NHS Blood and Transplant, Organ Donation and Transplantation Directorate, Bristol, UK.
NHS Blood and Transplant and Consultant, Southmead Hospital, Bristol, UK.
Anaesthesia. 2021 Dec;76(12):1625-1634. doi: 10.1111/anae.15485. Epub 2021 Apr 16.
Between 2013 and 2019, there was an increase in the consent rate for organ donation in the UK from 61% to 67%, but this remains lower than many European countries. Data on all family approaches (16,896) for donation in UK intensive care units or emergency departments between April 2014 and March 2019 were extracted from the referral records and the national potential donor audit held by NHS Blood and Transplant. Complete data were available for 15,465 approaches. Consent for donation after brain death was significantly higher than for donation after circulatory death, 70% (4260/6060) vs. 60% (5645/9405), (OR 1.58, 95%CI 1.47-1.69). Patient ethnicity, religious beliefs, sex and socio-economic status, and knowledge of a patient's donation decision were strongly associated with consent (p < 0.001). These factors should be addressed by medium- to long-term strategies to increase community interventions, encouraging family discussions regarding donation decisions and increasing registration on the organ donor register. The most readily modifiable factor was the involvement of an organ donation specialist nurse at all stages leading up to the approach and the approach itself. If no organ donation specialist nurse was present, the consent rates were significantly lower for donation after brain death (OR 0.31, 95%CI 0.23-0.42) and donation after cardiac death (OR 0.26, 95%CI 0.22-0.31) compared with if a collaborative approach was employed. Other modifiable factors that significantly improved consent rates included less than six relatives present during the formal approach; the time from intensive care unit admission to the approach (less for donation after brain death, more for donation after cardiac death); family not witnessing neurological death tests; and the relationship of the primary consenter to the patient. These modifiable factors should be taken into consideration when planning the best bespoke approach to an individual family to discuss the option of organ donation as an end-of-life care choice for the patient.
2013 年至 2019 年期间，英国的器官捐献同意率从 61%上升至 67%，但仍低于许多欧洲国家。从 2014 年 4 月至 2019 年 3 月，从 NHS 血液与移植的转介记录和国家潜在供体审计中提取了英国重症监护病房或急诊部门进行的所有家庭供体方法（16896 例）的数据。15465 例方法获得完整数据。脑死亡后捐献的同意率明显高于循环死亡后捐献的同意率，分别为 70%（4260/6060）和 60%（5645/9405）（OR 1.58，95%CI 1.47-1.69）。患者的种族、宗教信仰、性别和社会经济地位，以及对患者捐献决定的了解，与同意率密切相关（p<0.001）。这些因素应通过中长期策略来解决，以增加社区干预，鼓励家庭讨论捐献决定，并增加器官捐献登记。最容易改变的因素是在接近和进行供体方法时，所有阶段都有器官捐献专科护士的参与。如果没有器官捐献专科护士，脑死亡（OR 0.31，95%CI 0.23-0.42）和心脏死亡（OR 0.26，95%CI 0.22-0.31）的捐献同意率明显低于采用协作方法。其他可改变的因素，包括在正式方法中只有不到 6 名亲属在场；从重症监护病房入院到方法的时间（脑死亡的时间更短，心脏死亡的时间更长）；家人未见证神经死亡测试；以及主要同意者与患者的关系。在为患者规划最佳的个性化方法来讨论器官捐献作为终末期护理选择的选项时，应考虑这些可改变的因素。
