Desenvolvimento de um protocolo multidisciplinar para processo de doação de órgãos torácicos
Desenvolvimento de um protocolo multidisciplinar para processo de doação de órgãos torácicos
Data
2021
Autores
Cruz, Luiz Gustavo Torres Dias da
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
No Brasil, os transplantes de órgãos sólidos torácicos são menos frequentes que os de
órgãos sólidos (rim e fígado, por exemplo). Com o aumento da sobrevida e a qualidade de vida dos pacientes transplantados, a indicação dos transplantes e a procura por esta terapia cresceram significativamente nas duas últimas décadas. No entanto, embora a procura e a efetivação dos transplantes tenham aumentado, a falta de órgãos continua sendo uma das maiores barreiras das equipes transplantadoras em todos os países, pois a demanda é cada vez maior em relação à efetivação de doações, aumentando assim as listas de espera.
Mesmo com a existência de alguns protocolos de manutenção do potencial doador, podemos observar que o aproveitamento dos órgãos para transplantes segue reduzido no Brasil. Objetivos: Desenvolver um protocolo multidisciplinar sistematizado direcionado ao processo de doação de órgãos torácicos para Comissão Intra-Hospitalar de transplantes, a partir do levantamento bibliográfico de uma síntese de evidências na literatura científica especializada para auxiliar a construção do protocolo assistencial. Métodos: Revisão sistemática da literatura especializada para desenvolvimento de um protocolo sistematizado de cuidados específicos para captação torácica; construção de um questionário a partir das evidências científicas pesquisadas na literatura especializada, e posterior revisão técnica de tais evidências, realizada por um comitê de peritos. Resultados: Seguindo os critérios de seleção disponíveis na revisão sistemática da literatura, foram elencados doze (12) estudos para extração das evidências cientificas, todos disponibilizados em língua inglesa. Ao todo foram coletadas vinte e uma (21) evidências cientificas a partir do somatório total destas. O comitê de peritos foi composto por dezessete (17) membros, que tiveram acesso ao questionário. A categorização dos sujeitos respondentes deu-se da seguinte forma: nove (9) médicos, sete (7) enfermeiros e um (1) fisioterapeuta. O conjunto de evidências aqui demostrado pode contribuir para a melhoria do desfecho, na oferta de informações cientificas confiáveis e num campo mais amplo de engajamento da equipe multidisciplinar neste processo. Foram desenhados três (3) domínios, e a partir desses foi construído o protocolo aqui apresentado. Conclusão: O estudo realizou desenvolvimento dos domínios do processo de doação de órgãos torácicos, e propôs ações que possam ser realizadas pela equipe multidisciplinar em saúde nos diversos cenários existentes nas cidades brasileiras. A revisão utilizada como base cientifica sistematizou com novas evidências científicas para a comunidade acadêmica e/ou assistencial. Para finalizar, este Protocolo Multidisciplinar para Processo de Doação de Órgãos Torácicos é o início de uma trilha de conhecimento que visa reduzir o tempo de espera e trazer mais qualidade de vida aos 277 candidatos ao transplante de coração e aos 195 candidatos ao transplante de pulmão que existem no país em 2021.
In Brazil, transplants of solid thoracic organs are less frequent than those of solid organs (kidney and liver, for example). With the increase in survival and the quality of life of transplant patients, the indication for transplants and the demand for this therapy have grown significantly in the last two decades. However, although the demand and effectiveness of transplants has increased, the lack of organs remains one of the greatest barriers for transplant teams in all countries, as the demand is increasing in relation to the realization of donations, thus increasing the lists waiting. Even with the existence of some protocols for the maintenance of the potential donor, we can observe that the use of organs for transplantation remains reduced in Brazil. Objectives: To develop a systematic multidisciplinary protocol aimed at the process of donating thoracic organs to the Intra-Hospital Transplant Commission, based on a bibliographic survey of a synthesis of evidence in the specialized scientific literature to assist in the construction of the care protocol. Methods: Systematic review of the specialized literature to develop a systematic protocol of specific care for chest uptake; construction of a questionnaire based on the scientific evidence researched in the specialized literature, and subsequent technical review of such evidence, carried out by a committee of experts. Results: Following the selection criteria available in the systematic literature review, twelve (12) studies for the extraction of scientific evidence were listed, all available in English. In all, twenty-one (21) scientific evidences were collected from their total sum. The expert committee was composed of seventeen (17) members, who had access to the questionnaire. The categorization of respondent subjects was as follows: nine (9) doctors, seven (7) nurses and one (1) physiotherapist. The set of evidence shown here can contribute to improving the outcome, in providing reliable scientific information and in a broader field of engagement of the multidisciplinary team in this process. Three (3) domains were designed, and from these the protocol presented here was built. Conclusion: The study developed the domains of the thoracic organ donation process, and proposed actions that can be carried out by the multidisciplinary health team in the various scenarios existing in Brazilian cities. The review used as a scientific basis systematized new scientific evidence for the academic and / or care community. Finally, this Multidisciplinary Protocol for the Process of Donating Thoracic Organs is the beginning of a trail of knowledge that aims to reduce waiting time and bring more quality of life to the 277 heart transplant candidates and the 195 lung transplant candidates who exist in the country in 2021.
In Brazil, transplants of solid thoracic organs are less frequent than those of solid organs (kidney and liver, for example). With the increase in survival and the quality of life of transplant patients, the indication for transplants and the demand for this therapy have grown significantly in the last two decades. However, although the demand and effectiveness of transplants has increased, the lack of organs remains one of the greatest barriers for transplant teams in all countries, as the demand is increasing in relation to the realization of donations, thus increasing the lists waiting. Even with the existence of some protocols for the maintenance of the potential donor, we can observe that the use of organs for transplantation remains reduced in Brazil. Objectives: To develop a systematic multidisciplinary protocol aimed at the process of donating thoracic organs to the Intra-Hospital Transplant Commission, based on a bibliographic survey of a synthesis of evidence in the specialized scientific literature to assist in the construction of the care protocol. Methods: Systematic review of the specialized literature to develop a systematic protocol of specific care for chest uptake; construction of a questionnaire based on the scientific evidence researched in the specialized literature, and subsequent technical review of such evidence, carried out by a committee of experts. Results: Following the selection criteria available in the systematic literature review, twelve (12) studies for the extraction of scientific evidence were listed, all available in English. In all, twenty-one (21) scientific evidences were collected from their total sum. The expert committee was composed of seventeen (17) members, who had access to the questionnaire. The categorization of respondent subjects was as follows: nine (9) doctors, seven (7) nurses and one (1) physiotherapist. The set of evidence shown here can contribute to improving the outcome, in providing reliable scientific information and in a broader field of engagement of the multidisciplinary team in this process. Three (3) domains were designed, and from these the protocol presented here was built. Conclusion: The study developed the domains of the thoracic organ donation process, and proposed actions that can be carried out by the multidisciplinary health team in the various scenarios existing in Brazilian cities. The review used as a scientific basis systematized new scientific evidence for the academic and / or care community. Finally, this Multidisciplinary Protocol for the Process of Donating Thoracic Organs is the beginning of a trail of knowledge that aims to reduce waiting time and bring more quality of life to the 277 heart transplant candidates and the 195 lung transplant candidates who exist in the country in 2021.
Description
Palavras-chave
Doação de órgãos, Prática baseada em evidências, Revisão sistemática, Organ donation, Evidence-based practice, Systematic review
Citação
Cruz LGTD. Desenvolvimento de um protocolo multidisciplinar para processo de doação de órgãos torácicos. Dissertação [Mestrado Profissional em Ciências Cardiovasculares]. Instituto Nacional de Cardiologia; 2021.