Eligibility of patients withheld or withdrawn from life-sustaining treatment to organ donation after circulatory arrest death: epidemiological feasibility study in a French Intensive Care Unit

Lesieur, Olivier; Mamzer, Marie‐France; Leloup, Maxime; Gonzalez, Frédéric; Herbland, Alexandre; Hamon, Brigitte; Viallard, Marcel-Louis; Hervé, Christian

doi:10.1186/2110-5820-3-36

Cited by 7 publications

(5 citation statements)

References 26 publications

(34 reference statements)

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“…Our findings reflect previous overseas studies that report that 30% of patients prefer another trusted advocate rather than their spouse to be nominated as the SDM [6,[14][15][16][17]. Hence, physicians and nursing staff should be mindful of this when they raise end of life care issues with families and seek broader family consensus.…”

Section: Discussionsupporting

confidence: 71%

“…21% said they would choose other than their spouse as SDM and 76% of respondents preferred their family to share the decision making process [6]. Lesieur in examining organ donation practices, noted that the medical records before admission to one French ICU made no mention of anticipated directives by patients, or of a legally designated trusted person to act a SDM [16].…”

Section: Introductionmentioning

confidence: 99%

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Challenges in Determining the Substitute Decision Maker: Findings from an Australian Intensive Care Unit

Jl¹,

Cm²

2016

Adv Practice Nurs

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Background: Little research has been undertaken to explore how Substitute Decision Makers (SDM) are chosen by patients and especially for incompetent adults in an intensive care unit (ICU).Objective: To determine how substitute decision makers are chosen in ICU.Method: A retrospective cohort study using a clinical file audit to appraise socio-demographic and qualitative data from the medical record. The data from the medical record was collected by one researcher and analysed using a de-identified file. Ethics approval was sought and granted by the hospital Ethics Committee and the research was deemed to be low risk due to the nature of the retrospective file audit. Setting/Participants Patients admitted to ICU between July 2010 and June 2011 (n=1500) and died within ICU (n=236). The social demographic features were analysed using descriptive statistics and analysis using SPSS statistical software. Results:Most patients who died in ICU (70%) were aged over 60 years. While most widowed people and some married persons nominated an adult child as next of kin (NOK), 34% of single people nominated someone other than a family member as next of kin. The audit showed key differences between next of kin and the nominated substitute decision maker. For example, in all age groups, for those nominating a partner as next of kin (n=124) over a third had a different person assume the role of substitute decision maker. Conclusion:This retrospective study found that one third of patients preferred another trusted advocate to assume the role of substitute decision maker rather than their next of kin. Hence, the NOK of patients admitted to ICU should not be assumed to be their preferred substitute decision-maker. We recommend a community education program to raise awareness for families to begin conversations about preferences for substitute decision makers especially amongst ageing family members.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Challenges in Determining the Substitute Decision Maker: Findings from an Australian Intensive Care Unit

Jl¹,

Cm²

2016

Adv Practice Nurs

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“…Brain-injured patients are more likely to die under circumstances which may fulfill the Maastricht III conditions Severely brain-injured patients are more likely to die after withdrawal of life-sustaining treatments, in circumstances which may fulfill the requirements for organ retrieval under Maastricht III conditions (8,12,32). Contrary to ethicists (22,45,46), many intensivists clearly distinguish between "withholding" and "withdrawal" decisions, with the former being perceived as more passive (47)(48)(49)(50)(51)(52).…”

Section: Caregivers Have Equal Responsibility Towards Both the Dying mentioning

confidence: 88%

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

Lesieur¹,

Genteuil²,

Leloup³

2017

Ann. Transl. Med.

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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.

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“…Discussion around organ donation as a fundamental part of end‐of‐life care on the ICU is increasing 3,19,20 . Our premise was that there is no relationship between LSTL and organ donation in Swedish ICUs.…”

Section: Discussionmentioning

confidence: 99%

The relationship between life‐sustaining treatment limitation and organ donation in Swedish intensive care: A nationwide register study

Nolin¹,

Walther

2021

Acta Anaesthesiol Scand

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Background Life‐sustaining treatment limitation (LSTL) on the intensive care unit (ICU) may affect the rate of organ donation after brain death (DBD). The primary aim of this study was to examine whether there is a relationship between LSTL and DBD. Furthermore, we aimed to determine the rate of LSTL involved in ICU deaths and to describe technical and procedural characteristics of LSTL on Swedish ICUs. Methods This was an observational cohort study on all ICU deaths (n = 13 156) in Sweden between 2014 and 2017. We analysed differences in DBD rates between deaths in ICU with and those without LSTL, using descriptive statistics and logistic regression. Results After excluding 1084 deaths on specialised ICUs and units not registering goals of treatment, the study population comprised 12 072 deaths including 615 DBDs, of which 7865 had LSTL, 1706 had no LSTL and 2501 had no stated goals of treatment. The final cohort on which the relationship between DBD and LSTL was analysed comprised 9571 deaths including 419 DBDs. When no LSTL was documented, the rate of organ donation was 9.5% compared to 3.3% when LSTL was documented (P < .001). LSTL was associated with a lower DBD rate after adjusting for patient‐ and ICU‐related factors (OR 0.41, 95% CI 0.31‐0.53, P < .001). Conclusion There was an inverse relationship between LSTL and DBD amongst patients who died on the ICU. This relationship remained after adjusting for factors known to influence organ donation. The reason remains to be determined.

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Eligibility of patients withheld or withdrawn from life-sustaining treatment to organ donation after circulatory arrest death: epidemiological feasibility study in a French Intensive Care Unit

Cited by 7 publications

References 26 publications

Challenges in Determining the Substitute Decision Maker: Findings from an Australian Intensive Care Unit

Challenges in Determining the Substitute Decision Maker: Findings from an Australian Intensive Care Unit

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

The relationship between life‐sustaining treatment limitation and organ donation in Swedish intensive care: A nationwide register study

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