|
Prior to the introduction of brain death into law in the mid to late 1970s, all organ transplants from cadaveric donors came from non-heart beating donors (NHBDs). Donors after brain-dead (DBD),(beating heart cadavers), however, led to better results as the organs were perfused with oxygenated blood until the point of perfusion and cooling at organ retrieval, and so non-heart beating donors were generally no longer used except in Japan, where brain-death was not legally, until very recently, or culturally recognized. However, a growing discrepancy between demand for organs and their availability from DBDs has led to a re-examination of using non-heart beating donors, donors after circulatory death (DCDs), and many centres are now using such donors to expand their potential pool of organs. Tissue donation (corneas, heart valves, skin, bone) has always been possible for non-heart beating donors, and many centres now have established programmes for kidney transplants from such donors. A few centres have also moved into DCD liver and lung transplants. Many lessons have been learnt since the 1970s, and results from current DCDs transplants are comparable to transplants from DBDs.〔Summers DM, Johnson RJ, Allen J, Fuggle SV, Collett D, Watson CJ, et al. Analysis of factors that affect outcome after transplantation of kidneys donated after cardiac death in the UK: a cohort study. Lancet. 2010Oct.16;376(9749):1303–11.〕 ==Maastricht classification== NHBDs are grouped by the Maastricht classification: | rowspan = 2 | uncontrolled |- | II | Unsuccessful resuscitation |- | III | Awaiting cardiac arrest | rowspan = 2 | | rowspan = 2 | controlled |- | IV | Cardiac arrest after brain-stem death |- | V | colspan = 2 | Cardiac arrest in a hospital inpatient | uncontrolled (added in 2000) |} Categories I, II and V are termed ''uncontrolled'' and categories III and IV are ''controlled''. Only tissues such as heart valves and corneas can be taken from category I donors. Category II donors are patients who have had a witnessed cardiac arrest outside hospital, have cardiopulmonary resuscitation by CPR-trained providers commenced within 10 minutes but who cannot be successfully resuscitated. Category III donors are patients on intensive care units with non-survivable injuries who have treatment withdrawn; where such patients wished in life to be organ donors, the transplant team can attend at the time of treatment withdrawal and retrieve organs after cardiac arrest has occurred. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Non-heart-beating donation」の詳細全文を読む スポンサード リンク
|