Siminoff L A, Arnold R M, Caplan A L, Virnig B A, Seltzer D L
University of Pittsburgh, PA, USA.
Ann Intern Med. 1995 Jul 1;123(1):10-7. doi: 10.7326/0003-4819-123-1-199507010-00037.
To determine why Required Request policies, which mandate that hospitals request donation from donor-eligible families, have not resulted in increased organ procurement.
Stratified sample of 23 acute-care general hospitals in two metropolitan areas.
Chart review identified all eligible donors in study hospitals during a 20-month period. Health care professionals who spoke with the families of eligible donors after death were interviewed to determine families' and health care providers' behaviors after patients' deaths with reference to the donation process.
All patient deaths (n = 10,681) were reviewed, and 841 donor-eligible cases were chosen for in-depth study; 1809 health care professionals who provided care to these patients were interviewed.
The ability of health care providers to identify donor-eligible patients, approach families about donation, and obtain families' consent to donation.
83% of health care professionals correctly identified donor-eligible patients. The families of donor-eligible patients were approached about donation in 73.0% of the cases. Families were more likely to be approached about organ (86.6%) donation than either tissue (69.5%) or cornea (67.3%) donation (P < 0.001). The families of organ-eligible patients were less likely to be approached if the patient was female, was on a general medical or surgical floor, or was being cared for by internists. Only 46.5% of families of eligible donors agreed to donate organs, 34.5% agreed to donate tissues, and 23.5% agreed to donate corneas.
Although health care professionals do request that families donate, families consent to donation less frequently than was previously assumed. Empirically based education campaigns are needed so that health care professionals can improve their communication skills and so that discussion about this important issue can be stimulated among family members.
确定要求医院向符合捐赠条件的家庭请求捐赠的“必需请求”政策为何未使器官获取量增加。
来自两个大都市地区23家急性护理综合医院的分层样本。
通过病历审查确定研究医院在20个月期间的所有符合条件的捐赠者。对在患者死亡后与符合条件的捐赠者家属交谈过的医护人员进行访谈，以确定患者死亡后家属和医护人员在捐赠过程中的行为。
审查了所有患者死亡病例（n = 10681），选择了841例符合捐赠条件的病例进行深入研究；对为这些患者提供护理的1809名医护人员进行了访谈。
医护人员识别符合捐赠条件患者的能力、就捐赠事宜与家属沟通的能力以及获得家属捐赠同意的能力。
83%的医护人员正确识别了符合捐赠条件的患者。在73.0%的病例中，就捐赠事宜与符合捐赠条件患者的家属进行了沟通。与组织（69.5%）或角膜（67.3%）捐赠相比，家属更有可能被提及器官（86.6%）捐赠（P < 0.001）。如果患者为女性、在普通内科或外科病房或由内科医生护理，符合器官捐赠条件患者的家属被提及捐赠的可能性较小。只有46.5%的符合条件捐赠者家属同意捐赠器官，34.5%同意捐赠组织，23.5%同意捐赠角膜。
尽管医护人员确实会请求家属捐赠，但家属同意捐赠的频率低于先前的设想。需要开展基于实证的教育活动，以便医护人员能够提高沟通技巧，并促进家庭成员之间就这一重要问题进行讨论。
