Krmpotic Kristina, Payne Clare, Isenor Cynthia, Dhanani Sonny
1Pediatric Critical Care Medicine, Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, and Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada. 2Trillium Gift of Life Network, Toronto, ON, Canada. 3Nova Scotia Health Authority, Critical Care Organ Donation Program, Halifax, NS, Canada. 4Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 5Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Crit Care Med. 2017 Jun;45(6):989-992. doi: 10.1097/CCM.0000000000002432.
Rates of organ donation and transplantation have steadily increased in the United States and Canada over the past decade, largely attributable to a notable increase in donation after circulatory death. However, the number of patients awaiting solid organ transplantation continues to remain much higher than the number of organs transplanted each year. The objective of this study was to determine the potential to increase donation rates further by identifying gaps in the well-established donation after circulatory death process in Ontario.
Retrospective cohort study.
Provincial organ procurement organization.
Patients who died in designated donation hospitals within the province of Ontario, Canada between April 1, 2013, and March 31, 2015.
None.
Of 1,407 patient deaths following planned withdrawal of life-sustaining therapy, 54.0% (n = 760) were medically suitable for donation after circulatory death. In 438 cases where next of kin was approached, consent rates reached 47.5%. A total of 119 patients became actual organ donors. Only 66.2% (n = 503) of suitable patients were appropriately referred, resulting in 251 missed potential donors whose next of kin could not be approached regarding organ donation because referral occurred after initiation of withdrawal of life-sustaining therapy or not at all.
The number of medically suitable patients who die within 2 hours of planned withdrawal of life-sustaining therapy is nearly six times higher than the number of actual organ donors, with the greatest loss of potential due to delayed referral until at the time of or after planned withdrawal of life-sustaining therapy. Intensive care teams are not meeting their ethical responsibility to recognize impending death and appropriately refer potential organ donors to the local organ procurement organization. In cases where patients had previously registered their consent decision, they were denied a healthcare right.
在过去十年中，美国和加拿大的器官捐献与移植率稳步上升，这在很大程度上归因于循环性死亡后捐献的显著增加。然而，等待实体器官移植的患者数量仍远高于每年移植的器官数量。本研究的目的是通过找出安大略省成熟的循环性死亡后捐献流程中的差距，来确定进一步提高捐献率的潜力。
回顾性队列研究。
省级器官获取组织。
2013年4月1日至2015年3月31日期间在加拿大安大略省内指定捐献医院死亡的患者。
无。
在1407例计划撤掉维持生命治疗后的患者死亡案例中，54.0%（n = 760）在医学上适合循环性死亡后捐献。在438例与近亲接触的案例中，同意率达到47.5%。共有119名患者成为实际器官捐献者。只有66.2%（n = 503）的合适患者得到了恰当转诊，导致251名潜在捐献者流失，其近亲因在撤掉维持生命治疗开始后才转诊或根本未转诊而未能就器官捐献事宜与之接触。
在计划撤掉维持生命治疗后2小时内死亡且在医学上适合捐献的患者数量几乎是实际器官捐献者数量的六倍，最大的潜在损失是由于转诊延迟至计划撤掉维持生命治疗之时或之后。重症监护团队未履行其道德责任，即识别即将到来的死亡并将潜在器官捐献者恰当地转诊至当地器官获取组织。在患者此前已登记其同意决定的情况下，他们被剥夺了一项医疗权利。
