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循环死亡后的捐赠心脏拒绝:对联合器官共享网络拒绝代码的分析

Tyler M Dann^1,2, Brianna L Spencer^1,2, Spencer K Wilhelm^1,2

¹Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.

|May 1, 2024

概括

循环死亡 (DCD) 后的捐赠心脏比脑死亡 (DBD) 的捐赠心脏更频繁地被拒绝,因为人们担心延长死亡和器官保存. 改善DCD心脏移植需要解决这些保存问题.

科学领域:

心脏病学心脏病学
移植医学移植医学
器官捐赠器官捐赠器官捐赠器官捐赠器官捐赠器官捐赠器官捐赠器官捐赠器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器官捐献器

背景情况:

在循环死亡 (DCD) 后获得的捐赠心脏有可能增加心脏移植的可用性.
了解DCD心脏利用和拒绝模式对于优化捐赠池至关重要.

研究的目的:

分析DCD和脑死亡 (DBD) 捐赠者的当前心脏移植率.
用最近的国家数据来描述DCD心脏器官拒绝模式.

主要方法:

对2020-2022年联合器官共享网络 (UNOS) 和器官采购和移植网络 (OPTN) 数据的分析.
检查DCD和DBD候选者,移植和人口统计数据.
DCD拒绝代码的特征和区域移植率的变化.

主要成果:

DCD心脏的衰退频率是DBD心脏的3.37倍.
DCD拒绝的主要原因包括神经功能 (2022年92%),长时间的温暖缺血时间和器官保存问题.
在人口群体和UNOS区域之间观察到移植率的显著变化.

结论:

与DBD心脏相比,DCD捐赠心脏的拒绝率更高,主要是由于对死亡过程和器官保存的担忧.
诸如 ex situ 血液动力学评估和 normothermic 区域输液指南等策略可能会提高 DCD 心脏移植率.

关键词:

大脑死亡大脑死亡循环死亡循环死亡心脏移植心脏移植手术器官捐赠者器官捐赠者器官捐赠者拒绝代码拒绝代码移植者移植者捐赠者移植接收者移植接收者

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