Current Situation And Countermeasures Study On Organ Donation After Cardiac Death In Hunan Province

Background:At the present time, organ transplant represents the only effective therapy to various end-stage organ failure. The demand for organ transplantation has rapidly increased all over the world due to advances in the areas of organ preservation, retrieval and implantation techniques. However, the unavailability of adequate organs for transplantation to meet the existing demand has resulted in major organ shortage crises. In March2010, to overcome the shortage of available organs, the Red Cross of China and Ministry of Health jointly started a pilot programme of organ donation after cardiac death(DCD) in Tianjin,GuangDong, HuNan and other10provinces and cities. On September17,2010, the government and the Red Cross of Hunan province jointly held a press conference on organ donation. Therefor, the survey and mode of organ donation after cardiac death in Hunan province have important practical and theoretical significance.Objective:To investigate public sector management of organ donation in hunan province;To evaluate the organ donation coordinators’ post competency level; To resarch the public knowledge and attitudes toward organ donation; To analysis the decision-making process and influence factors of family regarding organ donation; To provide important suggestions for improving DCD in hunan province.Methods:A retrospective study of DCD datas in2010-2013; Using the methods of literature metrology and content analysis of the organ donation propaganda in hunan province; With the method of text analysis of organ donation organization structure and legal construction in hunan province; With the behavioral event interview, Delphi and analytic hierarchy process (ahp) construct the organ donation coordinators’ position competency evaluation system; By means of questionnaire survey, descriptive statistics analysis, correlation analysis, variance analysis, multiple linear regression and cluster analysis to evaluate the post competency levels of organ donation coordinators; Using questionnaire survey method, descriptive statistics analysis, t test, single factor variance analysis, multiple regression analysis survey social public kowledge and attitudes on organ donation; by the Cronbach’s Alpha analysis of coefficient of reliability test; By the content validity index values (CVI) and Pearson correlation analysis of the questionnaire content validity; To resarch influencing factors of donor family decisions using depth interview method, the method of grounded theory research and case analysis.Results:(1)From March2010to October31,2012,43cases of organ donation were done in hunan province, the third in the nation. The media reports of organ donation are most typical cases, supplemented by the press conference. However, at present about the publicity of the organ donation are scattered point, no series. At the same time, reports lack universal knowledge of organ donation. There are no Human organ donation fund in hunan province.(2) The average competency score of the42coordinators was79.43±8.51. According to the result of clustering analysis, coordinators’competency were divided into four categories: pass, medium, good, excellent. Most of coordinators were above medium. Research suggests that the age,professional, technical titles and working years have influenced on the coordinators’competency.(3) The mean knowledge score for the sample was71.96%, students slightly higher than the resident population (73.06%VS70.68%).most respondents (82.2%) had positive attitudes regarding donation,53.5%of respondents were willing to donate organs,71.7%of respondents agree with "Organ donation can make the dead achieve greater value of life",61.3%of respondents expressed"they would tell their family if they have the thought of organ donation",48.2%of respondents agree filling in the organ donation card when getting the driver’s license. Respondents with more knowledge about donation were found to be more willing to donate their organs or tissues after death, regression coefficient was0.666. Television or movie was the mostfrequently reported source of information about organ donation,only30.5%cited government publicity as a source of information on donation.(4) The consent rate of young donor families was66.67%, while the consent rate of adult donor families was26.04%. Young donor families were easier to consent to organ donation than adult donor families (P<.005). We found that the donors’ families had been affected by various factors throughout the process of deciding to consent donation. These factors are grouped into six main categories:(a) personal factors;(b) interpersonal factors;(c) social environment factors;(d) ethical factors;(e) traditional views and (f) conditions of organ request. And, most of the decision-making on organ donors’ family were the short-term decision and group decision.Conclusions:(1) The DCD of hunan province were located in the national front row. The basic knowledge of organ donation need further popularization.Organization structure and local laws and regulations still need to be further improved.(2) We constructed a competency model of organ donation coordinator.Most of coordinators were above medium in hunan province.(3) Hunan public were lack of knowledge about organ donation, it is necessary to popularize the related basic knowledge on medicine, the donor program and laws.(4)In Hunan, the funeral tradition influenced the young donor parents’ consent to donation, but had no relation with family decision of adult donors. And family members of young donor are relatively less, who are more likely to reach a consensus.(5) We put forward the countermeasures of promoting organ donation work from the Angles of public sector management, organ donation coordinators, public cognition, donors and their families and organ donation model.