Pearson I Y, Zurynski Y
Department of Intensive Care, Westmead Hospital, N.S.W., Australia.
Anaesth Intensive Care. 1995 Feb;23(1):68-74. doi: 10.1177/0310057X9502300113.
A questionnaire survey was carried out to examine the attitudes and practices of Australian and New Zealand intensivists with regard to brain death and organ donation. A return rate of 82.5% was achieved. Fifty-eight per cent had written evidence of their own wishes to donate organs and 94% would agree to donation from a dependent. At least one intensivist is involved in certifying brain death on 95% of occasions. Intensivists are involved in the request for organ donation over 90% of the time although one-third do not believe that it is their role to request organ donation. Although two-thirds believe that the family should always be approached for organ donation, another 52 out of 254 indicated that it was their (the intensivist's) role to decide if families should be asked for organ donation. Possible reasons for not requesting are language or other communication problems, perceptions of cultural differences and degrees of family distress. Twenty per cent of respondents do not provide haemodynamic support before brain death confirmation. Australian and New Zealand intensivists overwhelmingly support the concept of brain death, current methods of confirmation of brain death, organ donation and transplantation. Possible reasons behind loss of potential donors include decisions not to resuscitate both before and after brain death is confirmed. Perceptions of family grief and cultural differences clearly inhibit requests for organ donation. A very few units have an effective policy on approaching families about organ donation. Intensivists have almost exclusive control over requests for organ donation and thus bear a full professional responsibility for this element of hospital practice.
开展了一项问卷调查，以调查澳大利亚和新西兰重症监护医生对脑死亡和器官捐赠的态度及做法。问卷回收率为82.5%。58%的人有书面证据表明自己愿意捐赠器官，94%的人会同意接受受抚养人的捐赠。在95%的情况下，至少有一名重症监护医生参与脑死亡认证。超过90%的时间里，重症监护医生参与器官捐赠请求，尽管三分之一的人认为请求器官捐赠并非其职责。虽然三分之二的人认为应该总是与家属商讨器官捐赠事宜，但在254人中，另有52人表示，决定是否向家属提出器官捐赠请求是他们（重症监护医生）的职责。不提出请求的可能原因包括语言或其他沟通问题、对文化差异的认知以及家属的悲痛程度。20%的受访者在确认脑死亡之前不提供血流动力学支持。澳大利亚和新西兰的重症监护医生压倒性地支持脑死亡概念、当前脑死亡确认方法、器官捐赠及移植。潜在捐赠者流失背后的可能原因包括在确认脑死亡之前和之后决定不进行复苏。对家属悲痛的认知和文化差异显然阻碍了器官捐赠请求。极少数单位有关于与家属商讨器官捐赠的有效政策。重症监护医生几乎完全控制着器官捐赠请求，因此在医院实践的这一环节承担着全部专业责任。
