Organ Donation after Cardiac Death from Withdrawal of Life Support in Patients with Amyotrophic Lateral Sclerosis

Smith, Thomas J.; Vota, Scott; Patel, Shejal; Ford, Timothy; Lyckholm, Laurie; Bhushan, Anup; Bobb, Barton T.; Coyne, Patrick; Swainey, Craig

doi:10.1089/jpm.2011.0239

Cited by 14 publications

(10 citation statements)

References 17 publications

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“…In the United Kingdom, where the rate of organ harvesting under Maastricht III conditions is one of the highest in the world, the most common diagnoses in donors are severe and irreversible brain injuries [ 22 ]. However, conscious patients suffering from irreversible severe diseases with no hope for improvement (for example end-stage respiratory disease, locked-in syndrome, atrophic lateral sclerosis) may request both life-support withdrawal (i.e., turn off mechanical ventilation) and subsequent organ donation if not contraindicated [ 22 - 24 ]. In France, Leonetti’s law applies to conscious or unconscious patients, in end-of-life situation or with irreversible and severely-disabling diseases [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Eligibility of patients withheld or withdrawn from life-sustaining treatment to organ donation after circulatory arrest death: epidemiological feasibility study in a French Intensive Care Unit

et al. 2013

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BackgroundTransplantation brings sustainably improved quality of life to patients with end-stage organ failure. Persisting shortfall in available organs prompted French authorities and practitioners to focus on organ retrieval in patients withdrawn from life-sustaining treatment and awaiting cardiac arrest (Maastricht classification category III). The purpose of this study was to assess the theoretical eligibility of non-heart-beating donors dying in the intensive care unit (ICU) after a decision to withhold or withdraw life-sustaining treatment (WoWt).MethodsWe collected the clinical and biological characteristics of all consecutive patients admitted to our ICU and qualified for a WoWt procedure under the terms of the French Leonetti law governing end-of-life care during a 12-month period. The theoretical organ donor eligibility (for kidney, liver, or lung retrieval) of deceased patients was determined a posteriori 1) according to routine medical criteria for graft selection and 2) according to the WoWt measures implemented and their impact on organ viability.ResultsA total of 596 patients (mean age: 67 ± 16 yr; gender ratio M/F: 1.6; mean SAPS (Simplified Acute Physiology Score) II: 54 ± 24) was admitted to the ICU, of which 84 patients (mean age: 71 ± 14 yr, 14% of admissions, gender ratio M/F: 3.2) underwent WoWt measures. Eight patients left the unit alive. Forty-four patients presented a contraindication ruling out organ retrieval either preexisting admission (n = 20) or emerged during hospitalization (n = 24). Thirty-two patients would have been eligible as kidney (n = 23), liver (n = 22), or lung donors (n = 2). Cardiopulmonary support was withdrawn in only five of these patients, and three died within 120 minutes after withdrawal (the maximum delay compatible with organ viability for donor grafts).ConclusionsIn this pilot study, a significant number of patients deceased under WoWt conditions theoretically would have been eligible for organ retrieval. However, the WoWt measures implemented in our unit seems incompatible with donor organ viability. A French multicenter survey of end-of-life practices in ICU may help to identify potential appropriate organ donors and to interpret nation-specific considerations of the related professional, legal, and ethical frameworks.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…Many organ donation organizations do not accept organs from people with amyotrophic lateral sclerosis or other undiagnosed neurodegenerative conditions. Some authors have urged caution in this area, 17 but people with amyotrophic lateral sclerosis have successfully donated organs after WLSM, 18 and there appears to be no elevated risk of developing amyotrophic lateral sclerosis or many other neurodegenerative conditions after donation from selected persons with amyotrophic lateral sclerosis (Appendix 1). Because data are scarce about many neurodegenerative conditions, ongoing follow-up with the recipient is needed.…”

Section: Physicians Who Follow Organ Recipients Should Be Aware That mentioning

confidence: 99%

Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy

Downar

Shemie

Gillrie

et al. 2019

CMAJ

107

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First-person consent for organ donation after medical assistance in dying (MAiD) or withdrawal of life-sustaining measures (WLSM) should be an option in jurisdictions that allow MAiD or WLSM and donation after circulatory determination of death. • The most important ethical concern-that the decision for MAiD or WLSM is being driven by a desire to donate organsshould be managed by ensuring that any discussion about organ donation takes place only after the decision for MAiD or WLSM is made. • If indications for MAiD change, this guidance for policies and the practice of organ donation after MAiD should be reviewed to ensure that the changes have not created new ethical or practical concerns.

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“…3 Similarly, deceased organ donation by ALS patients has been reported in the peer-reviewed literature in <15 cases, with a nearexclusive focus on ethical aspects, but not on clinical or logistical issues. 1,2,4 Our center's patient-and family-centric approach has allowed us to gain clinical and regulatory experience with this rare donor type and provides the basis for the present discussion.…”

Section: Discussionmentioning

confidence: 99%

“…In spite of the severe shortage of organ donors, live and deceased organ donation by patients with advanced, progressive systemic neurological diseases remains very rare. [1][2][3][4][5] For several reasons, one of the most common such neurological condition that transplant providers may encounter is amyotrophic lateral sclerosis (ALS).…”

Section: Introductionmentioning

confidence: 99%

Barriers to live and deceased kidney donation by patients with chronic neurological diseases: Implications for donor selection, donation timing, logistics, and regulatory compliance

Troppmann

Santhanakrishnan

Sageshima

et al. 2019

American Journal of Transplantation

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Live and deceased kidney donation by the numerous patients with advanced, progressive systemic neurological diseases, and other chronic neurological conditions (eg, high C‐spine injury) remains largely unexplored. In a review of our current clinical practice, we identified multiple regulatory and clinical barriers. For live donation, mandatory reporting of postdonation donor deaths within 2 years constitutes a strong programmatic disincentive. We propose that the United Network for Organ Sharing should provide explicit regulatory guidance and reassurance for programs wishing to offer live donation to patients at higher risk of death during the reporting period. Under the proposal, live donor deaths within 30 days would still be regarded as donation‐related, but later deaths would be related to the underlying disease. For deceased donation, donation after circulatory death (DCD) immediately following self‐directed withdrawal of life‐sustaining treatment (“conscious DCD”) is not universally covered by existing DCD agreements with donor hospitals. Organ procurement organizations should thus systematically strive to revise these agreements. Obtaining adequate first‐person consent from these communicatively severely impaired patients may be challenging. Optimized preservation and allocation protocols may maximize utilization of these DCD kidneys. Robust public debate and action by all stakeholders is necessary to lower existing barriers and maximize donation opportunities for patients with chronic neurological conditions.

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Organ Donation after Cardiac Death from Withdrawal of Life Support in Patients with Amyotrophic Lateral Sclerosis

Cited by 14 publications

References 17 publications

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

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

Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy

Barriers to live and deceased kidney donation by patients with chronic neurological diseases: Implications for donor selection, donation timing, logistics, and regulatory compliance

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