The key points of development trend and clinical practice of global donation after cardiac death
-
摘要: 器官移植给许多终末期器官衰竭患者带来了治愈希望。但人体器官来源不足已成为严重制约人体器官移植发展的重要因素之一。心脏死亡器官捐献(DCD)是扩充供者来源的一种安全途径,各国在努力提高脑死亡器官捐献(DBD)数量的同时,在条件允许的情况下不应错失DCD的机会。本文从DCD历史背景和全球发展趋势、可控型DCD实施的基本条件、可控型DCD实践中的关键问题以及伦理审查等方面进行探讨。Abstract: Organ transplantation has brought hope for healing of patients with end-stage organ failure. However, the shortage of human organs has become one of the important factors that severely restrict the development of human organ transplantation. Donation after cardiac death (DCD) is a safe way to expand the source of donors. While trying to make extensive effort to increase the quantity of donation after brain death (DBD), countries attempt to grasp the opportunity of DCD when conditions permit. In this article, the historical background and global development trend of DCD, fundamental conditions for the implementation of controllable DCD, key issues and ethical review in the practice of controllable DCD were discussed.
-
图 1 2017年各国DCD和DBD的比例
(资料来源:参考文献[4])
Figure 1. Proportion of DCD and DBD of various countries in 2017
-
[1] 郑树森.走向世界的中国器官移植[J].中华消化外科杂志, 2015, 14(1):前插5-前插6. DOI:10.3760/j.issn.1673- 9752.2015.01.023.ZHENG SS. Chinese organ transplantation to the world[J]. Chin J Dig Surg, 2015, 14(1): forward insert 5- forward insert 6. DOI: 10.3760/j.issn.1673-9752.2015.01.023. [2] 朱艳平, 蔡常洁, 管向东.ICU器官捐献的供体管理[J/OL].中华重症医学电子杂志(网络版), 2017, 3(2): 85-90. DOI: 10.3877/j.issn.2096-1537.2017.02.002.ZHU YP, CAI CJ, GUAN XD. ICU management of organ donor[J/OL]. Chin J Crit Care Intensive Care Med (Electr Edit), 2017, 3(2): 85-90. DOI: 10.3877/j.issn.2096-1537.2017.02.002. [3] 高彤彤, 田慧.公民逝世后器官捐献供体评估、维护及护理[J/CD].实用器官移植电子杂志, 2017, 5(1): 31-33. DOI: 10.3969/j.issn.2095-5332.2017.01.011.GAO TT, TIAN H. Evaluation, maintenance and nursing of organ donation after citizen's death[J/CD]. Pract J Organ Transplant (Electr Vers), 2017, 5(1): 31-33. DOI: 10.3969/j.issn.2095-5332.2017.01.011. [4] GODT. Global observatory on donation and transplantation[EB/OL]. (2018-12-02). http://www.transplant-observatory.org/. [5] KATSAROS GD, SCHUCHT J, JONES CM, et al. Nationwide outcomes after renal transplantation from kidney-only versus multiple-organ deceased donors[J]. Am Surg, 2019, 85(9):1066-1072. [6] ARNAEZ J, GÓMEZ F, CASERÍO S. Pediatric donation after controlled cardiac death (Maastricht type Ⅲ donors)[J]. Med Intensiva, 2017, 41(6):386. DOI: 10.1016/j.medin.2016.10.012. [7] AGOPIAN VG. Liver transplantation with donation after cardiac death donors as a strategy for recipients with model for end-stage liver disease score > 15: has the die been cast?[J]. Liver Transpl, 2017, 23(5):579-580. DOI: 10.1002/lt.24756. [8] PENG JC, DING J, HE ZY, et al. The efficacy of extracorporeal membrane oxygenation in liver transplantation from non-heart-beating donors: a systemic review and Meta-analysis[J]. Medicine (Baltimore), 2019, 98(9):e14722. DOI: 10.1097/MD.0000000000014722. [9] YILDIZ I, KOCA YS, SABUNCUOGLU MZ. Urgent organ retrieval from non-heart-beating donor with declared brain death: harvest at arrest[J]. Chirurgia (Bucur), 2017, 112(2):130-135. DOI: 10.21614/chirurgia.112.2.130. [10] OLIVER JB, MACHINENI P, BONGU A, et al. Liver biopsy in assessment of extended criteria donors[J]. Liver Transpl, 2018, 24(2):182-191. DOI: 10.1002/lt.24947. [11] KOTLOFF RM, BLOSSER S, FULDA GJ, et al. Management of the potential organ donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement[J]. Crit Care Med, 2015, 43(6):1291-1325. DOI: 10.1097/CCM.0000000000000958. [12] KOOTSTRA G, DAEMEN JH, OOMEN AP. Categories of non-heart-beating donors[J]. Transplant Proc, 1995, 27 (5):2893-2894. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=10.1080/00015458.2008.11680172 [13] KeTLOD课题组.中欧器官捐献管理(双语版)[M].北京:科学出版社, 2018. [14] ODT Clinical. Annual activity report[EB/OL]. (2019-10-09).https://www.odt.nhs.uk/statistics-and-reports/annual-activity-report/. [15] OTA AG. Organ and tissue authority 2017-18 annual report[EB/OL]. (2019-10-09).https://donatelife.gov.au/about-us/strategy-and-performance/annual-report-0. [16] ISRANI AK, ZAUN D, ROSENDALE JD, et al. OPTN/SRTR 2017 annual data report: deceased organ donation[J]. Am J Transplant, 2019, 19 (Suppl 2):485-516. DOI: 10.1111/ajt.15280. [17] RUDGE C, MATESANZ R, DELMONICO FL, et al. International practices of organ donation[J]. Br J Anaesth, 2012, 108 (Suppl 1):i48-i55. DOI: 10.1093/bja/aer399. [18] 江文诗, MARIA PAULA GOMEZ, GLORIA PAEZ, et al.数据之美——聚焦全球器官捐献发展趋势[J/CD].中华移植杂志(电子版), 2019, 13(1): 28-33.DOI: 10.3877/cma.j.issn.1674-3903.2019.01.007.JIANG WS, MARIA PAULA GOMEZ, GLORIA PAEZ, et al. The beauty of the data-focusing on the trend of global organ donation[J/CD]. Chin J Transplant(Electr Vers), 2019, 13(1): 28-33.DOI: 10.3877/cma.j.issn.1674-3903.2019.01.007. [19] 中华医学会器官移植学分会.中国心脏死亡器官捐献工作指南(第2版)[J].中华器官移植杂志, 2011, 32(12):756-758.DOI: 10.3760/cma.j.issn.0254-1785.2011.12.014.Branch of Organ Transplantation of Chinese Medical Association. Guide of donation after cardiac death in China(2nd ed)[J]. Chin J Organ Transplant, 2011, 32(12):756-758.DOI: 10.3760/cma.j.issn.0254-1785.2011.12.014. [20] TEASDALE G, JENNETT B. Assessment of coma and impaired consciousness. a practical scale[J]. Lancet, 1974, 2(7872):81-84.DOI: 10.1016/s0140-6736(74)91639-0. [21] NHSBT. Organ donation and transplantation activity report 2018-2019[EB/OL]. (2019-10-01).https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/16537/organ-donation-and-transplantation-activity-report-2018-2019.pdf. [22] XU G, GUO Z, LIANG W, et al. Prediction of potential for organ donation after circulatory death in neurocritical patients[J]. J Heart Lung Transplant, 2018, 37(3):358-364. DOI: 10.1016/j.healun.2017.09.015. [23] LEWIS J, PELTIER J, NELSON H, et al. Development of the University of Wisconsin donation after cardiac death evaluation tool[J]. Prog Transplant, 2003, 13(4):265-273. doi: 10.1177/152692480301300405 [24] DEVITA MA, BROOKS MM, ZAWISTOWSKI C, et al. Donors after cardiac death: validation of identification criteria (DVIC) study for predictors of rapid death[J]. Am J Transplant, 2008, 8(2):432-441. DOI: 10.1111/j.1600-6143.2007.02087.x. [25] WIND J, SNOEIJS MG, BRUGMAN CA, et al. Prediction of time of death after withdrawal of life-sustaining treatment in potential donors after cardiac death[J]. Crit Care Med, 2012, 40(3):766-769. DOI: 10.1097/CCM.0b013e318232e2e7. [26] 中华医学会器官移植学分会.中国公民逝世后器官捐献流程和规范(2019版)[J].器官移植, 2019, 10(2):122-127. DOI: 10.3969/j.issn.1674-7445.2019.02.003.Branch of Organ Transplantation of Chinese Medical Association. Process and specification of Chinese donationafter citizen's death (2019 edition)[J]. Organ Transplant, 2019, 10(2):122-127.DOI:10.3969/j.issn.1674-7445. 2019.02.003.