Are terminally ill patients dying in the ICU suitable for non-heart beating organ donation?

Revelly, Jean-Pierre; Imperatori, L.; Maravic, Philippe; Schaller, Marie-Denise; Chioléro, René

doi:10.1007/s00134-006-0116-7

Cited by 17 publications

(10 citation statements)

References 9 publications

(13 reference statements)

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“…Our study is limited by the small number of patients assessed but is consistent with other published work regarding outcome following out‐of‐hospital cardiac arrest [10]. We believe that we are the first group to look at this population with a view to non‐heart‐beating organ donation.…”

Section: Discussionsupporting

confidence: 72%

Outcome after admission to ITU following out‐of‐hospital cardiac arrest: are non‐survivors suitable for non‐heart‐beating organ donation?

Gratrix¹,

Pittard

Bodenham

2007

Anaesthesia

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Summary We have reviewed retrospective data from two large UK teaching hospitals regarding outcome following out‐of‐hospital cardiac arrest and the suitability of non‐survivors for non‐heart‐beating organ donation. Patients were selected retrospectively from consecutive admissions from two intensive care units who had presented following out‐of‐hospital cardiac arrest, to a total of 50 patients in each centre. They had all been resuscitated to achieve a spontaneous cardiac output at the scene, in transit or after arrival in hospital, and required further intensive care support due to cardiovascular, respiratory, or neurological impairment. Eighty‐six patients (86%) died in the Intensive Care Unit and only 14 (14%) survived to discharge from the Unit. A further nine (9%) patients died in hospital before discharge home. Four patients (4%) were alive after 6 months and three (3%) were alive after 1 year. Fifty‐seven (57%) of patients had active withdrawal of treatment with only four (4%) being potentially suitable for organ procurement having not been excluded because of age, medical history or the length of time to die following withdrawal of treatment. Our results show that only a small increase in donor organs could be potentially achieved from this population. Further work is required to determine whether such patients should be considered as non‐heart‐beating donors.

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Section: Discussionsupporting

confidence: 72%

Outcome after admission to ITU following out‐of‐hospital cardiac arrest: are non‐survivors suitable for non‐heart‐beating organ donation?

Gratrix¹,

Pittard

Bodenham

2007

Anaesthesia

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“…This utilitarian approach has also provided implicit justification for manipulation of some aspects of the death process [33]. Intervention has been justified not only in the dying process but also in defining the word dead .…”

Section: The Dead Donor Rule and The Lawmentioning

confidence: 99%

Recovery of transplantable organs after cardiac or circulatory death: Transforming the paradigm for the ethics of organ donation

Verheijde

Rady

McGregor

2007

Philos Ethics Humanit Med

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Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and selfdetermination.

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“…The protocol is intended to predict whether circulatory arrest can occur within 60 min of withdrawal of life support. The high false-positive rate for selection of DCD candidates in the ICU can expose many dying ICU patients to unnecessary ante mortem interventions [14]. The quality of EOL care also has profound psychologic sequelae for families.…”

Section: End-of-life Carementioning

confidence: 99%

Untitled

2006

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Donation after circulatory death (DCD) can be performed on neurologically intact donors who do not fulfill neurologic or brain death criteria before circulatory arrest. This commentary focuses on the most controversial donor-related issues anticipated from mandatory implementation of DCD for imminent or cardiac death in hospitals across the USA. We conducted a nonstructured review of selected publications and websites for data extraction and synthesis. The recommended 5 min of circulatory arrest does not universally fulfill the dead donor rule when applied to otherwise neurologically intact donors. Scientific evidence from extracorporeal perfusion in circulatory arrest suggests that the procurement process itself can be the event causing irreversibility in DCD. Legislative abandonment of the dead donor rule to permit the recovery of transplantable organs is necessary in the absence of an adequate scientific foundation for DCD practice. The designation of organ procurement organizations or affiliates to obtain organ donation consent introduces self-serving bias and conflicts of interest that interfere with true informed consent. It is important that donors and their families are not denied a 'good death', and the impact of DCD on quality of end-of-life care has not been satisfactorily addressed to achieve this. IntroductionA mandatory implementation of donation after circulatory death (DCD) from eligible patients facing imminent or cardiac death in hospitals across the USA was introduced at a national conference and is to be effective from January 2007 [1]. The DCD requirement is focused on patients who are neurologically intact or do not fulfill neurologic death criteria before withdrawal of ventilator support [2]. The mandatory requirement will be implemented through the collaboration of the Institute of Medicine, Joint Commission on Accreditation of Healthcare Organizations, Center for Medicare and Medicaid Services, and the Department of Health and Human Services (see the glossary of terms in Table 1) [3,4].The transplantation community has been reorganized into 58 donation service areas (DSAs) to cover the entire country [5]. Each DSA is centered on one organ procurement organization (OPO) that facilitates the recovery and flow of transplantable organs from donor hospital(s) to regional transplant center(s) within a defined geographic location. Each of the DSAs will have to meet a target goal of 75% or higher of cadaveric organ donation rate from its affiliated hospitals. Determination of circulatory death for organ procurementThe uniform determination of death relies on irreversible cessation of circulatory or neurologic function. The unitarian determination of death by either neurologic or circulatory criteria rather than fulfilling both criteria simultaneously is accepted as the standard for cadaveric organ procurement [2]. The DCD criteria relies on expert opinion, which permits the procurement process after 5 min of apnea, unresponsiveness, and pulselessness [6].The pivotal assumption that DCD w...

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Are terminally ill patients dying in the ICU suitable for non-heart beating organ donation?

Cited by 17 publications

References 9 publications

Outcome after admission to ITU following out‐of‐hospital cardiac arrest: are non‐survivors suitable for non‐heart‐beating organ donation?

Outcome after admission to ITU following out‐of‐hospital cardiac arrest: are non‐survivors suitable for non‐heart‐beating organ donation?

Recovery of transplantable organs after cardiac or circulatory death: Transforming the paradigm for the ethics of organ donation

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