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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (06) : 589 -593. doi: 10.3877/cma.j.issn.2095-3232.2021.06.012

临床研究

供者管理模式对器官捐献结局的影响
刘剑戎1, 熊天威2, 周密1, 魏绪霞1, 安玉玲1, 易小猛1, 黎利娟1, 陆平兰1, 范明明1, 李梓钰1, 杨扬3, 易慧敏1,†()   
  1. 1. 510630　广州，中山大学附属第三医院外科重症监护室
    2. 510630　广州，中山大学附属第三医院器官捐献管理办公室
    3. 510630　广州，中山大学附属第三医院肝脏外科暨肝移植中心
  • 收稿日期:2021-08-25 出版日期:2021-09-23
  • 通信作者: 易慧敏
  • 基金资助:
    国家"十三五"重大科技专项(2017ZX10203205); 国家重点研发计划项目(2017YFA0104304); 国家自然科学基金(81770648，81972286，81870447); 广东省自然科学基金(2015A030312013，2016A030313224); 广东省科技计划项目(2017B020209004，20169013，2020B1212060019); 广州市科技计划项目(201508020262)

Effect of donor management scheme on organ donation outcome

Jianrong Liu1, Tianwei Xiong2, Mi Zhou1, Xvxia Wei1, Yuling An1, Xiaomeng Yi1, Lijuan Li1, Pinglan Lu1, Mingming Fan1, Ziyu Li1, Yang Yang3, Huimin Yi1,†()   

  1. 1. Surgical Intensive Care Unit, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    2. Organ Donation Management Office, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    3. Department of Hepatobiliary Surgery and Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2021-08-25 Published:2021-09-23
  • Corresponding author: Huimin Yi
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刘剑戎, 熊天威, 周密, 魏绪霞, 安玉玲, 易小猛, 黎利娟, 陆平兰, 范明明, 李梓钰, 杨扬, 易慧敏. 供者管理模式对器官捐献结局的影响[J]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 589-593.

Jianrong Liu, Tianwei Xiong, Mi Zhou, Xvxia Wei, Yuling An, Xiaomeng Yi, Lijuan Li, Pinglan Lu, Mingming Fan, Ziyu Li, Yang Yang, Huimin Yi. Effect of donor management scheme on organ donation outcome[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(06): 589-593.

目的

探讨器官捐献工作组（ODWG）管理模式对器官捐献结局的影响。

方法

回顾性分析2018年1月到2020年6月中山大学附属第三医院器官获取组织接收的182例供者临床资料。其中男150例，女32例；平均年龄（42±15）岁。以2019年3月作为时间节点将供者分为ODWG组（108例）和对照组（74例）。患者均签署知情同意书，符合医学伦理学规定。比较两组供者捐献类型、捐献器官质量控制指标等。两组率的比较采用χ2检验。

结果

本组捐献成功率为70%（128/182）。脑死亡器官捐献（DBD）供者91例，心脏死亡器官捐献（DCD） 80例。ODWG组DBD占67%（68/102），明显高于对照组的33%（23/69） （χ2=18.37，P<0.05）。ODWG组器官紧急获取率为1%（1/102），明显低于对照组的10%（7/69） （χ2=5.71，P<0.05）。ODWG组获取器官数295个，丢弃器官数22个，器官利用率93%（273/295），器官产出率268%（273/102），对照组相应为198个、26个、87%（172/198）、249%（172/69），ODWG组的器官利用率和器官产出率优于对照组。

结论

ODWG管理模式可明显提高器官捐献率，扩大器官池，是保证捐献-移植安全有效的方案。

关键词: 器官捐献, 器官移植, 供者管理, 重症监护
Objective

To evaluate the effect of Organ Donation Work Group (ODWG) management scheme on the outcome of organ donation.

Methods

Clinical data of 182 donors admitted to Organ Procurement Organization (OPO) in the Third Affiliated Hospital of Sun Yat-sen University from January 2018 to June 2020 were retrospectively analyzed. Among them, 150 donors were male and 32 female, aged (42±15) years on average. Regarding March 2019 as the time point, all donors were divided into the ODWG (n=108) and control groups (n=74). The informed consents of all patients were obtained and the local ethical committee approval was received. The donor donation types and parameters of quality control of donated organs were statistically compared between two groups. The rate comparison was performed byChi-square test.

Results

The success rate of organ donation was 70%(128/182). Among them, 91 cases were donation after brain death (DBD) and 80 cases were donation after cardiac death (DCD). In the ODWG group, the proportion of DBD cases was 67%(68/102), significantly higher than 33%(23/69) in the control group (χ2=18.37, P<0.05). In the ODWG group, the emergency organ procurement rate was 1%(1/102), significantly lower than 10%(7/69) in the control group (χ2=5.71, P<0.05). In the ODWG group, the number of procured organs was 295, the number of discarded organs was 22, the utilization rate of organs was 93%(273/295), the output rate of organs was 268%(273/102). They were correspondingly 198, 26, 87%(172/198) and 249%(172/69) in the control group. The organ utilization rate and output rate in the ODWG group were higher than those in the control group.

Conclusions

ODWG management scheme can significantly improve the organ donation rate and expand the organ pool, which is a protocol to guarantee the efficacy and safety of organ donation-transplantation.

Key words: Organ donation, Organ transplantation, Donor management, Intensive care
表1 ODWG组和对照组供者捐献前临床特征比较
组别 例数 年龄（岁，±s） 性别（例） 血型（例）
男 女 A B O AB
ODWG组 108 43±15 84 24 30 19 53 6
对照组 74 41±16 66 8 13 21 29 6
统计值   t=0.80 χ2=3.95 χ2=5.47
P值   0.422 0.047 0.140
组别 例数 Na（mmol/L，±s) Scr[μmol/L，M（QR）] ALB(g/L，±s) ALT[U/L，M（QR）] TB[μmol/L，M（QR）] DB[μmol/L，M（QR）]
ODWG组 108 156±16 119(140) 35±6 33(50) 13(22) 5(5)
对照组 74 154±13 131(194) 34±7 39(80) 14(16) 6(9)
统计值   t=0.48 Z=-0.89 t=1.69 Z=-0.76 Z=-0.18 Z=-1.83
P值   0.634 0.371 0.094 0.447 0.861 0.067
表2 182例供者器官捐献结局
组别 例数 维护时间（h，±s） 捐献前死亡（例） 器官紧急获取（例） 每位供者捐献器官数量（个） 顺利捐献（例） DBD/DCD（例）
ODWG组 108 40±19 6 1 2.7±1.0 77 68/34
对照组 74 47±35 5 7 2.5±0.9 51 23/46
统计值   t=-1.66 χ2=0.11 χ2=5.71 t=1.30 χ2=0.05 χ2=18.37
P值   0.099 0.760 0.008 0.196 0.816 <0.001
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