A few realistic questions raised by organ retrieval in the intensive care unit

Abstract

Organ transplantation saves the lives of many persons who would otherwise die from end-stage organ disease. The increasing demand for donated organs has led to a renewed interest in donation after circulatory determination of death (CDD). In many countries (including France), terminally ill patients who die of circulatory arrest after a planned withdrawal of life support may be considered as organ donors under certain conditions. While having equal responsibility towards the potential donor and the persons awaiting a transplant, caregivers may experience an ethical dilemma between the responsibility to deliver the best care to the dying, and the need to retrieve the organs. Once it has been established that the patient wishes to be a donor, we assume that end-of-life care and organ donation may have convergent goals when they contribute to transforming a comfortable death into a chance of life for others in need.

Impact of the use of vasoactive drugs in cardiac death donors on the early postoperative renal function and related complications in renal transplant recipients

“…However, the long-term However, the dysfunction of sympathetic and parasympathetic nerves after brain death in DCD donors leads to dysregulation of vascular tone, unstable hemodynamics, and decreased blood pressure, causing the warm ischemia of the organ. As extended hypotension will increase the risk of primary non-function, the hemodynamic instability after donor brain death can lead to donation failure in 25% of the potential donors, and more than 80% of potential donors require vasoactive drugs to support their hemodynamic stability (5,6). Therefore, enhanced donor maintenance and the optimized use of vasoactive drugs are vital for graft function recovery and long-term graft survival.…”

Determining the Level of Importance of Variables in Predicting Kidney Transplant Survival Based on a Novel Ranking Method

“…For patients with end-stage organ failure, organ transplantation is either the only therapeutic option or the most appropriate and cost-effective treatment. 1 Among the organs that can be transplanted, the kidneys have the highest demand. For example, in the United States, as of April 2019, there were about 113 600 patients on the waiting list of transplantation, with >95 000 of them requiring kidney (83.63%).…”

Transferring an ICU Patient at the End of His Life for the Purpose of Organ Donation: Could It Be Considered?

“…The underlying principle is that the decision to withdraw LST must be made in the patient’s best interest, independently from any consideration regarding organ donation, and that cDCD must not alter end-of-life care [ 3 ]. The challenge is not only to identify potential cDCD donors, but also to provide support to grieving families and to give caregivers a reassuring ethical framework [ 4 ]. Yet, caregivers can feel particularly uncomfortable when, in practice, end-of-life care and organ donation overlap.…”