总结中国心脏死亡器官捐献(DCD)发展概况、影响潜在DCD供者捐献因素及体外膜肺氧合(ECMO)技术应用的单中心经验。

回顾性分析2010年1月至2015年12月广州军区总医院器官获取组织(OPO)服务范围内所有DCD供者资料。总结我院DCD例数、年均增长率、每百万人口器官捐献率、DCD来源供肝丢弃情况、中国Ⅰ、Ⅱ、Ⅲ类捐献比例、我院OPO服务范围内潜在DCD供者捐献影响因素及ECMO在DCD中的应用情况。同时查阅同一时期中国及广东省DCD数据。我院与全国中国Ⅰ类供者比例、我院和广东省DCD例数年均增长率比较分别采用卡方检验和Man-Whitney U检验。P<0.05为差异有统计学意义。

2010年1月至2015年12月，我院共实现241例DCD，中国Ⅰ、Ⅱ、Ⅲ类捐献比例分别为29.9%(72/241)、26.6%(64/241)、43.5%(105/241)。我院中国Ⅰ类捐献比例(29.9%)高于全国水平(13%)(χ²＝55.381，P<0.05)。241例DCD共获取供肝234例，因供肝因素放弃移植26例，丢弃率为11.1%(26/234)，影响供肝丢弃主要因素为冷/热缺血时间过长、供肝肝硬化、灌注不良、肝功能异常和挫裂伤。期间，我院和广东省DCD例数年均增长率分别为67.78%和104.50%(U＝11.0，P>0.05)，差异无统计学意义；我院和广东省每百万人口(PMP)器官捐献率分别从0.407、0.144 PMP升高至3.948、4.145 PMP。同期我院OPO服务范围内医院上报潜在DCD供者778例，捐献转化率为31.0%(241/778)。影响潜在DCD供者捐献的因素主要包括家属及社会因素、供者自身病情及医患关系。2010年1月至2015年12月，我院共完成145例ECMO辅助下DCD器官获取，其中中国Ⅰ、Ⅱ、Ⅲ类捐献供器官中应用率分别为58.3%(42/72)、62.5%(40/64)和60.0%(63/105)。

提高公众对器官捐献的关注度和接受度，合理应用器官保存技术，将有助于推动DCD肝移植发展。

To summarize the development of China donation after cardiac death (DCD), influence factors of DCD potential donors and application of extracorporeal membrane oxygenation (ECMO) in DCD.

The clinical data of DCD donors in Guangzhou General Hospital of Guangzhou Military of PLA Organ Procurement Organization (OPO) during January 2010 and December 2015 was analyzed retrospectively, mainly focusing on the indexes like the total number of DCD, average growth rate per annum, donation rate per million population (PMP), discard of DCD donor liver, proportion of C-Ⅰ, C-Ⅱ and C-Ⅲ, influence factors of organ donation in DCD potential donors and the ECMO application in DCD. The data of DCD of China and Guangdong province during the same period was also summerized. Chi-square test and Man-Whitney U test was used to compare the proportion of C-Ⅰ between our hospital and China and average growth rate per annum between our hospital and Guangdong province, respectively. P<0.5 was deemed statiatically significant.

There were 241 DCD donors during January 2010 and December 2015 in our hospital, with C-Ⅰ, C-Ⅱ and C-Ⅲ accounting for 29.9% (72/241) , 26.6% (64/241) and 43.5% (105/241), respectively. The proportion of C-Ⅰ(29.9%) in our hospital was higher than national average (13%) (χ²=55.381, P<0.05). 234 donor livers were obtained from 241 DCD donors, 26 of the livers were discarded and the liver discard rate was 11.1% (26/234). The main reasons for discard were overlength of cold/warm ischemia time, liver cirrhosis, poor perfusion, abnormal liver function and contusion. There was no statistical significance for average growth rate per annum of DCD between our hospital (67.78%) and Guangdong province (104.50%) (U=11.0, P>0.05). The donation rate per million population of our hospital and Guangdong province was increased from 0.407 PMP and 0.144 PMP to 3.948 PMP and 4.145 PMP, respectively. The donation conversion rate was 31.0% (241/778) within the scope of the OPO of our hospital. The influence factors for poor conversion rate were mainly because of family and social factors, the condition of donors and doctor-patient relationship. One hundred and forty-five DCD donors were implemented organ donation supported by ECMO during the same period, with C-Ⅰ, C-Ⅱ and C-Ⅲ accounting for 58.3% (42/72), 62.5% (40/64) and 60.0% (63/105).

Enhancing the attention and acceptance of organ donation in public, and reasonable application of organ preservation technology will help to promote the development of DCD liver transplantation.