Both family consent and legal consent were required for organ/tissue
donation from non-heart-beating donors (NHBD) in Taiwan.
取得家屬與法律同意
(P.S. NHBD和現在各位鍵盤醫師認定的移植條件不是同一群人,
這些人是不用判腦死的)
A district attorney had to come to the bedside to confirm the donor's asystole,
confirm the family consent, and complete some legal documents before a legal
consent was issued for organ donation.
要等到檢察官到場確認患者已無心跳,有家屬同意與相關法律文件
The resultant warm ischemic time would be unpredictably long and in fact
precluded the organ donation from NHBD in Taiwan.
在台灣這些無謂的時間浪費是難以預測的久, 而且阻礙了部份器官移植的可能
We developed a method of using extracorporeal membrane oxygenation (ECMO)
to maintain NHBD for a longer time and prevent warm ischemic injury of the
donor abdominal organs.
因此,我們發展出一個方法,在這個等待期能防止器官衰敗
After ventilator disconnection in NHBD, phentolamine and heparin were
injected and mannitol infusion was given.
拔掉呼吸器後,打phentolamine, heparine, mannitol
After the donor's asystole was confirmed by the electrocardiogram (EKG)
strip recording, the ECMO support was set up through the right femoral
veno-arterial route,
由心電圖確認捐贈者已無心跳,開始放置ECMO
an occlusion balloon catheter was inserted through the left femoral artery
to occlude the thoracic aorta, and bilateral femoral arteries were ligated.
放入一個阻隔氣球到左股動脈(左下肢最大動脈), 完全阻擋胸主動脈的血,並將雙側
股動脈的結紮掉(指遠端)
(P.S. 前幾篇有鍵盤醫師回說這是IABP用來保護心臟的, 我快笑死了,
想回打臉文之前,連柯醫師的paper都不看,你們也認真點好嗎?)
Usually, the ECMO could begin within 10 min after the donor's asystole.
通常我們只需10分鐘可搞定
The ECMO, combined with a cooler, provided cold oxygenated blood to the
abdominal visceral organs,and prevented their warm ischemic injuries.
Under the ECMO support (range: 45-70 min), eight renal grafts were procured
from 4 NHBD.
點點點ECMO的好處
With the exception of the first two renal grafts with delayed function, all
others had immediate function postoperatively and dialysis was no
longer needed.
我們這個方法在器官移植成功上的介紹
In conclusion, by our ECMO technique, NHBD could be maintained for a longer
time and the renal grafts had better immediate postoperative function than
those reported by other methods.
結論, 使用ECMO可以在 NHBD患者上維持器官新鮮度更久.