Gilbert & Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.
Dana-Farber Cancer Institute, Department of Informatics and Analytics, Boston, Massachusetts, United States of America.
PLoS One. 2024 Feb 13;19(2):e0295930. doi: 10.1371/journal.pone.0295930. eCollection 2024.
Organ donation shortage and in particular organ procurement is an international concern as the gap between the number of donors and recipients is steadily growing. Organ procurement is a chain of steps with donor identification and referral (ID&R) as the very first link in this chain. Failure of this step hinders the progress in the organ transplantation program.
Our study was conducted to evaluate and highlight the gap between the national system and the practice at the identification and referral (ID&R) step of the organ procurement chain in a single tertiary-care academic health center in Beirut: the Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), and to appraise the literature for challenges at this step and for possible interventions for improvement based on the international experience.
This retrospective study was a descriptive case series of ICU and ED deceased patients at a single tertiary-care university hospital in Beirut. Patients' characteristics were collected from medical records for all patients who died between 2017 and 2019 while in the ICU or the ED and shared with the National Organization for Organ and Tissue Donation and Transplantation (NOD-Lb), for each subject separately, to decide on the donor status. All data collected from the patient cohort was analyzed using R version 3.6.1. Wilcoxon signed-rank test, chi-squared, and fisher-exact tests were used to compare differences in clinical characteristics in terms of donor status when appropriate.
This study served as 3 years audit of a single hospital experience, and it demonstrates failure to make any referrals to NOD-Lb and zero actual organ and tissue donations over the study period. The review of 295 deceased subjects' charts demonstrates 295 missed alerts to NOD-Lb and the overall missing of 5 organ and tissue donors and 24 cornea donors assuming the organ procurement chain of steps will continue uninterrupted after ID&R.
The data gathered suggests the presence of an inefficient identification and referral system that is translated into a complete failure of reporting to NOD-Lb from LAUMC-RH. A systematic evidence-based approach to evaluate for the most cost-effective intervention to increase identification and referral rates is needed with a serious effort to examine and account for any inefficient implantation.
器官捐献短缺，特别是器官获取，是一个国际关注的问题，因为捐献者和接受者之间的差距在稳步扩大。器官获取是一个由多个步骤组成的链条，而供体识别和转介（ID&R）是这个链条中的第一个环节。这一步骤的失败阻碍了器官移植项目的进展。
我们的研究旨在评估和突出黎巴嫩贝鲁特一家三级保健学术中心（黎巴嫩美国大学医学中心 - 里兹克医院，LAUMC-RH）器官获取链的 ID&R 步骤中，国家系统与实践之间的差距，并评估该步骤的文献，以及根据国际经验，为改进提出可能的干预措施。
这项回顾性研究是对贝鲁特一家三级保健大学医院重症监护室和急诊部死亡患者的描述性病例系列研究。从 2017 年至 2019 年期间在重症监护室或急诊部死亡的所有患者的病历中收集患者特征，并分别与国家器官和组织捐献与移植组织（NOD-Lb）共享，以便为每位患者决定供体状态。使用 R 版本 3.6.1 分析从患者队列中收集的所有数据。适当情况下，使用 Wilcoxon 符号秩检验、卡方检验和 Fisher 精确检验比较供体状态方面的临床特征差异。
这项研究是对一家医院 3 年的审核，结果表明在研究期间，LAUMC-RH 没有向 NOD-Lb 进行任何转介，也没有实际的器官和组织捐献。对 295 名死亡患者的病历进行审查，发现有 295 次向 NOD-Lb 的警报被忽略，并且假设器官获取链的步骤在 ID&R 之后将继续不间断，整体错过了 5 名器官和组织捐献者和 24 名角膜捐献者。
所收集的数据表明，存在一个效率低下的识别和转介系统，导致 LAUMC-RH 完全未能向 NOD-Lb 报告。需要采用系统的循证方法，评估最具成本效益的干预措施，以提高识别和转介率，并认真努力检查和说明任何效率低下的植入情况。
