Racial Equity in Family Approach for Patients Medically Suitable for Deceased Organ Donation.

IF 7.7 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Medicine Pub Date : 2024-09-16 DOI:10.1097/CCM.0000000000006415

James R Rodrigue, Jesse D Schold, Alexandra Glazier, Tom D Mone, Richard D Hasz, Dorrie Dils, Jill Grandas, Jeffrey Orlowski, Santokh Gill, Jennifer Prinz

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引用次数: 0

Abstract

Objectives: To conduct a contemporary analysis of the association between family approach of medically suitable potential organ donors and race/ethnicity.

Design: Retrospective review of data collected prospectively by Organ Procurement Organizations (OPOs).

Setting: Ten OPOs representing eight regions of the Organ Procurement and Transplantation Network and 26% of all deceased donor organs recovered in the United States.

Subjects: All hospitalized patients on mechanical ventilation and referred to OPOs as potential donors from January 1, 2018, to December 31, 2022.

Interventions: None.

Measurements and main results: OPOs provided data on referral year, race, sex, donor registration status, screening determination, donation medical suitability, donation type (brain death, circulatory death), and family approach. We evaluated factors associated with family approach to discuss donation using descriptive statistics and multivariable logistic models. Of 255,429 total cases, 138,622 (54%) were screened-in for further evaluation, with variation by race/ethnicity (50% White, 60% Black, 69% Hispanic, and 60% Asian). Among those screened-in, 31,253 (23%) were medically suitable for donation, with modest variation by race/ethnicity (22% White, 26% Black, 23% Hispanic, and 21% Asian). Family approach rate by OPOs of medically suitable cases was 94% ( n = 29,315), which did not vary by race/ethnicity (94% White, 93% Black, 95% Hispanic, and 95% Asian). Family approach by OPOs was lower for circulatory death (95%) vs. brain death (97%) cases but showed minimal differences in approach rate based on race/ethnicity between medically suitable patients with different death pathways. In contrast, donor registration status of medically suitable potential donors was highly variable by race/ethnicity (37% overall; 45% White, 21% Black, 29% Hispanic, and 25% Asian). Multivariable models indicated no significant difference of family approach between White and Black (odds ratio [OR], 1.09; 95% CI, 0.95-1.24) or Asian (OR, 1.23; 95% CI, 0.95-1.60) patients.

Conclusions: Findings indicate racial equity in OPO family approach rates among patients who were medically suitable for organ donation.

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医学上适合进行器官捐献的患者的种族平等家庭方法。

目的对医学上合适的潜在器官捐献者的家庭方式与种族/民族之间的关系进行当代分析：设计：对器官获取组织（OPO）前瞻性收集的数据进行回顾性审查：10个OPO代表了器官获取和移植网络的8个地区，占美国所有已捐献器官的26%：2018年1月1日至2022年12月31日期间，所有接受机械通气并作为潜在捐献者转诊至OPO的住院患者：无：OPO提供了关于转诊年份、种族、性别、捐献者登记状态、筛查确定、捐献医疗适宜性、捐献类型（脑死亡、循环死亡）和家庭方式的数据。我们使用描述性统计和多变量逻辑模型评估了与家属讨论捐献方式相关的因素。在 255,429 个总病例中，138,622 人（54%）被筛查出接受进一步评估，不同种族/族裔（50% 白人、60% 黑人、69% 西班牙人和 60% 亚洲人）之间存在差异。在筛选出的患者中，31253 人（23%）在医学上适合捐献，不同种族/族裔之间的差异不大（白人 22%、黑人 26%、西班牙裔 23% 和亚裔 21%）。在医学上适合捐献的病例中，OPO的家庭接洽率为94%（n = 29,315），不因种族/族裔而异（94%为白人，93%为黑人，95%为西班牙裔，95%为亚裔）。在循环死亡（95%）与脑死亡（97%）病例中，OPO的家属接洽率较低，但在不同死亡途径的医学合适患者之间，基于种族/族裔的接洽率差异很小。与此相反，医学上合适的潜在捐献者的捐献者登记情况因种族/人种而异（总体为 37%；白人为 45%，黑人为 21%，西班牙裔为 29%，亚裔为 25%）。多变量模型显示，白人与黑人（几率比 [OR]，1.09；95% CI，0.95-1.24）或亚裔（OR，1.23；95% CI，0.95-1.60）患者之间的家庭方式无明显差异：研究结果表明，在医学上适合器官捐献的患者中，OPO家属接洽率的种族公平性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.