Mazaheri Masoud, Mojtabaee Meysam, Mohsenzadeh Mojtabaee, Sadegh Beigee Farahnaz
From the Organ Procurement Unit (OPU), Lung Transplantation Research Center (LTRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.
Exp Clin Transplant. 2019 Jan;17(Suppl 1):128-130. doi: 10.6002/ect.MESOT2018.O79.
In Iran, each medical university can have one organ procurement unit for its own hospital. If the family consents, all patients with brain death must be transferred to the organ procurement unit. When brain death is officially confirmed and the family gives the second consent, the organs are then retrieved in the operating room.
To minimize the number of "failed donations" (and to reduce their related costs), we studied 685 patients with brain death who were transferred to the Masih Daneshvari Organ Procurement Unit (Tehran, Iran) from 2016 to 2018 in terms of their outcomes. Of these, 623 led to (at least one) organ donation, whereas the remaining 62 had different causes for unsuccessful organ retrieval and donation.
Two causes (not officially confirmed and family withdrawal) were responsible for 4 failed donations (0.5%). We focused on the remaining 58 cases, which had principally medical grounds for unsuccessful organ retrieval and donation. These were further subcategorized into 3 groups: expired, unacceptable laboratory results, and exclusion in the operating room. We compared these groups versus the successful donation group in terms of average age, male-to-female ratio, average body mass index, pace of brain death occurrence, and days of hospitalization. Results showed that age, body mass index, and cause of brain death are important predictive factors in differentiating successful and failed donations, whereas sex and days of hospitalization are not so decisive.
Special precautions must be considered before transfer of brain dead donors who are overweight, are of older age, and have nonhemorrhagic causes of brain death. Stricter criteria are needed to control psychologic and financial burdens of failed transfers of deceased donors to the organ procurement unit.
在伊朗，每所医科大学可为其附属医院设立一个器官获取单位。如果家属同意，所有脑死亡患者都必须转至器官获取单位。当脑死亡得到正式确认且家属再次同意后，器官随后在手术室中获取。
为尽量减少“捐赠失败”的数量（并降低相关成本），我们研究了2016年至2018年期间转至马西·达内什瓦里器官获取单位（伊朗德黑兰）的685例脑死亡患者的结局。其中，623例实现了（至少一次）器官捐赠，而其余62例器官获取和捐赠未成功则有不同原因。
两个原因（未正式确认和家属撤回同意）导致4例捐赠失败（0.5%）。我们关注其余58例，这些病例器官获取和捐赠未成功主要有医学原因。这些病例进一步分为3组：患者死亡、实验室结果不可接受以及在手术室被排除。我们在平均年龄、男女比例、平均体重指数、脑死亡发生速度和住院天数方面，将这些组与成功捐赠组进行了比较。结果表明，年龄、体重指数和脑死亡原因是区分成功和失败捐赠的重要预测因素，而性别和住院天数则不那么具有决定性。
对于超重、年龄较大且脑死亡原因非出血性的脑死亡供体，在转运前必须考虑采取特殊预防措施。需要更严格的标准来控制已故供体转运至器官获取单位失败所带来的心理和经济负担。
