Martínez-Soba F, Miñambres E, Martínez-Camarero L, Arlabán-Carpintero M, Moreno-Ortigosa J A, Calleja-Muñoz V, Ballesteros M A
Donor Coordination Unit, Hospital San Pedro, Logroño, Spain.
Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; School of Medicine, University of Cantabria, Santander, Spain.
Transplant Proc. 2019 Mar;51(2):299-302. doi: 10.1016/j.transproceed.2018.11.005. Epub 2018 Nov 29.
A program of intensive care to facilitate organ donation (ICOD) represents one of the ways to increase donation rate following brain death (BD).
To analyze the impact and cost-effectiveness of setting up an ICOD strategy.
Retrospective cases of BD donors from the Spanish region La Rioja were included, after implementation of an ICOD program (2011-2016). This was activated in cases of devastating neurologic injury where treatment had been rejected following therapeutic futility criteria. Follow-up of kidney and liver transplant patients with the obtained grafts was carried out.
A total of 134 potential donors were admitted to intensive care unit (ICU), of whom 106 were selected under the ICOD strategy. BD was diagnosed in 108 cases (25 conventional donors, 83 ICOD donors). A total of 21.6% of potential ICOD donors did not evolve to BD, subsequently dying in the ICU. ICOD cases accounted for more than 50% of donors each year. This cohort had an average stay of 2.4 days in the ICU and accounted for a small proportion of total ICU admissions. A total of 68 (81.9%) ICOD donors were finally effective and 146 grafts were extracted, the majority being abdominal organs (liver and kidney). Probability of survival 1 year after liver transplant (ICOD donor) was 90.9%, with 1 case of primary graft failure. Survival 1 year after kidney transplant (ICOD donor) was 92.7%. No differences were detected in survival rates of kidney and liver transplant patients regarding donor type (ICOD vs conventional).
Implementation of an ICOD program allows an increase in the pool of valid and quality grafts for transplant as well as implying a minimum consumption of intensive medicine resources. The results in transplant patients support this strategy.
一项促进器官捐献的重症监护计划（ICOD）是提高脑死亡（BD）后捐献率的方法之一。
分析建立ICOD策略的影响和成本效益。
纳入西班牙拉里奥哈地区实施ICOD计划（2011 - 2016年）后BD捐献者的回顾性病例。该计划在出现毁灭性神经损伤且根据治疗无效标准治疗被拒绝的情况下启动。对接受所获移植物的肾移植和肝移植患者进行随访。
共有134名潜在捐献者入住重症监护病房（ICU），其中106名根据ICOD策略被选中。108例被诊断为BD（25例传统捐献者，83例ICOD捐献者）。共有21.6%的潜在ICOD捐献者未发展为BD，随后在ICU死亡。ICOD病例每年占捐献者的50%以上。该队列在ICU的平均停留时间为2.4天，占ICU总入院人数的一小部分。共有68名（81.9%）ICOD捐献者最终有效，提取了146个移植物，大多数为腹部器官（肝脏和肾脏）。肝移植（ICOD捐献者）后1年的生存率为90.9%，有1例原发性移植物功能衰竭。肾移植（ICOD捐献者）后1年的生存率为92.7%。在肾移植和肝移植患者的生存率方面，未检测到捐献者类型（ICOD与传统）之间的差异。
实施ICOD计划可增加用于移植的有效和优质移植物库，同时意味着重症医学资源的消耗最小。移植患者的结果支持这一策略。
