| 摘要: | 研究目的:器官移植是末期器官衰竭病患的主要治療方式，然而目前所面臨的主要問題與挑戰是器官的來源不足。台灣每百萬人口的器官捐贈為8.0，遠較歐美為低；根據研究，早期發現潛在捐贈者可以提升實際器官捐贈數並改善器官品質，因此各國莫不致力於潛在捐贈者之發現與登錄工作。然而國內對此之相關研究與登錄卻付之闕如。本研究之目的為探討南部某醫學中心潛在捐贈者的數量與實際捐贈者人數，以了解目前器官捐贈之狀況，並分析影響同意器官捐贈之因素。藉由調查分析結果，期望能提出相關建議以有效提升捐贈率。研究方法：本研究以病歷回顧性方式調查南部某醫學中心於2010年至2012年，3年期間內加護病房的死亡資料，篩選腦死亡的潛在器官捐贈者，並收集潛在器官捐贈者的基本資料，如年齡、性別、臨床診斷、平均加護病房住院天數、腦死臨床症狀等，並調查實際同意器官捐贈之情形；以描述性統計、獨立t檢定、卡方檢定、Wilcoxon等級和檢定等分析與探討同意器官捐贈的相關影響因素。研究結果 ： 在研究期間確定潛在器官捐贈者共135位，醫療人員有向家屬提出器官捐贈有48位，實際進行器官捐贈有25位，其中有58例（佔42％）未被發現為潛在器官捐贈者。轉化率平均值為18.51%；同意率平均值為56.25%； 請求率平均值為35.56％；轉介率值平均為57.03％。潛在器官捐者的性別與是否同意器官捐贈無顯著相關（p=0.687）；實際同意器官捐贈的潛在器官捐者與不同意器官捐贈的潛在器官捐者的年齡有顯著性差異（p = 0.035）；實際同意器官捐贈的潛在器官捐者與不同意器官捐贈的潛在器官捐者的平均住院天數有顯著性差異（p=0.027）；潛在器官捐者的臨床診斷與實際是否同意器官捐贈無顯著相關（p = 0.462~0.679）。研究結論與建議： 研究結果顯示實際同意器官捐贈的潛在器官捐者其年齡顯著低於不同意器官捐贈的潛在器官捐者，因此醫療人員請求的對象應傾向年紀較輕的潛在器官捐贈者。為了滿足不斷增長的器官需求，醫療加護單位應加強識別和支持潛在器官捐贈者，並落實執行醫療專業人員器官捐贈請求的教育訓練，以提升潛在的器官捐贈者的器官捐贈同意率。
Introduction: Organ transplantation has become a major treatment option of patients with end stage organ failure. At present, the most challenge is still the shortage of organs. As to cadaveric donation, organ retrieval is done after brain death judgment. In Taiwan, the organ donation rate is 6.8 per million populations. It’s far lower than the Western countries. According to previous studies, early detection of potential donor can increase the actual donated organ number and improve the organ quality. Therefore, every country makes its effort to increase the amount of potential donors. However, the data is scarce in Taiwan. The purpose of this study is to investigate the definite number of potential and actual donors at a medical center in the southern Taiwan. Also, we try to analyze the factors that influence the family’s agreement of organ donation, and hope to find the way to improve the donation rate. Method: The charts of mortality cases in a 3-year period from January, 2010 to December, 2012 at a medical center in the southern Taiwan were retrospectively reviewed. Potential donor was defined if brain death was diagnosed clinically. Patient’s data including age, sex, diagnoses, length of hospital stays and clinical signs of brain death were recorded. Other data, such as actual donor number and donation request were also investigated. The statistical analysis was performed using independent t-test, Chi Square test, Wilcoxon rank-sum test to analyze the factors that influence the family’s agreement of organ donation. Result: During the study period, there were 135 potential donors, while 58 of them were not registered by the procurement team. Only 48 of them received donation request and 25 became the actual donors. The conversion rate was 18.76% (actual donors / potential donors). The consent rate was 60% (consents of organ donation / donation requests), while the request rate was 35.63% (donation requests / potential donors). The sex and the diagnosis of potential donors was not significantly associated whether the family agreed to organ donation or not (p=0.687 and p=0.462~0.679)). Among the potential donors, the age and length of hospital stays of the actual donors were significantly different from who were not actual donors (p=0.035 and p=0.027 respectively). Conclusion: According to the results of this study, the potential donors who became actual donors were younger that who were not. Hence, we should focus on the donor request of the younger potential donors. In addition, inability to find the potential donors and lack of donation request are the major causes for low donor numbers. To meet the need of organs for transplantation, efforts in educating the staff to find and refer the potential donors, and increase the donation request may be the solution. |
