Intensive Care Medicine

, Volume 40, Issue 9, pp 1323–1331 | Cite as

Eligibility for organ donation following end-of-life decisions: a study performed in 43 French intensive care units

  • Olivier Lesieur
  • Maxime Leloup
  • Frédéric Gonzalez
  • Marie-France Mamzer
Original

Abstract

Purpose

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.

Methods

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.

Results

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patients who would have been eligible as organ donors regardless of measures implemented, cardiopulmonary support was withdrawn in only 154 of these patients, 70 of whom died within 120 min of the withdrawal of life-sustaining treatment.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.

Conclusion

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.

Keywords

Tissue and organ procurement Withholding treatment Life support care Medical futility Fatal outcome Terminal care 

References

  1. 1.
    Kutsogiannis DJ, Asthana S, Townsend DR et al (2013) The incidence of potential missed organ donors in intensive care units and emergency rooms: a retrospective cohort. Intensive Care Med 39:1452–1459. doi:10.1007/s00134-013-2952-6 PubMedCrossRefGoogle Scholar
  2. 2.
    Kompanje EJO, Jansen NE, de Groot YJ (2013) “In plain language”: uniform criteria for organ donor recognition. Intensive Care Med 39:1492–1494. doi:10.1007/s00134-013-2986-9 PubMedCrossRefGoogle Scholar
  3. 3.
    Al-Khafaji A, Murugan R, Kellum JA (2013) What’s new in organ donation: better care of the dead for the living. Intensive Care Med 39:2031–2033. doi:10.1007/s00134-013-3038-1 PubMedCrossRefGoogle Scholar
  4. 4.
    Shemie SD, Baker AJ, Knoll G et al (2010) National recommendations for donation after cardiocirculatory death in Canada: donation after cardiocirculatory death in Canada. CMAJ 175(8):S1. doi:10.1503/cmaj.060895 CrossRefGoogle Scholar
  5. 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. 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. 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
  8. 8.
    Kootstra G, Daemen JH, Oomen AP (1995) Categories of non-heart-beating donors. Transplant Proc 27:2893–2894PubMedGoogle Scholar
  9. 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. 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
  11. 11.
    Puybasset L, Bazin J-E, Beloucif S et al (2014) Critical appraisal of organ procurement under Maastricht 3 condition. Ann Fr Anesth Réanimation 33:120–127. doi:10.1016/j.annfar.2013.11.004 CrossRefGoogle Scholar
  12. 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
  13. 13.
    Antoine C, Mourey F, Prada-Bordenave E, Steering committee on DCD program, (2014) How France launched its donation after cardiac death program. Ann Fr Anesth Réanimation 33:138–143. doi:10.1016/j.annfar.2013.11.018 CrossRefGoogle Scholar
  14. 14.
    Bradley JA, Pettigrew GJ, Watson CJ (2013) Time to death after withdrawal of treatment in donation after circulatory death (DCD) donors. Curr Opin Organ Transplant 18:133–139. doi:10.1097/MOT.0b013e32835ed81b PubMedCrossRefGoogle Scholar
  15. 15.
    Suntharalingam C, Sharples L, Dudley C et al (2009) Time to cardiac death after withdrawal of life-sustaining treatment in potential organ donors. Am J Transplant 9:2157–2165. doi:10.1111/j.1600-6143.2009.02758.x PubMedCrossRefGoogle Scholar
  16. 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
  17. 17.
    Manara AR, Murphy PG, O’Callaghan G (2012) Donation after circulatory death. Br J Anaesth 108:108–121. doi:10.1093/bja/aer357 CrossRefGoogle Scholar
  18. 18.
    Detry O, Laureys S, Faymonville M-E et al (2008) Organ donation after physician-assisted death. Transpl Int 21:915–915. doi:10.1111/j.1432-2277.2008.00701.x PubMedCrossRefGoogle Scholar
  19. 19.
    Smith TJ, Vota S, Patel S et al (2012) Organ donation after cardiac death from withdrawal of life support in patients with amyotrophic lateral sclerosis. J Palliat Med 15:16–19. doi:10.1089/jpm.2011.0239 PubMedCrossRefGoogle Scholar
  20. 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
  21. 21.
    Wind J, Snoeijs MGJ, Brugman CA et al (2012) Prediction of time of death after withdrawal of life-sustaining treatment in potential donors after cardiac death. Crit Care Med 40:766–769. doi:10.1097/CCM.0b013e318232e2e7 PubMedCrossRefGoogle Scholar
  22. 22.
    DeVita MA, Brooks MM, Zawistowski C et al (2008) Donors after cardiac death: validation of identification criteria (DVIC) study for predictors of rapid death. Am J Transplant 8:432–441. doi:10.1111/j.1600-6143.2007.02087.x PubMedCrossRefGoogle Scholar
  23. 23.
    Rabinstein AA, Yee AH, Mandrekar J et al (2012) Prediction of potential for organ donation after cardiac death in patients in neurocritical state: a prospective observational study. Lancet Neurol 11:414–419. doi:10.1016/S1474-4422(12)70060-1 PubMedCrossRefGoogle Scholar
  24. 24.
    Forte DN, Vincent JL, Velasco IT, Park M (2012) Association between education in EOL care and variability in EOL practice: a survey of ICU physicians. Intensive Care Med 38:404–412. doi:10.1007/s00134-011-2400-4 PubMedCrossRefGoogle Scholar
  25. 25.
    Wilkinson DJC, Truog RD (2013) The luck of the draw: physician-related variability in end-of-life decision-making in intensive care. Intensive Care Med 39:1128–1132. doi:10.1007/s00134-013-2871-6 PubMedCrossRefGoogle Scholar
  26. 26.
    Wilson ME, Rhudy LM, Ballinger BA et al (2013) Factors that contribute to physician variability in decisions to limit life support in the ICU: a qualitative study. Intensive Care Med 39:1009–1018. doi:10.1007/s00134-013-2896-x PubMedCrossRefGoogle Scholar
  27. 27.
    Cook D, Rocker G (2014) Dying with Dignity in the Intensive Care Unit. N Engl J Med 370:2506–2514. doi:10.1056/NEJMra1208795 PubMedCrossRefGoogle Scholar
  28. 28.
    Rady MY, Verheijde JL (2013) The science and ethics of withdrawing mechanical positive pressure ventilatory support in the terminally ill. J Palliat Med 16:828–830. doi:10.1089/jpm.2013.0166 PubMedCrossRefGoogle Scholar
  29. 29.
    Wilkinson D, Savulescu J (2014) A costly separation between withdrawing and withholding treatment in intensive care. Bioethics 28:127–137. doi:10.1111/j.1467-8519.2012.01981.x PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Kompanje EJO, van der Hoven B, Bakker J (2008) Anticipation of distress after discontinuation of mechanical ventilation in the ICU at the end of life. Intensive Care Med 34:1593–1599. doi:10.1007/s00134-008-1172-y PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Price D (2011) End-of-life treatment of potential organ donors: paradigm shifts in intensive and emergency care. Med Law Rev 19:86–116. doi:10.1093/medlaw/fwq032 PubMedCrossRefGoogle Scholar
  32. 32.
    Coggon J (2013) Elective ventilation for organ donation: law, policy and public ethics. J Med Ethics 39:130–134. doi:10.1136/medethics-2012-100992 PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Davila D, Ciria R, Jassem W et al (2012) Prediction models of donor arrest and graft utilization in liver transplantation from Maastricht-3 donors after circulatory death. Am J Transplant 12:3414–3424. doi:10.1111/j.1600-6143.2012.04242.x PubMedCrossRefGoogle Scholar
  34. 34.
    De Groot YJ, Lingsma HF, Bakker J et al (2012) External validation of a prognostic model predicting time of death after withdrawal of life support in neurocritical patients. Crit Care Med 40:233–238. doi:10.1097/CCM.0b013e31822f0633 PubMedCrossRefGoogle Scholar
  35. 35.
    Epker JL, Bakker J, Kompanje EJO (2011) The use of opioids and sedatives and time until death after withdrawing mechanical ventilation and vasoactive drugs in a Dutch Intensive Care Unit. Anesth Analg 112:628–634. doi:10.1213/ANE.0b013e31820ad4d9 PubMedCrossRefGoogle Scholar
  36. 36.
    Brieva J, Coleman N, Lacey J et al (2013) Prediction of death in less than 60 minutes following withdrawal of cardiorespiratory support in ICUs. Crit Care Med 41:2677–2687. doi:10.1097/CCM.0b013e3182987f38 PubMedCrossRefGoogle Scholar
  37. 37.
    Lewis J, Peltier J, Nelson H et al (2003) Development of the University of Wisconsin donation after cardiac death evaluation tool. Prog Transplant 13:265–273PubMedGoogle Scholar
  38. 38.
    Cooke CR, Hotchkin DL, Engelberg RA et al (2010) Predictors of time to death after terminal withdrawal of mechanical ventilation in the ICU. Chest 138:289–297. doi:10.1378/chest.10-0289 PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Pine JK, Goldsmith PJ, Ridgway DM et al (2010) Predicting donor asystole following withdrawal of treatment in donation after cardiac death. Transplant Proc 42:3949–3950. doi:10.1016/j.transproceed.2010.09.080 PubMedCrossRefGoogle Scholar
  40. 40.
    Shaw D, Elger B (2014) Persuading bereaved families to permit organ donation. Intensive Care Med 40:96–98. doi:10.1007/s00134-013-3096-4 PubMedCrossRefGoogle Scholar
  41. 41.
    Shemie SD, Hornby L, Baker A et al (2014) International guideline development for the determination of death. Intensive Care Med 40:788–797. doi:10.1007/s00134-014-3242-7 PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Olivier Lesieur
    • 1
  • Maxime Leloup
    • 1
  • Frédéric Gonzalez
    • 2
  • Marie-France Mamzer
    • 3
  1. 1.RéanimationCH Saint-LouisLa RochelleFrance
  2. 2.Réanimation Médico-ChirurgicaleCHU AvicenneBobignyFrance
  3. 3.EA 4569Université Paris DescartesParisFrance

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