van Wonderen M L de Boom, Singerling J Blok, den Toom M Huijzer, Grootendorst D C, de Koster M Franken, Brumsen C
Department of Hospital Medicine, Haaglanden Medical Centre, Burg. Banninglaan 1, 2262 BA, Leidschendam, The Hague, The Netherlands.
Department of Organ and Tissuedonation, Haaglanden Medical Centre, The Hague, The Netherlands.
Cell Tissue Bank. 2018 Dec;19(4):777-782. doi: 10.1007/s10561-018-9733-y. Epub 2018 Nov 16.
The number of tissue donations decreased in The Netherlands over recent years. The aim of this project was to determine the number of missed tissue donors in the Haaglanden Medical Centre and to develop a strategy to improve the number of tissue donors. We retrospectively analyzed patient files of all deceased patients in 2014 for their potential as tissue donors. Our objectives were to determine the number of missed tissue donors and the percentage of correctly identified tissue donors among all physicians and hospitalists in training. In addition, a clinical audit and three focus group interviews were used to determine the level of knowledge about and adherence to local and national protocols. The findings enabled us to suggest national and local improvements to reduce the percentage of missed tissue donors. The number of missed tissue donors was 94 (17.2%) of 548 deceased patients in 2014. The percentage of correctly identified tissue donors was 65.7% among all physicians (Cohen's Kappa coefficient 0.557, p ≤ 0.001) and 57.1% among hospitalists in training (Cohen's Kappa coefficient 0.492, p ≤ 0.001). In 31 patients (32.4%), the reported contra-indication by physicians was not a contra-indication for tissue donation in The Netherlands. There was no statistical difference in correct identification between physicians and hospitalists in training (p = 0.321, Mann-Whitney). The most effective actions to increase the number of tissue donations include to better inform physicians about contra-indications and help them in the recognition of a tissue donor.
近年来，荷兰的组织捐赠数量有所下降。本项目的目的是确定海牙兰登医疗中心错过的组织捐赠者数量，并制定一项策略以增加组织捐赠者的数量。我们回顾性分析了2014年所有死亡患者的病历，以评估他们作为组织捐赠者的潜力。我们的目标是确定错过的组织捐赠者数量，以及所有医生和实习住院医师中正确识别的组织捐赠者的百分比。此外，通过临床审计和三次焦点小组访谈来确定对地方和国家协议的了解程度和遵守情况。这些发现使我们能够提出国家和地方层面的改进建议，以减少错过的组织捐赠者的百分比。2014年，548名死亡患者中有94名（17.2%）被错过作为组织捐赠者。所有医生中正确识别的组织捐赠者的百分比为65.7%（科恩卡方系数0.557，p≤0.001），实习住院医师中这一比例为57.1%（科恩卡方系数0.492，p≤0.001）。在31名患者（32.4%）中，医生报告的禁忌症在荷兰并非组织捐赠的禁忌症。医生和实习住院医师在正确识别方面没有统计学差异（p=0.321，曼-惠特尼检验）。增加组织捐赠数量的最有效行动包括更好地向医生告知禁忌症，并帮助他们识别组织捐赠者。
