title: Cranioplasty with bandaging. New forms of limitation of life support and organ donation.
abstract: Most of transplanted organs are obtained from brain death (BD) donors. In neurocritical patients with catastrophic injuries and decompressive craniectomy (DC), which show a dreadful development in spite of this treatment, DC could be a futile tool to avoid natural progress to BD. We propose if cranial compressive bandage (cranioplasty with bandage) could be an ethically correct practice, similar to other life-sustaining treatment limitation (LSTL) common methods. Based on a clinical case, we contacted with the Assistance Ethics Committee and some bioethics professionals asking them two questions: 1) Is ethically correct to perform a cranioplasty with bandage in those patients with LSTL indication? 2) Thinking in organ donation possibility, is this option preferable? Conclusions 1) Cranioplasty with bandage could be considered an ethically acceptable LSTL practice, similar to other procedures. 2) It facilitates organ donation for transplant, which provides value-added because of its own social good. 3) In these cases, it is necessary to know previous patient's will or, in absentia, to obtain family consent after a detailed procedure report.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo. dolores.escudero@sespa.princast.es
authors.forename: D
authors.initials: D
authors.lastname: Escudero
authors.forename: L
authors.initials: L
authors.lastname: Cofiño
authors.forename: D
authors.initials: D
authors.lastname: Gracia
authors.forename: M
authors.initials: M
authors.lastname: Palacios
authors.forename: M
authors.initials: M
authors.lastname: Casares
authors.forename: L
authors.initials: L
authors.lastname: Cabré
authors.forename: P
authors.initials: P
authors.lastname: Simón
authors.forename: P
authors.initials: P
authors.lastname: Miranda
authors.forename: K
authors.initials: K
authors.lastname: Martínez
authors.forename: S
authors.initials: S
authors.lastname: Iribarren
authors.forename: I
authors.initials: I
authors.lastname: Saralegui
authors.forename: R M
authors.initials: RM
authors.lastname: Simó
authors.forename: B
authors.initials: B
authors.lastname: de León
authors.forename: V
authors.initials: V
authors.lastname: Español
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000941:ethics* / Q000706:statistics & numerical data*; D006801:Humans; D008020:Life Support Care / Q000941:ethics*; D008297:Male; D009927:Tissue and Organ Procurement / Q000941:ethics* / Q000379:methods*