Raios Cassandra, Keating Jenny L, Stitt Nicola, Opdam Helen I, Skinner Elizabeth H
1 Faculty of Medicine, Nursing, and Health Science, Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia.
2 Department of Physiotherapy, Western Health, Footscray, Victoria, Australia.
Prog Transplant. 2017 Jun;27(2):112-124. doi: 10.1177/1526924816680098. Epub 2016 Dec 27.
There is a critical shortage of donor lungs however, considerable ethical considerations are associated with the conduct of research to optimize care of the potential organ donor.
To investigate pathways of consent, respiratory care by physiotherapists and donation rates to contextualize future research on physiotherapy effects on donor lung suitability for procurement.
Retrospective audit.
Australian tertiary hospital.
Potential organ donors (defined as patients who may have been eligible to donate organs for transplantation via either brain death or circulatory death) 75 years or younger presenting to the emergency department or the intensive care unit (ICU) between September 2011 and December 2012.
Donation rates, timing of organ procurement from initial hospital presentation, number of persons designated to make health-care decisions approached for and consenting to donation and clinical research, and number of patients assessed and/or treated by physiotherapists.
Records of 65 potentially eligible donors were analyzed. Eighteen (28%) of the 65 became donors. Organ procurement occurred at a median of 48 hours (interquartile range: 34-72 hours) after ICU admission. All decision-makers approached regarding participation in clinical research (4 [6%] of the 65) consented. Physiotherapists assessed 48 (74%) of the 65 patients at least once and provided 28 respiratory treatments to 18 (28%) of the 65 patients, including lung hyperinflation and positioning. Limitations were the retrospective, single-center design and the "potential organ donor" definition.
Organ procurement occurs early. There is potential for early intervention to improve lung donor rates. Randomized controlled trials investigating protocolized respiratory packages of care may increase the potential donor pool and transplantation rates.
供体肺严重短缺，然而，开展优化潜在器官供体护理的研究存在诸多伦理考量。
探讨同意途径、物理治疗师的呼吸护理以及捐赠率，以便为未来关于物理治疗对供体肺适合获取程度影响的研究提供背景信息。
回顾性审计。
澳大利亚三级医院。
2011年9月至2012年12月期间，年龄在75岁及以下、前往急诊科或重症监护病房（ICU）的潜在器官供体（定义为可能符合通过脑死亡或循环死亡捐赠器官用于移植条件的患者）。
捐赠率、从首次入院到器官获取的时间、被邀请做出医疗保健决策并同意捐赠及临床研究的人数，以及接受物理治疗师评估和/或治疗的患者人数。
分析了65名潜在合格供体的记录。65名中有18名（28%）成为供体。器官获取在入住ICU后的中位时间为48小时（四分位间距：34 - 72小时）。所有被邀请参与临床研究的决策者（65名中的4名[6%]）都表示同意。物理治疗师对65名患者中的48名（74%）至少进行了一次评估，并为65名患者中的18名（28%）提供了28次呼吸治疗，包括肺过度充气和体位摆放。局限性在于回顾性、单中心设计以及“潜在器官供体”的定义。
器官获取较早进行。早期干预有可能提高肺供体率。研究标准化呼吸护理方案的随机对照试验可能会增加潜在供体库和移植率。
