CAJ | 학술논문

背景:器官短缺是全球移植界共同面临的难题,为扩大供者来源,缓解日益紧张的器官短缺,回避因脑死亡立法及诊断标准缺位造成的困惑,卫生部和中国红十字会联合推动心脏死亡器官捐献.目的:探讨开展儿童心脏死亡器官捐献的可行性.方法:回顾性分析解放军南京军区福州总医院1例儿童心脏死亡肾脏捐献案例,结合文献进行分析.结果与结论:4岁男孩,心肺复苏后脑死亡,经过2次两组专家时隔24 h 按脑死亡判定标准(儿童)和脑死亡判定技术规范,以及阿托品试验结果独立作出判定.捐献者父母对捐献方案知情同意,书面表达捐献意愿,且得到医院伦理委员会批准.按中国心脏死亡器官捐献工作指南逐步完成捐献申请、审批、转运、器官维护,以及生命支持治疗撤除、器官切取过程,热缺血时间13 min.按年龄、体质量和组织配型结果选择受者,2只肾脏分别植入2例尿毒症受者体内,左肾接受者为13岁女性,右肾接受者为35岁女性,术后未发生肾功能延迟恢复,无移植肾血管栓塞、尿瘘、输尿管梗阻等并发症.术后1年内移植肾由术前7 cm 增大至10 cm,尿蛋白阴性,血肌酐≤60μmol/L,估算肾小球滤过率70-150 mL/min.术后至今均未发生严重感染事件,血压正常,无糖尿病、高脂血症、肝功能损害等并发症,现生活自理,精神状态好,遵医行为佳.提示儿童心脏死亡器官捐献是过渡时期解决器官来源的方向之一.必须严格遵守患者救治利益高于一切的基本原则,积极探索儿童心脏死亡器官捐献规范化操作程序.
배경:기관단결시전구이식계공동면림적난제,위확대공자래원,완해일익긴장적기관단결,회피인뇌사망입법급진단표준결위조성적곤혹,위생부화중국홍십자회연합추동심장사망기관연헌.목적:탐토개전인동심장사망기관연헌적가행성.방법:회고성분석해방군남경군구복주총의원1례인동심장사망신장연헌안례,결합문헌진행분석.결과여결론:4세남해,심폐복소후뇌사망,경과2차량조전가시격24 h 안뇌사망판정표준(인동)화뇌사망판정기술규범,이급아탁품시험결과독립작출판정.연헌자부모대연헌방안지정동의,서면표체연헌의원,차득도의원윤리위원회비준.안중국심장사망기관연헌공작지남축보완성연헌신청、심비、전운、기관유호,이급생명지지치료철제、기관절취과정,열결혈시간13 min.안년령、체질량화조직배형결과선택수자,2지신장분별식입2례뇨독증수자체내,좌신접수자위13세녀성,우신접수자위35세녀성,술후미발생신공능연지회복,무이식신혈관전새、뇨루、수뇨관경조등병발증.술후1년내이식신유술전7 cm 증대지10 cm,뇨단백음성,혈기항≤60μmol/L,고산신소구려과솔70-150 mL/min.술후지금균미발생엄중감염사건,혈압정상,무당뇨병、고지혈증、간공능손해등병발증,현생활자리,정신상태호,준의행위가.제시인동심장사망기관연헌시과도시기해결기관래원적방향지일.필수엄격준수환자구치이익고우일절적기본원칙,적겁탐색인동심장사망기관연헌규범화조작정서.
BACKGROUND: The organ shortage is the common difficulty faced by the global transplant community. In order to expand the donor sources, to ease the growing tension of the organ shortage and to avoid confusion caused by the absence of brain death legislation and diagnostic criteria, the Ministry of Health and the Red Cross Society of China have jointly promote the cardiac death organ donation. OBJECTIVE: To investigate the feasibility of organ donation from pediatric donors after cardiac death. METHODS: One case of organ donation from a pediatric donor at Fuzhou General Hospital of Nanjing Military Command of PLA was retrospectively analyzed combined with the analysis of the literatures. RESULTS AND CONCLUSION: A 4-year-old boy was independently diagnosed with brain death after cardiopulmonary resuscitation by two groups of specialists at an interval of 24 hours. The criteria included the Diagnostic Criteria for Brain Death (for adults), the Technological Specification for Brain Death (for adults) and atropine test results. The donor parents should be informed and consent with the donor programs and ful y expressed the donation wil ingness, and the program should be approved by the hospital ethics committee. The fol owing steps including donation application, approval, transportation, organ maintaining, mechanical support removal and organ recovery were conducted according to the organ donation guidelines in China after cardiac death. The warm ischemia time was 13 minutes. Two renal grafts were transplanted to two uremic recipients selected by age, weight and human leukocyte antigen matching. The left kidney recipient was a 13-year-old female patient and the right kidney recipient was a 35-year-old female patient. No complications such as delayed graft function, renal graft vascular thrombosis, urinary fistula or ureteral obstruction were observed. The graft length was increased from 7 cm postoperation to 10 cm at 1 year after operation, with negative proteinuria, serum creatinine of 60 μmol/L and estimated glomerular filtration rate was ranged from 70 to 150 mL/min. No long term complications such as serious infections, hypertension, diabetes, hyperlipidemia or liver dysfunction were observed. The recipients have good levels of daily living activities, psychological status and adherence. Organ donation from pediatric donors after cardiac death was one of the alternative solutions to the shortage of organ sources in transitional period. We should explore the standardized operating procedures of pediatric donation after cardiac death based on the top priority principles of patient interests.