Published in:
01-05-2006 | Original
Are terminally ill patients dying in the ICU suitable for non-heart beating organ donation?
Published in: Intensive Care Medicine | Issue 5/2006
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Objective
To evaluate the feasibility of implementing a program of controlled
non-heart beating organ donation, in patients undergoing the withdrawal of
intensive care treatment.
Design and setting
Prospective observational study. Medical and Surgical ICUs in a tertiary university hospital.
Patients
Consecutive patients younger than 70 years dying in the ICU after treatment
withdrawal for dire neurological prognosis.
Measurements and results
We analyzed prospectively collected data from the ICU clinical information
system. Seventy-three of 516 ICU deaths (13%) were identified, equally
distributed among traumatic, stroke, and anoxic brain injury. The management
and the course in these three diagnostic categories were similar. All
patients underwent withdrawal of mechanical ventilation and half were
extubated. Median time to death was of 4.8 h (IQR 1.4–11.5). In 70% of
cases the patient received analgesia and 30% sedation. Such treatment was
not related to earlier death. Hypotension was observed in 50% of patients
during the 30 min preceding cardiac death.
Conclusions
With our current management of terminal patients controlled non-heart
beating organ procedure may be difficult due to the duration and variability
of the dying process. This observation suggests that we can perform better
by evaluating this process moreclosely.