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中华移植杂志(电子版) ›› 2024, Vol. 18 ›› Issue (04) : 213 -221. doi: 10.3877/cma.j.issn.1674-3903.2024.04.003

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以循环标准判定死亡的遗体器官捐献分类标准、实施流程及需要注意的问题
霍枫(), 李智霞, 季茹, 谭晓宇, 范晓礼, 叶啟发()   
  1. 510010 广州,中国人民解放军南部战区总医院器官移植科
    430071 武汉,国家人体捐献器官获取质量控制中心 武汉大学中南医院
  • 收稿日期:2024-06-06 出版日期:2024-08-08
  • 通信作者: 霍枫, 叶啟发
  • 基金资助:
    中国器官移植发展基金会移植健康管理专项基金(COTDF-020004)广州市科技计划项目(202002030201)南部战区总医院科技计划项目(2021NZA004)

Classification, implementation process, and considerations for donation after circulatory determination of death

Feng Huo(), Zhixia Li, Ru Ji, Xiaoyu Tan, Xiaoli Fan, Qifa Ye()   

  1. Department of Organ Transplantation, General Hospital of Southern Theatre Command of PLA,Guangzhou 510010, China
    National Quality Control Center for Donated Organ Procurement,Zhongnan Hospital of Wuhan University, Wuhan 430071, China
  • Received:2024-06-06 Published:2024-08-08
  • Corresponding author: Feng Huo, Qifa Ye
引用本文:

霍枫, 李智霞, 季茹, 谭晓宇, 范晓礼, 叶啟发. 以循环标准判定死亡的遗体器官捐献分类标准、实施流程及需要注意的问题[J]. 中华移植杂志(电子版), 2024, 18(04): 213-221.

Feng Huo, Zhixia Li, Ru Ji, Xiaoyu Tan, Xiaoli Fan, Qifa Ye. Classification, implementation process, and considerations for donation after circulatory determination of death[J]. Chinese Journal of Transplantation(Electronic Edition), 2024, 18(04): 213-221.

近十年来我国脑死亡器官捐献意识和能力均有了显著提升。 在脑死亡器官捐献持续增量的同时,科学规范地推动以循环标准判定死亡的遗体器官捐献同样是未来发展的方向。本文结合多个国家的相关指南、国际上相关领域最新研究进展以及作者经验,对相关定义的变迁、分类标准的完善、实施流程以及实施过程需要注意的问题等进行了阐述,旨在为以循环标准判定死亡的遗体器官捐献与获取工作提供科学规范的实践指导,为进一步提高遗体器官捐献率和捐献器官利用率奠定相关基础。

In the past decade, there has been a significant improvement in awareness and capacity for donation after brain death in China. While efforts to increase donation after brain death continue, it is equally important to scientifically and systematically advance the practice of donation after circulatory determination of death. This paper integrates guidelines from various countries, the latest international research development, and the authors′ experiences to elaborate on the evolution of relevant definitions, the refinement of classification criteria, the implementation process and its steps,as well as considerations during the implementation process. The aim is to provide scientific and standardized practical guidance for organ donation and retrieval after cardiac death, thereby establishing a foundation for further increasing organ donation rates and the utilization rate of donated organs.

表1 Maastricht 分类标准[9]
表2 2016 版Maastricht 分类标准[10]
表3 改良2016 版Maastricht 分类标准
图1 Maastricht-Ⅲ或Maastricht-ⅣB 器官获取(不使用常温局部机械灌注)流程 注: WLST.撤除生命支持治疗; SBP.外周收缩压; SpO2.外周血氧饱和度; fDWIT. 供者功能性热缺血时间; tDWIT. 供者总热缺血时间;1 mmHg=0.133 kPa
图2 Maastricht-Ⅲ或Maastricht-ⅣB 器官获取(使用常温局部机械灌注)流程 注: WLST.撤除生命支持治疗; NRP. 常温局部机械灌注; SBP. 外周收缩压; SpO2. 外周血氧饱和度; fDWIT. 供者功能性热缺血时间;tDWIT.供者总热缺血时间; 1 mmHg=0.133 kPa
图3 Maastricht-Ⅱ器官获取流程 注: CA.心脏骤停; VS.生命体征; PI.发生意外的过程; CPR.心肺复苏; ER.急救室; NRP.常温局部机械灌注; ECMO. 体外膜肺氧合;fDWIT.供者功能性热缺血时间; tDWIT.供者总热缺血时间
图4 Maastricht-ⅣA 器官获取流程(同意以神经学标准判定死亡的遗体器官捐献) 注: DBD.脑死亡器官捐献; CA.心脏骤停; NRP.常温局部机械灌注; ECMO. 体外膜肺氧合; fDWIT.供者功能性热缺血时间; tDWIT.供者总热缺血时间
图5 Maastricht-ⅣA 器官获取流程(仅同意以循环标准判定死亡的遗体器官捐献) 注: CA.心脏骤停; NRP.常温局部机械灌注; ECMO.体外膜肺氧合; fDWIT.供者功能性热缺血时间; tDWIT.供者总热缺血时间
图6 Maastricht-ⅣA 器官获取流程(等待器官捐献知情同意) 注: CA.心脏骤停; NRP.常温局部机械灌注; ECMO.体外膜肺氧合; fDWIT.供者功能性热缺血时间; tDWIT.供者总热缺血时间
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