即将到来的异种移植时代是否会让我们不再需要寻找更多的非活体器官捐献者?

Fernando M Gonzalez, Francisca Del Rocío Gonzalez
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引用次数: 0

摘要

尽管器官移植是治疗终末期器官功能障碍最成功的方法,但每年的实体器官移植数量远远低于满足等待名单上患者需求的数量。对这一现象的解释是,由于以下几个因素,非活体器官供体相对稀缺,例如:(1)神经危重症患者到急诊服务的时间较晚;(2)例如,专门从事采购的卫生专业人员或急诊和重症监护病房的临床医生未能发现这些患者可能是器官捐献者;(3)晚期将患者转至重症监护病房,以尽量恢复其健康,并提供血液动力学、通气和代谢支持;(四)对可能供体的生理状况不确定的;(5)由于脑或心源性死亡,对受试者死亡的诊断较晚或错误的阳性诊断;(六)取得直接亲属或者机关合法许可有困难的;(7)实际捐献器官的缺陷回收手术。最近关于转基因猪异种移植相对成功的报道为解决这种供需不匹配提供了可能,但在接受器官来源的逐步替代移植之前,仍然存在一些技术问题(器官排斥和机会性感染)和经济问题。粗略的经济成本分析表明,假设获得任何转基因猪器官的成本都很高,甚至无法满足最富裕国家对固体器官的需求。
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Is the near coming xenotransplantation era relieving us from needing to look for more non-living organ donors?

Despite organ transplantation being the most successful treatment for end-stage organ dysfunction, the number of annual solid organ transplantations is much lower than that required to satisfy the demand of patients on waiting lists. The explanation for this phenomenon is the relative scarcity of non-living organ donors due to several factors, such as: (1) Late arrival of patients with a neurocritical condition to an emergency service; (2) lack of detection of those patients as possible organ donors by health professionals dedicated to pro curement or by clinicians at emergency and intensive care units, for instance; (3) late transfer of the patient to an intensive care unit to try to recover their health and to provide hemodynamic, ventilatory, and metabolic support; (4) lack of confirmation of the physiological status of the possible donor; (5) late or incorrect positive diagnosis of the subject's death, either due to brain or cardiac death; (6) difficulty in obtaining legal authorization, either by direct relatives or by the authority, for the extraction of organs; and (7) deficient retrieval surgery of the organs actually donated. The recent reports of relatively successful xenotransplants from genetically modified pigs open the possibility to fix this mismatch between supply and demand, but some technical (organ rejection and opp ortunistic infections), and economic issues, still remain before accepting a progressive replacement of the organ sources for transplantation. An approximate economic cost analysis suggests that the hypothetical acquisition cost of any genetically modified pig derived organ is high and would not even satisfy the solid organ demand of the wealthiest countries.

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