Eligibility for organ donation following end-of-life decisions: a study performed in 43 French intensive care units
- 644 Downloads
A persistant shortage of available organs for transplantation has driven French medical authorities to focus on organ retrieval from patients who die following the withdrawal of life-sustaining therapy. This study was designed to assess the theoretical eligibility of patients who have died in French intensive care units (ICUs) after a decision to withhold or withdraw life-sustaining therapy to organ donation.
This was an observational multi-center study in which data were collected on all consecutive patients admitted to any of the 43 participating ICUs during the study period who qualified for a withholding/withdrawal procedure according to French law. The theoretical organ donor eligibility of the patients once deceased was determined a posteriori according to current medical criteria for graft selection, as well as according to the withholding/withdrawal measures implemented and their impact on the time of death.
A total of 5,589 patients were admitted to the ICU during the study period, of whom 777 (14 %) underwent withholding/withdrawal measures. Of the 557 patients who died following a foreseeable circulatory arrest, 278 (50 %) presented a contraindication ruling out organ retrieval. Of the 279 patients who would have been eligible as organ donors regardless of measures implemented, cardiopulmonary support was withdrawn in only 154 of these patients, 70 of whom died within 120 min of the withdrawal of life-sustaining treatment. Brain-injured patients accounted for 29 % of all patients who qualified for the withholding/withdrawal of treatment, and 57 % of those died within 120 min of the withdrawal/withholding of treatment.
A significant number of patients who died during the study period in French ICUs under withholding/withdrawal conditions would have been eligible for organ donation. Brain-injured patients were more likely to die in circumstances which would have been compatible with such practice.
KeywordsTissue and organ procurement Withholding treatment Life support care Medical futility Fatal outcome Terminal care
- 5.Gries CJ, White DB, Truog RD et al (2013) An official American thoracic society/international society for heart and lung transplantation/society of critical care medicine/association of organ and procurement organizations/united network of organ sharing statement: ethical and policy considerations in organ donation after circulatory determination of death. Am J Respir Crit Care Med 188:103–109. doi:10.1164/rccm.201304-0714ST PubMedCrossRefGoogle Scholar
- 6.British Transplantation Society (2013) United Kingdom Guidelines. Transplantation from donors after deceased circulatory death. Available at: http://www.bts.org.uk/Documents/2013-02-04%20DCD%20guidelines.pdf. Accessed 14 Jul 2014
- 7.Organ and Tissue Authority, Australian National Government (2010) Protocol for donation after cardiac death. Available at: http://www.donatelife.gov.au/national-protocol-donation-and-cardiac-death. Accessed 14 Jul 2014
- 9.Cabrol C (2007) Organ procurement from non-heart-beating donors. Bull Acad Natl Méd 191:633–638. Available at: http://www.academie-medecine.fr/wp-content/uploads/2013/03/2007.3.pdf. Accessed 14 Jul 2014
- 10.Comité Consultatif National d’Ethique pour les sciences de la vie et de la santé (2011) Avis n°115: questions d’éthique relatives au prélèvement et au don d’organes à des fins de transplantation. Available at: http://www.ccne-ethique.fr/sites/default/files/publications/avis_115eng_0.pdf. Accessed 14 Jul 2014
- 12.Graftieaux J-P, Bollaert P-E, Haddad L et al (2012) Contribution of the ethics committee of the French Intensive Care Society to describing a scenario for implementing organ donation after Maastricht type III cardiocirculatory death in France. Ann Intensive Care 2:23. doi:10.1186/2110-5820-2-23 PubMedCentralPubMedCrossRefGoogle Scholar
- 16.Journal Officiel de la République Française du 23 avril 2005 (2005) Loi n° 2005-370 du 22 avril 2005 relative aux droits des malades et à la fin de vie. Available at: http://www.legifrance.gouv.fr. Accessed 14 Jul 2014
- 20.Lesieur O, Mamzer M-F, Leloup M et al (2013) 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. Ann Intensive Care 3:36. doi:10.1186/2110-5820-3-36 PubMedCentralPubMedCrossRefGoogle Scholar