Contribution of the ethics committee of the French society of intensive care medicine to a scenario for the implementation of organ donation after Maastricht III-type cardiac death in France.
French law allows organ donation after death due to cardiocirculatory arrest. In the Maastricht classification, type III non-heart-beating donors are those who experience cardiocirculatory arrest after the withdrawal of life-sustaining treatments. French authorities in charge of regulating organ donation (Agence de la Biomédecine, ABM) are considering organ collection from Maastricht type III donors. We describe a scenario for Maastricht type III organ donation that fully complies with the ethical norms governing care to dying patients. That organ donation may occur after death should have no impact on the care given to the patient and family. The dead-donor rule must be followed scrupulously: the organ retrieval procedure must neither cause nor hasten death. The decision to withdraw life-sustaining treatments, withdrawal modalities, and care provided to the patient and family must adhere strictly to the requirements set forth in patient-rights legislation (the 2005 Léonetti law in France) and should not be influenced in any way by the possibility of organ donation. A major ethical issue regarding the family is how best to transition from discussing treatment-withdrawal decisions to discussing possible organ retrieval for donation should the patient die rapidly after treatment withdrawal. Close cooperation between the healthcare team and the organ retrieval team is crucial to minimize the distress of family members during this transition. Modalities for implementing Maastricht type III organ donation are discussed here, including the best location for withdrawing life-sustaining treatments (operating room or intensive care unit).
Département d'anesthésie-réanimation, CHU de Reims, hôpital Robert-Debré, avenue du Général-Koenig, 51100 Reims, France. Electronic address: jpgraftieaux@chu-reims.fr.
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JP
Graftieaux
Service de réanimation médicale, CHU de Nancy, hôpital central, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France.
P-E
PE
Bollaert
Consultation douleur, CHU Saint-Louis, avenue Claude-Vellefaux, 75010 Paris, France.
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L
Haddad
Service de réanimation médicale, CHU Saint-Louis, avenue Claude-Vellefaux, 75010 Paris, France.
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N
Kentish-Barnes
Service de réanimation médicochirurgicale, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif cedex, France.
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G
Nitenberg
Service de réanimation médicale, CHU de Poitiers, hôpital Jean-Bernard, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
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R
Robert
Service de réanimation médicale, CHU de Nantes, Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 01, France.
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D
Villers
Service de réanimation médicochirurgicale, CHU Louis-Mourier, 92700 Colombes, France.
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D
Dreyfuss
D060666:Airway Extubation; D001294:Attitude to Health; D001926:Brain Death; D016265:Conflict of Interest; D003422:Critical Care; D003643:Death; D034462:Dissent and Disputes; D017041:Ethics Committees; D005602:France; D006323:Heart Arrest; D006801:Humans; D010348:Patient Care Team; D011368:Professional-Family Relations; D011379:Prognosis; D012955:Societies, Medical; D013727:Terminal Care / Q000941:ethics* / Q000331:legislation & jurisprudence / Q000592:standards; D020458:Third-Party Consent; D014019:Tissue Donors / Q000145:classification*; D020858:Tissue and Organ Harvesting / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards; D009927:Tissue and Organ Procurement / Q000941:ethics* / Q000331:legislation & jurisprudence / Q000592:standards; D028761:Withholding Treatment / Q000331:legislation & jurisprudence
Cardiocirculatory arrest; Organ donation; Treatment withdrawal