Wick L, Mickell J, Barnes T, Allen J
Department of Pediatrics, Children's Medical Center of the Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
Transplant Proc. 1995 Aug;27(4):2539-44.
To examine the national Pediatric Intensive Care Unit (PICU) experience regarding Medical Examiner (ME) refusal of organ procurement from potential donors. To review our experience regarding PICU mortalities, organ donation, and impact of the ME on the organ donation process.
National survey of PICU directors requesting demographics, type of ME system, perceptions of ME responsiveness to organ donation, and data regarding potential donors and their outcomes. Also, a retrospective chart review of all PICU deaths from 1990 to 1992 at a tertiary care center, noting the number of potential organ donors, ME cases, those harvested, rejected, and reason for rejection.
PICU directors selected from a list of Pediatric Section members of the Society of Critical Care Medicine. The response rate was 59%. The chart review was performed in a 1000-bed hospital with a 12-bed PICU.
PICU directors' perceptions of ME responsiveness to organ donation were not determined by size of PICU, area served, type of hospital, ME system, or means of contacting the ME. ME refusal accounted for 15% and 16% of total refusals in the survey and chart review, respectively. Family refusal accounted for 49% and 28% in these same groups. Survey respondents' hints and suggestions to decrease denial and increase organ donation focused on improved communication (61% and 33%), and education (16% and 55%).
ME refusal does impact on pediatric organ donation, but not as significantly as family refusal. Increased organ procurement in ME-related cases will require improved communication between MEs, physicians, and the Organ Procurement Organizations (OPOs).
调查全国儿科重症监护病房（PICU）在法医（ME）拒绝从潜在捐赠者获取器官方面的情况。回顾我们在PICU死亡、器官捐赠以及法医对器官捐赠过程的影响方面的经验。
对PICU主任进行全国性调查，询问人口统计学信息、法医系统类型、对法医对器官捐赠反应的看法以及关于潜在捐赠者及其结果的数据。此外，对一家三级医疗中心1990年至1992年期间所有PICU死亡病例进行回顾性图表审查，记录潜在器官捐赠者数量、法医案例、已采集、被拒绝的案例以及拒绝原因。
从危重症医学会儿科分会成员名单中选取PICU主任。回复率为59%。图表审查在一家拥有1000张床位且设有12张床位PICU的医院进行。
PICU主任对法医对器官捐赠反应的看法并非由PICU规模、服务区域、医院类型、法医系统或与法医联系的方式决定。在调查和图表审查中，法医拒绝分别占总拒绝数的15%和16%。在这些相同组中，家属拒绝分别占49%和28%。调查受访者关于减少拒绝并增加器官捐赠的提示和建议主要集中在改善沟通（分别为61%和33%）以及教育（分别为16%和55%）。
法医拒绝确实会影响儿科器官捐赠，但不如家属拒绝影响显著。在与法医相关的案例中增加器官获取量将需要改善法医、医生和器官获取组织（OPO）之间的沟通。
