摘要
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24h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13min。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7cm增大至10cm,尿蛋白阴性,血肌酐≤60μmol/L,估算肾小球滤过率70-150mL/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。
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 fully expressed the donation willingness, and the program should be approved by the hospital ethics committee. The following 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 mUmin. 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.
出处
《中国组织工程研究》
CAS
CSCD
2013年第5期817-824,共8页
Chinese Journal of Tissue Engineering Research
关键词
器官移植
肾移植
心脏死亡
器官捐献
儿童
脑死亡
肾脏
热缺血时间
肾功能
伦理
并发症
组织配型
organ transplantation
renal transplantation
cardiac death
organ donation
child
brain death
kidney warm ischemia time
renal function
ethics
complications
tissue typing
