生体臓器・組織・細胞移植ドナーに対する危機管理プログラムdonor advocacy teamの重要性

「I. はじめに」米国では200件に1名の割合で, 生体肝移植ドナーの死亡が生じると報告され, 本邦においては, 割合は低いものの, 7,000件を超す生体肝移植のなかで, 1名のドナー死亡を認めている. また生体腎移植は本邦で20,000件以上が施行されているが, 2013年, 腹腔鏡下ドナー手術時, 大量出血死や, 2013年, 術後34日目, 肺炎による死亡が報告されたことは記憶に新しい. Cheah らの報告では, 21カ国, 71プログラムの11,533ドナーでの合併症率は24%で, 死亡例は23/11,533例(0.2%)で, 19例が手術関連死であったと報告している. また ne...

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Published inJapanese Journal of Transplantation Vol. 51; no. 1; pp. 066 - 070
Main Authors 金高, 賢悟, 高槻, 光寿, 黒木, 保, 栗原, 慎太郎, 夏田, 孔史, 原, 貴信, 日高, 匡章, 曽山, 明彦, 藤田, 文彦, 大野, 慎一郎, 北里, 周, 江口, 晋, 宮崎, 泰司, 釘山, 統太, 長井, 一浩
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本移植学会 2016
日本移植学会
The Japan Society for Transplantation
Subjects
Online AccessGet full text
ISSN0578-7947
2188-0034
DOI10.11386/jst.51.1_066

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Abstract 「I. はじめに」米国では200件に1名の割合で, 生体肝移植ドナーの死亡が生じると報告され, 本邦においては, 割合は低いものの, 7,000件を超す生体肝移植のなかで, 1名のドナー死亡を認めている. また生体腎移植は本邦で20,000件以上が施行されているが, 2013年, 腹腔鏡下ドナー手術時, 大量出血死や, 2013年, 術後34日目, 肺炎による死亡が報告されたことは記憶に新しい. Cheah らの報告では, 21カ国, 71プログラムの11,533ドナーでの合併症率は24%で, 死亡例は23/11,533例(0.2%)で, 19例が手術関連死であったと報告している. また near-miss events (NME) は1.1%でみられたと報告されている.
AbstractList 「I. はじめに」米国では200件に1名の割合で, 生体肝移植ドナーの死亡が生じると報告され, 本邦においては, 割合は低いものの, 7,000件を超す生体肝移植のなかで, 1名のドナー死亡を認めている. また生体腎移植は本邦で20,000件以上が施行されているが, 2013年, 腹腔鏡下ドナー手術時, 大量出血死や, 2013年, 術後34日目, 肺炎による死亡が報告されたことは記憶に新しい. Cheah らの報告では, 21カ国, 71プログラムの11,533ドナーでの合併症率は24%で, 死亡例は23/11,533例(0.2%)で, 19例が手術関連死であったと報告している. また near-miss events (NME) は1.1%でみられたと報告されている.
It is reported that in the United States 1 living liver-transplant donor may die out of every 200 such transplants. Although the incidence is low in Japan, only 1 living liver donor died in more than 7,000 living liver transplants, and the death of a living kidney-transplant donor reported in 2013 remains vivid in our memory. It is advisable for medical transplant personnel to recognize that the death of a living organ-or tissue-transplant donor can occur and that a risk-management program medical facilities should be developed because of this possibility. Nagasaki University Hospital has established and implemented a Donor Advocacy Team (DAT), which is a risk-management program, in the event of a serious, persistent, or fatal impairment that a living donor may experience in a living-organ, tissue, or cell transplant. The purposes of the program are (1) to disclose official information immediately, (2) to provide physical care and psychiatric care for the patient experiencing impairment and the family, (3) to provide psychological care for the medical staff in charge of the transplant, (4) to standardize the responses of the diagnosis and treatment department staff and other hospital staffs, and (5) to minimize the damage the whole medical transplantation system may suffer and leverage it for improvement. The workflow for (1) and (5), such as reporting and responses to the government, mass media, transplant-related societies, and organ-transplant networks, has been established to assure implementation. Because the DAT plays a wide variety of roles, including provision of care not only for relevant donors and families, but also for hospital staff (doctors, nurses, and paramedical personnel), and immediate transmission of information, a risk-management team consisting of professionals from different fields, including a doctor, risk manager, psychological counselor, spokesperson, legal professional, bioethicist, and social worker, should be assembled for smooth operation.
Author 宮崎, 泰司
藤田, 文彦
日高, 匡章
原, 貴信
黒木, 保
釘山, 統太
曽山, 明彦
栗原, 慎太郎
北里, 周
大野, 慎一郎
高槻, 光寿
夏田, 孔史
江口, 晋
長井, 一浩
金高, 賢悟
Author_FL NAGAI Kazuhiro
HIDAKA Masaaki
TAKATSUKI Mitsuhisa
KUROKI Tamotsu
HARA Takanobu
KUGIYAMA Tota
MIYAZAKI Yasushi
SOYAMA Akihiko
北里 周
EGUCHI Susumu
FUJITA Fumihiko
KANETAKA Kengo
NATSUDA Koji
栗原 慎太郎
ONO Shinichiro
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4) 日本移植学会ホームページ. http://www.asas.or.jp/jst/news/20140227.html
11) Ratner LE, Snadoval PR. When disaster strikes: death of living organ donor. Am J Transplant 2010; 10: 2577-2581.
12) Akoad ME, Pomfret EA. Laparoscopic live donor hepatectomy: random mutation or stepwise evolution? Am J Transpl 2013; 13: 2243-2244.
13) 日本移植学会ホームページ. http://www.asas.or.jp/jst/pdf/info_20130812.pdf
7) Miller C, Smith ML, Fujiki M, et al. Preparing for the inevitable: the death of a living liver donor. Liver Transpl 2013; 19: 656-660.
2) Patel S, Orloff M, Tsoulfas G, et al. Living-donor liver transplantation in the United States: identifying donors at risk for perioperative complications. Am J Transplant 2007; 7: 2344-2349.
5) Cheah YL, Simpson MA, Pomposelli JJ, et al. Incidence of death and potentially life-threatening near-miss events in living donor hepatic lobectomy: a world-wide survey. Liver Transpl 2013; 19: 499-506.
1) Trotter JF, Adam R, Lo CM, et al. Documented deaths of hepatic lobe donors for living donor liver transplantation. Liver Transpl 2006; 12: 1485-1488.
8) Miller C. Preparing for the inevitable: the death of a living liver donor. Liver Transpl 2014; 20 (Suppl 2) : S47-S51.
10) Simpson MA, Pomfret EA. Checking the harness: safety for living liver donors. Liver Transpl 2012; 18 (Suppl 2) : S15-S19.
3) Akabayashi A, Slingsby BT, Fujita M. et al. The first donor death after living-related liver transplantation in Japan. Transplantation 2004; 77: 634.
9) Bramstedt KA. Living liver donor mortality: where do we stand? Am J Gastroenterol 2006; 101: 755-759.
6) Ringe B, Strong RW. The dilemma of living liver donor death: to report or not to report? Transplantation 2008; 85: 790-793.
References_xml – reference: 4) 日本移植学会ホームページ. http://www.asas.or.jp/jst/news/20140227.html
– reference: 7) Miller C, Smith ML, Fujiki M, et al. Preparing for the inevitable: the death of a living liver donor. Liver Transpl 2013; 19: 656-660.
– reference: 3) Akabayashi A, Slingsby BT, Fujita M. et al. The first donor death after living-related liver transplantation in Japan. Transplantation 2004; 77: 634.
– reference: 2) Patel S, Orloff M, Tsoulfas G, et al. Living-donor liver transplantation in the United States: identifying donors at risk for perioperative complications. Am J Transplant 2007; 7: 2344-2349.
– reference: 8) Miller C. Preparing for the inevitable: the death of a living liver donor. Liver Transpl 2014; 20 (Suppl 2) : S47-S51.
– reference: 9) Bramstedt KA. Living liver donor mortality: where do we stand? Am J Gastroenterol 2006; 101: 755-759.
– reference: 1) Trotter JF, Adam R, Lo CM, et al. Documented deaths of hepatic lobe donors for living donor liver transplantation. Liver Transpl 2006; 12: 1485-1488.
– reference: 14) 日本骨髄バンクホームページ. http://www.jmdp.or.jp/donation/about/benefit.html
– reference: 5) Cheah YL, Simpson MA, Pomposelli JJ, et al. Incidence of death and potentially life-threatening near-miss events in living donor hepatic lobectomy: a world-wide survey. Liver Transpl 2013; 19: 499-506.
– reference: 13) 日本移植学会ホームページ. http://www.asas.or.jp/jst/pdf/info_20130812.pdf
– reference: 11) Ratner LE, Snadoval PR. When disaster strikes: death of living organ donor. Am J Transplant 2010; 10: 2577-2581.
– reference: 12) Akoad ME, Pomfret EA. Laparoscopic live donor hepatectomy: random mutation or stepwise evolution? Am J Transpl 2013; 13: 2243-2244.
– reference: 10) Simpson MA, Pomfret EA. Checking the harness: safety for living liver donors. Liver Transpl 2012; 18 (Suppl 2) : S15-S19.
– reference: 6) Ringe B, Strong RW. The dilemma of living liver donor death: to report or not to report? Transplantation 2008; 85: 790-793.
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Snippet 「I. はじめに」米国では200件に1名の割合で, 生体肝移植ドナーの死亡が生じると報告され, 本邦においては, 割合は低いものの, 7,000件を超す生体肝移植のなかで, 1...
It is reported that in the United States 1 living liver-transplant donor may die out of every 200 such transplants. Although the incidence is low in Japan,...
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SourceType Publisher
StartPage 066
SubjectTerms donor advocacy team
living donor
risk management
safety
transplantation
Title 生体臓器・組織・細胞移植ドナーに対する危機管理プログラムdonor advocacy teamの重要性
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