Donör havuzunun gizli hazinesi: greft olarak kullanılmayan donör kalplerinin analizi

Abstract

Amaç: Bu çalışmada beyin ölümü gerçekleşen hastalarda organ bağışının seyrini araştırmak, organ bağışından organ nakline kadar olan aşamaları incelemek, kullanılmayan veya reddedilen vericilerin nedenlerini ortaya çıkarmak ve çözüm önerileri ortaya konması amaçlandı. Gereç ve Yöntemler: Ocak 2015-Aralık 2016 tarihleri arasında, aile izinleri olan tüm kadavra bağışçılarının Sağlık Bakanlığı Ulusal Koordinasyon Merkezi Başkanlığı arşivlerindeki donör kayıt verilerini inceledik. Donör adaylarının demografik verileri, yoğun bakım kalış süresindeki verileri ve donör olarak kullanılmama nedenleri incelendi. Sonuçlar: 985 donör incelendi; %65'i erkek, ortalama yaş 47.5 (0-96) idi ve donörlerin %65'inde nörolojik nedenlerle beyin ölümü gerçekleşmişti. Ortalama beyin ölümü rapor süresi 5.4 ± 9.3 (1-169) gündü. Donörlerin 169’unda (%17.1) enfeksiyon tespit edildi. Ortalama yoğun bakımda kalış süresi 8,55 ± 4,42 (2-38) gündü. Donörlerin sadece 159’undan (%16,2) kalp grefti alındı. 495 (%50,2) donör tıbbi nedenlerle reddedildi, 64 (%6,5) donör, alıcı merkezler tarafından reddedildiği için kalp nakli için uygun değildi. Potansiyel bağışçıların %20'sinde kalp bağışı için aile onayı alınmadı. Aile onayı olmayan bağışçıların %70'i 65 yaşın altındaydı ve %67'sinin greft olarak kalp kullanımından kaçınmak için herhangi bir tıbbi sorunu yoktu. Kalp onayı olmayan donörlerde greft olarak karaciğer kullanım oranı %71, böbrek için kullanım oranı %70 idi. Sonuç: Beyin ölümü tanısından donörlerin bakımına kadar olan süreci yürütecek ve yönlendirecek organ nakli ekiplerine ihtiyacımız vardır.

Keywords

• kalp nakli
• beyin ölümü
• donör

The hidden treasure of the donor pool: An analysis of donor hearts not used as grafts

Abstract

Aim: The aim was to investigate the course of organ donation in patients with brain death, examine the steps from organ donation to transplant, reveal the reasons of donors that are not used or are refused and to propose a solution. Material and Methods: Between January 2015 to December 2016, we reviewed data of donor registry in Ministry of Health, Department of the National of Coordination Center archives of all cadaveric donors whose family permit approved were investigated. Data of demographics, intensive care unit data and reasons of unused as donor were analyzed. Results: 985 donors were examined; 65% was male, mean age was 47.5 (0-96) and 65% of the donors had brain death due to neurological reasons. Mean brain death report duration was 5.4 ± 9.3 (1-169) days. A total of 169 (17.1%) infections in donors were detected. Mean intensive care unit stay was 8.55 ± 4.42 (2-38) days. Only 16.2% (159) heart grafts were used in donors. 495 (50.2%) donors were rejected for medical reasons, 64 donors (6.5%) were not eligible for heart grafts due to rejection by centers. Family approval for the heart donation was not obtained in 20% of the potential donors. 70% of donors without family approval was under 65 year-old and 67% of them did not have any medical problems for avoiding heart usage as a graft. In donors without heart approval as a graft, rate of liver use as a graft was 71% and rate for kidney was 70%. Conclusion: We need organ transplant teams who will conduct and lead the process from the diagnosis of brain death to the care of donors.

Keywords

• organ donation
• heart
• organ transplantation
• brain death

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