Mogući darovatelji bubrega nakon cirkulacijske smrti u Kliničkome bolničkom centru Osijek

Abstract

Uvod: U Republici Hrvatskoj zakon ne predviđa darovanje organa nakon cirkulacijske smrti iako je ono često u pojedinim drugim državama. Cilj: utvrditi koliko je mogućih darovatelja bubrega nakon cirkulacijske smrti bilo u jednogodišnjem razdoblju (2012.) u Kliničkome bolničkom centru Osijek (KBCO). Nacrt istraživanja: presječno istraživanje. Ispitanici i postupci: ispitanici su bili preminule osobe (N=1652) primljene na Zavod za patologiju KBCO tijekom 2012. Procjenjivalo se zadovoljavaju li Maastrichtske kriterije za darovanje organa nakon cirkulacijske smrti. Podaci su preuzeti iz medicinske dokumentacije i statistički obrađeni u SPSS-u. Rezultati: Maastrichtske kriterije zadovoljilo je 215 ispitanika (13 %), 53 od tih ispitanika isključeno je zbog kontraindikacija za transplantaciju (TX), te je konačan broj mogućih darovatelja bio 162 (10 %). Medijan dobi bio je 72 godine (42-91), a 83 od 162 (51 %) bilo je muškoga spola. Najčešći su uzroci smrti srčanožilne bolesti (78 %), a najviše mogućih darovatelja nakon cirkulacijske smrti preminulo je na Klinici za internu medicinu (42 %). Najčešće zadovoljeni Maastrichtski kriterij je bio drugi (88 %, neuspješna reanimacija). Nije utvrđena statistički značajna udruženost pojedinih Maastrichtskih kriterija sa spolom niti s dobi. U značajno ranijoj životnoj dobi preminuli su muški ispitanici. Zaključak: broj mogućih darovatelja bubrega nakon cirkulacijske smrti tijekom godine dana u KBCO bio je 162. Mogućnost darovanja nakon cirkulacijske smrti mogla bi povećati broj mogućih darovatelja bubrežnih presadaka i još više poboljšati uspjeh TX u Republici Hrvatskoj. Na razini KBCO može se reći da bi se broj TX s mogućim darovateljima mogao povećati i do 27 puta (otprilike je aktualno 12 TX godišnje, uz mogućnost po dvije bubrežne TX od jednoga darovatelja), premda bi vjerojatno manje tih darovatelja bilo i ostvareno, s obzirom na njihovu stariju životnu dob te moguće protivljenje obitelji darovanju organa.

Introduction: In the Republic of Croatia organ donation after circulatory death (DCD) is not regulated by law, although this practice is well represented in some other countries. Goal of the research: To determine how many potential donors after circulatory death were eligible during the one-year period (2012) at University Hospital Centre Osijek (UHCO). Study design: cross-sectional study. Examinees and methods: The examinees included 1652 deceased persons who were admitted to the Department of Pathology of the UHCO during 2012. They were assessed for meeting the Maastricht criteria for organ DCD. Data were taken from medical documentation and statistically analyzed by SPSS. Results: 215 examinees met the Maastricht criteria (13 %), 53 of them were excluded due to the contraindications for donation, thus the final number of potential DCD was 162 (10 %). The median age was 72 years (range 42-91), and 83 (51 %) of 162 were males. The most common causes of death were cardiovascular diseases (78 %), and the highest number of potential DCD died at the Department of Internal Medicine (42 %). The most commonly met Maastricht criterion was the criterion 2 (88 %, unsuccessful resuscitation). Only one examinee met Maastricht criteria 1. Statistically significant association of particular Maastricht criteria with sex or age was not found. The examinees of male gender died at an earlier age. Conclusion: the number of potential DCD in a single year at the UHCO was 162, of which 161 were for kidney donation. Transplantation (TX) from DCD would increase the number of potential donor kidney transplants and further enhance the success of TX in Croatia. At the level of UHCO the number of kidney TX with those donors could increase up to 27 times (considering 12 kidney TX annually so far and 2 possible kidneys from a single DCD), although in reality probably less of those DCD would be realized, due to their old age and possibility of their families refusing the organ donation.