数据之美——聚焦全球器官捐献发展趋势
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摘要
器官移植术是20世纪出现的针对器官功能衰竭的最有效治疗方法,每年拯救全球超过12万例患者。但供器官短缺的现状,与器官移植技术和辅助药物的发展不匹配,制约了器官移植事业的发展。我国自2015年起已成为全球器官捐献和移植大国之一,2017年公民逝世后器官捐献数量超过5 000例,占全球捐献总量的15%以上。黄洁夫教授总结的器官捐献与移植"中国模式"得到了世界卫生组织、国际移植界的高度重视和充分肯定。本文通过整理全球及各国的器官捐献与移植数据,剖析全球现状与发展趋势,进一步探索我国公民器官捐献的影响因素并提出针对性的应对策略,以期实现我国器官捐献和移植的"自给自足"。
Organ transplantation is the most effective treatment for organ failure occurred in the 20 th century, saving more than 120 000 organ failure patients worldwide every year. However, the global organ shortage, which does not match the development of organ transplantation and adjuvant drugs, restricts the development of organ transplantation. Since 2015, China reached the second largest country in terms of the absolute number of organ transplantation worldwide. In 2017, the number of organ donation after citizens′ death exceeded 5 000 cases, accounting for more than 15% of the total global donation. The "Chinese model" of organ donation and transplantation summarized by professor Huang Jiefu has been highly valued and fully affirmed by the World Health Organization and the international transplant community. By analyzing the global data of organ donation and transplantation, this paper describes the current global situation and developing trend for further exploring the influencing factors of organ donation and transplantation in China, and putting forward corresponding countermeasures in order to achieve self-sufficiency of organ donation for transplantation in China.
Organ transplantation is the most effective treatment for organ failure occurred in the 20 th century, saving more than 120 000 organ failure patients worldwide every year. However, the global organ shortage, which does not match the development of organ transplantation and adjuvant drugs, restricts the development of organ transplantation. Since 2015, China reached the second largest country in terms of the absolute number of organ transplantation worldwide. In 2017, the number of organ donation after citizens′ death exceeded 5 000 cases, accounting for more than 15% of the total global donation. The "Chinese model" of organ donation and transplantation summarized by professor Huang Jiefu has been highly valued and fully affirmed by the World Health Organization and the international transplant community. By analyzing the global data of organ donation and transplantation, this paper describes the current global situation and developing trend for further exploring the influencing factors of organ donation and transplantation in China, and putting forward corresponding countermeasures in order to achieve self-sufficiency of organ donation for transplantation in China.
引文
1 WHO.Transplantation of human cells,tissues and organs[EB/OL].[2018-11-29].http://www.who.int/transplantation/en/.
2 GODT.Global Observatory on Donation and Transplantation[EB/OL].[2018-11-29].http://www.transplant-observatory.org/reports/.
3黄洁夫.器官捐献与移植事业的“中国模式”[J].中华器官移植杂志,2017,38(3):129-130.
4 GODT.Global transplantation activities of solid organs,2016[EB/OL].[2018-11-29].www.transplant-observatory.org.
5 Matesanz R.The Madrid resolution on organ donation and transplantation:national responsibility in meeting the needs of patients,guided by the WHO principles[J].Transplantation,2011,91(Suppl 11):S29-S31.
6 Steering Committee of the Istanbul Summit.Organ trafficking and transplant tourism and commercialism:the Declaration of Istanbul[J].Lancet,2008,372(9632):5-6.
7 Sixty-Third World Health Assembly,World Health Organization.Human organ and tissue transplantation.Resolution WHA 63.22 of the Sixty-Third World Health Assembly[J].Cell Tissue Bank,2010,11(4):411-412.
8 Delmonico FL,Domínguez-Gil B,Matesanz R,et al.A call for government accountability to achieve national self-sufficiency in organ donation and transplantation[J].Lancet,2011,378(9800):1414-1418.
9 Ke TLOD课题组.中欧器官捐献管理(双语版)[M].北京:科学出版社,2018:38-42.
10 TPM-DTI.International Registry in Organ Donation and TransplantationIRODa T[EB/OL].[2018-11-13].www.irodat.org.
11国家卫生健康委员会.2017年国家医疗服务与质量安全报告[M].北京:科学技术文献出版社,2018:600-617.
12 SRTR.Organ procurement organization(OPO)reports[EB/OL].https://www.srtr.org/reports-tools/opo-specific-reports/.
13 Sadler AM Jr,Sadler BL.Will an opt-out organ transplant law save lives?[EB/OL].[2018-12-20].https://blogs.bmj.com/bmj/2018/09/06/will-an-opt-out-organ-transplant-law-save-lives/.
14 World Bank.Spain[EB/OL].[2018-12-20].https://data.worldbank.org.cn/country/ES.
15 James Badcock.How Spain became the world leader in organ donations[EB/OL].[2018-12-20].http://www.ont.es/Documents/NEWSWEEK%20How%20Spain%20Became%20the%20World%20Leader%20in%20Organ%20Donation.pdf.
16李姗霓,高伟,郑虹.美国器官移植的法制与体制建设概要[J/CD].实用器官移植电子杂志,2015,3(2):74-78.
17国家统计局.中华人民共和国2016年国民经济和社会发展统计公报[EB/OL].[2018-11-29].http://www.stats.gov.cn/tjsj/zxfb/201702/t20170228_1467424.html.
18 Spinello IM.Brain death determination[J].J Intensive Care Med,2015,30(6):326-372.
19 Jansen NE,van Leiden HA,Haase-Kromwijk BJ,et al.Organ donation performance in the Netherlands 2005-08;medical record review in 64 hospitals[J].Nephrol Dial Transplant,2010,25(6):1992-1997.
20 NHS Blood and Transplant.Organ donation and transplantation activity report 2016/17[EB/OL].[2018-12-07].https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/4657/activity_report_2016_17.pdf.
21 Cheung CY,Pong ML,Au Yeung SF,et al.Factors affecting the deceased organ donation rate in the Chinese community:an audit of hospital medical records in Hong Kong[J].Hong Kong Med J,2016,22(6):570-575.
22 Jansen NE,van Leiden HA,Haase-Kromwijk BJ,et al.Organ donation performance in the Netherlands 2005-08;medical record review in 64 hospitals[J].Nephrol Dial Transplant,2010,25(6):1992-1997.
23 Domínguez-Gil B,Delmonico FL,Shaheen FA,et al.The critical pathway for deceased donation:reportable uniformity in the approach to deceased donation[J].Transpl Int,2011,24(4):373-378.
24 Roels L,Spaight C,Smits J,et al.Critical care staffs'attitudes,confidence levels and educational needs correlate with countries'donation rates:data from the Donor Action database[J].Transpl Int,2010,23(8):842-850.
25 Listed NA.Medicare and Medicaid programs;hospital conditions of participation;identification of potential organ,tissue,and eye donors and transplant hospitals'provision of transplant-related data-HCFA.Final rule[J].Fed Regist,1998,63(119):33856-33875.
26 Spencer M.The Barriers to organ and tissue donation in palliative care[J].End of Life Journal,2012,2(2):1-11.
27 Willis D,Draper H.To make the unusual usual:is there an imperative to discuss organ donation with palliative care patients?[J].Int JPalliat Nurs,2012,18(1):5-7.
28 ANZICS.The ANZICS statement on death and organ donation[M].3rd ed.Brisbane:ANZICS,2008.
29徐哲,司晶,叶少军,等.器官捐献协调员在公民逝世后器官捐献供者转运方面的作用[J/CD].中华移植杂志:电子版,2018,12(2):69-71.
30杨颖,黄海,邱鸿钟.我国公民逝世后器官捐献意愿调查及影响因素研究[J].中国医院,2014,18(3):18-19.
31付成琴,权明桃,吴华炼,等.我国公民器官捐献的态度及影响因素分析[J].中国医学伦理学,2016,29(3):448-451.
32黄丽婷,杨顺良.公民逝世后器官捐献工作培训对医护人员认知水平的影响[J].器官移植,2017,7(3):201-204.
2 GODT.Global Observatory on Donation and Transplantation[EB/OL].[2018-11-29].http://www.transplant-observatory.org/reports/.
3黄洁夫.器官捐献与移植事业的“中国模式”[J].中华器官移植杂志,2017,38(3):129-130.
4 GODT.Global transplantation activities of solid organs,2016[EB/OL].[2018-11-29].www.transplant-observatory.org.
5 Matesanz R.The Madrid resolution on organ donation and transplantation:national responsibility in meeting the needs of patients,guided by the WHO principles[J].Transplantation,2011,91(Suppl 11):S29-S31.
6 Steering Committee of the Istanbul Summit.Organ trafficking and transplant tourism and commercialism:the Declaration of Istanbul[J].Lancet,2008,372(9632):5-6.
7 Sixty-Third World Health Assembly,World Health Organization.Human organ and tissue transplantation.Resolution WHA 63.22 of the Sixty-Third World Health Assembly[J].Cell Tissue Bank,2010,11(4):411-412.
8 Delmonico FL,Domínguez-Gil B,Matesanz R,et al.A call for government accountability to achieve national self-sufficiency in organ donation and transplantation[J].Lancet,2011,378(9800):1414-1418.
9 Ke TLOD课题组.中欧器官捐献管理(双语版)[M].北京:科学出版社,2018:38-42.
10 TPM-DTI.International Registry in Organ Donation and TransplantationIRODa T[EB/OL].[2018-11-13].www.irodat.org.
11国家卫生健康委员会.2017年国家医疗服务与质量安全报告[M].北京:科学技术文献出版社,2018:600-617.
12 SRTR.Organ procurement organization(OPO)reports[EB/OL].https://www.srtr.org/reports-tools/opo-specific-reports/.
13 Sadler AM Jr,Sadler BL.Will an opt-out organ transplant law save lives?[EB/OL].[2018-12-20].https://blogs.bmj.com/bmj/2018/09/06/will-an-opt-out-organ-transplant-law-save-lives/.
14 World Bank.Spain[EB/OL].[2018-12-20].https://data.worldbank.org.cn/country/ES.
15 James Badcock.How Spain became the world leader in organ donations[EB/OL].[2018-12-20].http://www.ont.es/Documents/NEWSWEEK%20How%20Spain%20Became%20the%20World%20Leader%20in%20Organ%20Donation.pdf.
16李姗霓,高伟,郑虹.美国器官移植的法制与体制建设概要[J/CD].实用器官移植电子杂志,2015,3(2):74-78.
17国家统计局.中华人民共和国2016年国民经济和社会发展统计公报[EB/OL].[2018-11-29].http://www.stats.gov.cn/tjsj/zxfb/201702/t20170228_1467424.html.
18 Spinello IM.Brain death determination[J].J Intensive Care Med,2015,30(6):326-372.
19 Jansen NE,van Leiden HA,Haase-Kromwijk BJ,et al.Organ donation performance in the Netherlands 2005-08;medical record review in 64 hospitals[J].Nephrol Dial Transplant,2010,25(6):1992-1997.
20 NHS Blood and Transplant.Organ donation and transplantation activity report 2016/17[EB/OL].[2018-12-07].https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/4657/activity_report_2016_17.pdf.
21 Cheung CY,Pong ML,Au Yeung SF,et al.Factors affecting the deceased organ donation rate in the Chinese community:an audit of hospital medical records in Hong Kong[J].Hong Kong Med J,2016,22(6):570-575.
22 Jansen NE,van Leiden HA,Haase-Kromwijk BJ,et al.Organ donation performance in the Netherlands 2005-08;medical record review in 64 hospitals[J].Nephrol Dial Transplant,2010,25(6):1992-1997.
23 Domínguez-Gil B,Delmonico FL,Shaheen FA,et al.The critical pathway for deceased donation:reportable uniformity in the approach to deceased donation[J].Transpl Int,2011,24(4):373-378.
24 Roels L,Spaight C,Smits J,et al.Critical care staffs'attitudes,confidence levels and educational needs correlate with countries'donation rates:data from the Donor Action database[J].Transpl Int,2010,23(8):842-850.
25 Listed NA.Medicare and Medicaid programs;hospital conditions of participation;identification of potential organ,tissue,and eye donors and transplant hospitals'provision of transplant-related data-HCFA.Final rule[J].Fed Regist,1998,63(119):33856-33875.
26 Spencer M.The Barriers to organ and tissue donation in palliative care[J].End of Life Journal,2012,2(2):1-11.
27 Willis D,Draper H.To make the unusual usual:is there an imperative to discuss organ donation with palliative care patients?[J].Int JPalliat Nurs,2012,18(1):5-7.
28 ANZICS.The ANZICS statement on death and organ donation[M].3rd ed.Brisbane:ANZICS,2008.
29徐哲,司晶,叶少军,等.器官捐献协调员在公民逝世后器官捐献供者转运方面的作用[J/CD].中华移植杂志:电子版,2018,12(2):69-71.
30杨颖,黄海,邱鸿钟.我国公民逝世后器官捐献意愿调查及影响因素研究[J].中国医院,2014,18(3):18-19.
31付成琴,权明桃,吴华炼,等.我国公民器官捐献的态度及影响因素分析[J].中国医学伦理学,2016,29(3):448-451.
32黄丽婷,杨顺良.公民逝世后器官捐献工作培训对医护人员认知水平的影响[J].器官移植,2017,7(3):201-204.