Department of Surgery, School of Medicine, Emory University, Atlanta, GA; LifeLink of Georgia, Norcross, GA.
Wake Forest University School of Medicine, Winston-Salem, NC.
J Am Coll Surg. 2018 Apr;226(4):414-422. doi: 10.1016/j.jamcollsurg.2017.12.029. Epub 2018 Jan 5.
Although successful on many fronts, solid organ transplantation fails patients who die on waitlists. Too few organ donors beget this failure. Dispelling misperceptions associated with donation and transplantation would expectedly increase donation and decrease waitlist mortality; recipients would also receive transplants earlier in their disease process, leading to better post-transplantation outcomes.
Survey responses to 7 questions pertaining to organ donation and transplantation were analyzed to determine their association with willingness to donate. Subgroup analyses according to race, residence status (rural vs nonrural), and education level were performed.
There were 766 respondents; 84.6% were willing to be a donor, 76.2% were female, 79.7% were Caucasian, and 16.5% were African-American. Having concerns about getting inadequate medical care if registered as a donor was the strongest independent predictor of willingness to donate overall (odds ratio 0.21; 95% CI 0.13 to 0.36) and in each subgroup; African Americans were more likely than Caucasians to have this concern (20.2% vs 9.5%; p < 0.001). Race (odds ratio 0.41; 95% CI 0.22 to 0.75 for African Americans) and age were also predictive overall, but less so. Willingness to donate a family member's organs depended on whether a discussion about donation had hypothetically occurred: 61.0% would donate if there had been no discussion; 95.2% would donate if the family member had said "yes" to donation; and 11.0% would donate if the family member had said "no" (p < 0.001). If there was no prior discussion, having concerns about getting less-aggressive medical care predicted willingness to donate a family member's organs (odds ratio 0.40; 95% CI 0.25 to 0.65).
The strongest deterrent of willingness to donate one's own or a family member's organs is a misperception that should be correctable. Race and age are less predictive. Efforts to dispel misperceptions and increase donation remain desperately needed to improve waitlist mortality and post-transplantation outcomes.
尽管在许多方面取得了成功，但实体器官移植仍使等待名单上的患者死亡。器官捐献者太少导致了这种失败。消除与捐献和移植相关的误解有望增加捐献并降低等待名单上的死亡率；接受者也将在疾病过程的更早阶段接受移植，从而获得更好的移植后结果。
分析了 7 个与器官捐献和移植相关的问题的调查回复，以确定它们与捐赠意愿的关联。根据种族、居住状况（农村与非农村）和教育水平进行了亚组分析。
共有 766 名受访者；84.6%的人愿意成为捐献者，76.2%为女性，79.7%为白种人，16.5%为非裔美国人。如果注册为捐献者，担心得不到足够的医疗护理是总体上愿意捐赠的最强独立预测因素（优势比 0.21；95%置信区间 0.13 至 0.36），并且在每个亚组中也是如此；非裔美国人比白种人更有可能有这种担忧（20.2%对 9.5%；p<0.001）。种族（优势比 0.41；95%置信区间 0.22 至 0.75 为非裔美国人）和年龄也是总体上的预测因素，但影响较小。愿意捐献家庭成员的器官取决于是否曾讨论过捐献：如果没有讨论，61.0%的人会捐献；如果家庭成员同意捐献，95.2%的人会捐献；如果家庭成员表示“不”，则 11.0%的人会捐献（p<0.001）。如果没有事先讨论，如果担心得到不那么积极的医疗护理，则会预测出愿意捐献家庭成员的器官（优势比 0.40；95%置信区间 0.25 至 0.65）。
愿意捐献自己或家庭成员的器官的最大障碍是误解，这是可以纠正的。种族和年龄的预测能力较小。为消除误解和增加捐献而做出的努力仍然是急需的，以改善等待名单上的死亡率和移植后的结果。
