Burckhardt Ringe, Russell W. Strong. 肝脏中心，胆胰疾病，德雷克赛尔大学医药学院，费城，宾夕法尼亚州，美国；亚历山德拉公主医院，布里斯本大学，布里斯本，澳大利亚

对肝移植来说，在尸体捐赠的器官不可用的情况下， 活体捐赠就变得很重要。目前世界上活体捐赠的数量在逐渐增加，而捐献者的安全也是人们普遍关心的问题之一。除了2006年出版的4篇独立评论外，没有其他关于捐献者死亡数量的精确报道。

　　我们回顾了1989年的医学文献以更新活体肝供者的死亡率，这些文献既有轶事报导，也有复杂的调查。在回顾文献的过程中，我们也同时评定这些信息的准确性，并为每种资料来源设定了准确性等级（用C表示）：C1，直接报导，由发生死亡事故的移植中心的成员直接发布；C2，间接报导，作者与所报导的移植中心无直接关系；C3，信息来自口头表述或个人交流。我们发现， C1组中有11个案例，即，捐赠死者的身份和移植中心已得到证实，事故的细节已经在单一病例报告中详细叙述。C2组中有10例死亡事故，只涉及到6个移植中心。有9例捐赠死者被提及，但他们的信息准确性级别却为C1。7例发生在欧洲，8例发生在北美，4例在南美，8例在亚洲，1例在非洲。另外两例额外捐助也包括在内：一例因肝脏移植获救，另一例仍然处于植物神经状态。在世界范围内共施行了超过10000例活体肝移植，捐赠者的死亡率为0.1-0.3%。只有C1类的捐赠死者允许鉴定风险因素：手术前状态，特别是肝脏问题；社会心理层面上的行为异常，包括吸烟和吸毒；肝右叶移植；术后并发症等。

在该过程中，为了真正做到知情同意和赢得公众信任，必须强制报导所有捐赠者死亡的案例。不幸的是，活体肝供者的死亡数和公开报导的数目不相符的现象并未得到改变，谣传和事实之间的尴尬依然存在。获得准确信息的唯一途径是由发生事故的移植中心直接报道。这项调查应该鼓励所有参与施行活体肝移植手术的外科医生揭露他们周围发生的死亡事故。

World Update on Living Liver Donor Mortality
Burckhardt Ringe, Russell W. Strong. Center for Liver, Biliary and Pancreas Disease, Drexel University College of Medicine, Philadelphia, PA, USA; Princess Alexandra Hospital, University of Brisbane, Brisbane, Australia

Living donation has become a valuable resource of liver grafts when deceased donor organs are not available, and this option is being increasingly offered in transplant programs throughout the world. One major concern has always been the risk for the donor. Despite 4 independent reviews published in 2006, there is no accurate information on the number of donor deaths.

We reviewed the medical literature since 1989 - from anecdotal reports to sophisticated surveys, to update the worldwide living liver donor mortality rate. Our goal was to also assess the accuracy of the information, assigning a certainty (C) level to each source identified which was defined as follows: C1, direct report by a member representing the transplant center where the fatality occurred; C2, indirect publication by an author not involved in the care; and C3, information based on verbal presentation or personal communication.

We found 11 cases classified as C1: donor deaths and centers were identified, and details of the complications were published in single case reports. In the C2 group there were 10 fatalities, and only six centers were documented by other authors. Nine donor deaths were mentioned, however, their certainty level was C1. Seven donor deaths had occurred in Europe, eight in North America, four in South America, eight in Asia, and one in Africa. Two additional donors were included: one was rescued with a liver transplant, and the other remained in a vegetative state. Based on an estimate of over 10,000 living donor liver transplants performed worldwide, the donor death rate is 0.1-0.3%. Only C1 donor deaths allowed to identify specific risk factors: preoperative medical conditions - especially liver problems, known psychosocial behavioural abnormalities - including smoking and drugs, right lobe donation, and postoperative surgical complications.

　　In order to maintain truly informed consent and public confidence in this procedure, it is imperative to report all deaths of living donors. Unfortunately, the discrepancy between published and unpublished living liver donor mortality has not changed, and the dilemma of rumors versus facts is prevailing. The only way to get accurate information is direct reporting by the transplant program where the fatality occurred This survey should encourage all surgeons performing living donor liver transplantation to disclose their own fatalities.

[责任编辑:刘聪]