Department of Surgery, Division of Paediatric Surgery, University of Cape Town, and Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
Department of Surgery, Division of General Surgery, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa.
S Afr Med J. 2024 Apr 24;114(3b):e1330. doi: 10.7196/SAMJ.2024.v114i3b.1330.
Solid-organ transplantation (SOT) has been proven to be a highly effective and life-saving treatment modality for adults and children suffering from end-stage organ failure. However, high paediatric waiting-list mortality has been reported, and children may suffer irreversible physical and deleterious psychological effects if not transplanted timeously.
To identify in-hospital barriers to organ donation and gain a better understanding of the paediatric donor landscape.
A retrospective descriptive study of consecutive deceased-donor referrals at Red Cross War Memorial Children's Hospital over a 14-year period, from 1 January 2007 to 31 December 2020.
During the study period, 156 in-hospital deaths were recorded in the trauma unit and 1 425 in the paediatric intensive care unit. Ninety-three of the 1 581 patients (5.9%) were referred to the on-call transplant co-ordinator as potential organ donors, of whom 69% had been involved in a traumatic accident, including 52% in road traffic collisions. The mean age of the potential donors was 7 years with 60.2% being boys. On initial assessment, 67 of the 93 potential donors (72%) were assessed as eligible for donation of at least one solid organ. The transplant co-ordinator attempted to approach all families for consent; however, five families/next of kin could not be located despite multiple attempts. Among the remaining 62 eligible donors, 44 families/next-of-kin declined consent for solid-organ donation, resulting in a consent rate of 29% (n=18). Several families refused consent for religious reasons. One of the consented donors did not proceed to procurement as there were no suitable recipients. Seventeen donors proceeded to theatre, the intention being solid-organ procurement, but in 2 donors the organs were assessed as being unsuitable for transplant. From the remaining 15 donors, a total of 46 organs were procured and successfully transplanted: 14 livers, 30 kidneys and 2 hearts.
During the 14-year study period, only 15 deceased donors could be utilised for SOT, as a result of low in-hospital referral (5.9%) and consent rates (29%). The reasons for low referral and consent rates are complex and often multifactorial, which the current study was not designed to investigate in sufficient detail. Future studies should be designed to further interrogate our findings, while accommodating for nuances specific to the paediatric deceased-donor population and their families.
实体器官移植（SOT）已被证明是治疗成人和儿童终末期器官衰竭的一种非常有效和救生的治疗方法。然而，据报道，儿科候补名单死亡率很高，如果不及时进行移植，儿童可能会遭受不可逆转的身体和有害的心理影响。
确定院内器官捐献的障碍，并更好地了解儿科供体情况。
对 2007 年 1 月 1 日至 2020 年 12 月 31 日期间在红十字会纪念儿童医院连续 14 年进行的 156 例创伤单元院内死亡和 1425 例儿科重症监护病房院内死亡的回顾性描述性研究。
在研究期间，创伤单元记录了 156 例院内死亡，儿科重症监护病房记录了 1425 例院内死亡。在 1581 名患者中，有 93 名（5.9%）被转介给随叫随到的移植协调员作为潜在器官捐献者，其中 69%的患者参与了创伤性事故，包括 52%的道路交通碰撞。潜在供体的平均年龄为 7 岁，其中 60.2%为男孩。在初步评估中，93 名潜在供体中有 67 名（72%）被评估为至少有一个实体器官可供捐献。移植协调员试图与所有家属接触以获得同意；然而，尽管多次尝试，仍有 5 个家庭/近亲无法找到。在 62 名符合条件的供体中，44 个家庭/近亲拒绝同意捐献实体器官，同意率为 29%（n=18）。一些家庭因宗教原因拒绝同意。一名同意捐献者因没有合适的受体而未进行采购。17 名供体进入手术室，打算进行实体器官采集，但在 2 名供体中，器官被评估为不适合移植。从其余 15 名供体中，共采集并成功移植了 46 个器官：14 个肝脏、30 个肾脏和 2 个心脏。
在 14 年的研究期间，由于院内转诊（5.9%）和同意率（29%）低，只有 15 名已故供体可用于 SOT。转诊和同意率低的原因很复杂，往往是多因素的，目前的研究没有设计来充分详细地调查这些原因。未来的研究应旨在进一步探讨我们的发现，同时考虑到儿科已故供体人群及其家属的具体细微差别。
