循环性死亡后的捐赠:国际视角

Q4 Medicine
Barry D. Kahan
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引用次数: 0

摘要

移植事业的蓬勃发展增加了对活体器官捐献者以外的人体器官的需求。虽然脑死亡后捐献(DBD)的人继续提供全球绝大多数尸体器官,但在显示严重脑损伤但不符合电击标准的患者中招募捐献者的做法日益增多。这些患者包括在撤除机器辅助通气后无法维持血液循环的人群,他们的家属同意器官取回--这就是心循环死亡(DCD)后捐献的对象。移植报告》中的这组文章揭示了世界各地不同的做法,不仅包括恢复 DCD 器官的手术程序,还包括克服取回器官后的缺血再灌注损伤 (IRi)。这些文章揭示了美国、南美、欧洲、亚洲和中东的中心、国家和国际 DCD 器官移植指南以及肾、肝、肺、心脏和胰腺移植的结果。一方面,人们很少关注使用体外机器灌注来诊断、减轻和治疗 DCD 器官的 IRI。另一方面,在宣布死亡后通过心肺旁路对捐献者进行体内再灌注的做法甚至在医学专家中也引起了相当大的争议。美国《统一死亡判定法》(UDDA)委员会即将进行的审议必须考虑到生物伦理和生物哲学因素以及公众舆论和社会共识,以便为 DCD 程序奠定坚实的基础,满足不断增长的患者需求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Donation after circulatory death: An international view

The blossoming transplantation enterprise has increased the demand for human organs beyond those available from living donors. While individuals undergoing donation after brain death (DBD) continue to yield the vast majority of cadaveric organs recovered worldwide, a growing practice recruits donors among patients displaying severe brain injury but not meeting the criterion of electrosilence. These patients include a cohort who cannot maintain their circulation after withdrawal of machine-assisted ventilation and whose families consent to organ retrieval – subjects for donation after cardiocirculatory death (DCD). Expositions in this collection of articles in Transplantation Reports reveal variable practices worldwide, not only in surgical procedures to recover DCD organs, but also to overcome the ischemia-reperfusion injuries (IRi) consequent to retrieval. The contributions reveal center, national and international guidelines for, as well as outcomes of kidney, liver, lung, cardiac and pancreas transplantations of DCD organs in The United States, South America, Europe, Asia and The Middle East.

On the one hand, there is little concern about the use of ex vivo machine perfusion to diagnose, mitigate and treat IRI in DCD organs. On the other hand, in vivo donor re-vitilization by cardiopulmonary bypass after declaration of death has incited considerable controversy even among medical professionals. Bioethical and biophilosophical considerations as well as public opinion and social consensus must inform forthcoming deliberations of The United States Uniform Determination of Death Act (UDDA) Commission in order to place DCD procedures on a firm footing to meet burgeoning patient needs.

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来源期刊
Transplantation Reports
Transplantation Reports Medicine-Transplantation
CiteScore
0.60
自引率
0.00%
发文量
24
审稿时长
101 days
期刊介绍: To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI
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