Hungarian National Blood Transfusion Service, Budapest, Hungary.
Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
Transpl Int. 2023 Sep 12;36:11498. doi: 10.3389/ti.2023.11498. eCollection 2023.
The primary aim of this study was to describe regulations and practices concerning the family approach to discuss donation, specifically after the neurological determination of death, one of the most challenging steps in the donation pathway. A secondary objective was to assess the impact of legislation on consent rates for organ donation. The Council of Europe surveyed 39 member states about national regulations, practices, and consent rates; 34 replied. Opt-out legislation is present in 19, opt-in in 9 and a mixed system in six countries. An opt-out register is kept by 24 countries and an opt-in register by 18 countries, some keeping both. The mean consent rate was 81.2% of all family approaches. Most countries regulate how death using neurological criteria is confirmed (85.3%), while regulation of other aspects of the deceased donation pathway varies: the timing of informing the family about brain death (47.1%) and organ donation (58.8%), the profile of professional who discusses both topics with the family (52.9% and 64.7%, respectively) and the withdrawal of treatment after brain death (47.1%). We also noted a mismatch between what regulations state and what is done in practice in most countries. We suggest possible reasons for this disparity.
本研究的主要目的是描述与家庭讨论捐赠相关的规定和实践，特别是在脑死亡这一器官捐献过程中最具挑战性的步骤之后。次要目标是评估立法对器官捐献同意率的影响。欧洲委员会对 39 个成员国的国家法规、实践和同意率进行了调查，其中 34 个国家做出了回应。19 个国家实行默认同意制度，9 个国家实行选择同意制度，6 个国家实行混合制度。24 个国家保留了默认同意登记簿，18 个国家保留了选择同意登记簿，有些国家同时保留了这两种登记簿。所有家庭讨论中，同意率的平均值为 81.2%。大多数国家规定了如何确认使用神经学标准的死亡（85.3%），而对死者捐赠途径的其他方面的规定则有所不同：告知家属脑死亡（47.1%）和器官捐赠（58.8%）的时间、与家属讨论这两个话题的专业人员的特征（分别为 52.9%和 64.7%）以及脑死亡后的治疗退出（47.1%）。我们还注意到，在大多数国家，法规规定的内容和实际做法之间存在不匹配的情况。我们提出了这种差异可能存在的原因。
