
每百万人口中实际捐赠者的数量是全球用于衡量器官捐赠率最常用的指标。然而，该指标被认为并不充分，因为它没有考虑潜在捐赠者库。本研究的目的是确定脑死亡死者进行实体器官捐赠的真正潜力以及华人社区潜在捐赠者未进行捐赠的原因。
回顾了香港一家大型地区医院2014年1月1日至12月31日期间所有住院死亡患者的病历。那些接受机械通气且有脑损伤记录且年龄≤75岁的患者被归类为可能的器官捐赠者。记录并评估了一些潜在器官捐赠者未成为实际器官捐赠者的原因。
在3659例患者死亡中，121例被归类为可能的器官捐赠者。可能的器官捐赠者的平均年龄为59.4岁，其中72.7%为男性。大多数（88%）来自非重症监护病房。在121例可能的器官捐赠者中，排除13例不太可能符合脑死亡标准的患者后，108例被归类为潜在器官捐赠者。最终11例患者成为实际器官捐赠者，总体转化率为10%。未捐赠的原因包括医学禁忌（46%）、未识别并通知器官捐赠协调员（14%）、捐赠者维持失败（11%）、脑死亡诊断未确立（18%）以及亲属拒绝（11%）。
通过在捐赠过程的不同阶段采取行动，有可能大幅提高器官捐赠率。对当前做法进行持续准确的审核是必要的。
