Are terminally ill patients dying in the ICU suitable for non-heart beating organ donation?
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.


METHODS
Prospective observational study. Medical and Surgical ICUs in a tertiary university hospital.


METHODS
Consecutive patients younger than 70 years dying in the ICU after treatment withdrawal for dire neurological prognosis.


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 more closely.
Revelly
Jean-Pierre
JP
Surgical Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland. jrevelly@chuv.hospvd.ch
Imperatori
Luca
L
Maravic
Philippe
P
Schaller
Marie-Denise
MD
Chioléro
René
R
D000368:Aged; D006321:Heart; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D011446:Prospective Studies; D013557:Switzerland; D019452:Terminally Ill; D009927:Tissue and Organ Procurement; D028761:Withholding Treatment