Department of Surgery, Faculty of Health Sciences, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa.
S Afr Med J. 2020 Jan 29;110(2):132-134. doi: 10.7196/SAMJ.2020.v110i2.14125.
South Africa (SA) has one of the lowest deceased organ donor rates in the world (1.4 donors per million population), with thousands of patients awaiting solid-organ transplantation. In order to improve access to transplantation we have to clearly define the reasons for the low deceased donation rate, specific to the population we serve.
Review of actual donor statistics highlights our successes, yet is not able to contextualise the factors responsible for the unsuccessful conversion of referred organ donors to actual organ donors. In an attempt to identify key factors preventing referred donors from becoming actual donors, we analysed the donor referral patterns at our institution over a 10-year period.
This was a retrospective descriptive study of consecutive deceased donor referrals at Groote Schuur Hospital, Cape Town, SA (from January 2007 to December 2016), utilising a regional donor referral registry. Qualitative and quantitative data were collected and presented as descriptive statistics and temporal trends.
Over the 10-year study period, 861 possible organ donors were referred, with a steady increase in the number of referrals over time. Of the referrals, 514 (59.7%) were eligible for donation of at least one solid organ. Of the 508 families that were approached for consent to donation, 342 declined consent for a variety of reasons, resulting in a consent rate of 32.7%. Ultimately, at least one solid organ was obtained from 159 of the 166 consented donors. Despite the increasing number of possible and eligible donors, a statistically significant decline in consent rate was observed over time (ptrend=0.023). Furthermore, increasing trends in medical (as opposed to trauma) (ptrend<0.001) and extended criteria (as opposed to standard criteria) donor referrals (ptrend<0.001) were observed over the 10-year study period.
Donor referral patterns have changed over time, with a notable increase in medical and extended criteria donors. Despite the increase in possible and eligible donors, the consent rate has declined. Further qualitative and quantitative research studies are required to understand and address this trend.
南非（SA）是世界上器官捐献率最低的国家之一（每百万人中有 1.4 名捐献者），成千上万的患者等待实体器官移植。为了增加移植机会，我们必须明确界定我们所服务人群中导致低死亡捐献率的具体原因。
审查实际供体统计数据突出了我们的成功，但无法将导致未将被推荐器官捐献者转化为实际器官捐献者的因素具体化。为了确定阻止被推荐捐献者成为实际捐献者的关键因素，我们分析了我们机构在 10 年期间的供体推荐模式。
这是对南非开普敦格罗特舒尔医院（Groote Schuur Hospital）连续死亡供体推荐的回顾性描述性研究（从 2007 年 1 月至 2016 年 12 月），利用区域供体推荐登记册。收集定性和定量数据，并以描述性统计数据和时间趋势呈现。
在 10 年的研究期间，共推荐了 861 名可能的器官捐献者，随着时间的推移，推荐数量稳步增加。在这些推荐中，514 名（59.7%）有资格捐献至少一种实体器官。在与 508 个家庭联系以获得同意捐献的过程中，由于各种原因，342 个家庭拒绝了同意，同意率为 32.7%。最终，在 166 名同意捐献的供体中，至少有 159 名供体获得了至少一种实体器官。尽管可能的和合格的供体数量不断增加，但同意率随着时间的推移呈显著下降趋势（ptrend=0.023）。此外，在 10 年的研究期间，观察到医疗（而非创伤）（ptrend<0.001）和扩展标准（而非标准标准）供体推荐（ptrend<0.001）的趋势呈上升趋势。
随着时间的推移，供体推荐模式发生了变化，医疗和扩展标准供体明显增加。尽管可能的和合格的供体数量增加，但同意率下降。需要进一步进行定性和定量研究，以了解和解决这一趋势。
