title: Eligibility for organ donation following end-of-life decisions: a study performed in 43 French intensive care units.
abstract: OBJECTIVE
  A persistent 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patients who would have been eligible as organ donors regardless of measures implemented, cardiopulmonary support was withdrawn in only 154 of these patients, 70 of whom died within 120 min of the withdrawal of life-sustaining treatment.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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Réanimation, CH Saint-Louis, 17019, La Rochelle, France, olivier.lesieur@gmail.com.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lesieur
authors.forename: Maxime
authors.initials: M
authors.lastname: Leloup
authors.forename: Frédéric
authors.initials: F
authors.lastname: Gonzalez
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Mamzer
mesh_terms: D000368:Aged; D046148:Donor Selection; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care; D008297:Male; D028761:Withholding Treatment
references.citation: Intensive Care Med. 2008 Sep;34(9):1593-9
references.pmid: 18516588
references.citation: Intensive Care Med. 2014 Jun;40(6):788-97
references.pmid: 24664151
references.citation: Transpl Int. 2008 Sep;21(9):915
references.pmid: 18537924
references.citation: Am J Transplant. 2012 Dec;12(12):3414-24
references.pmid: 23016623
references.citation: J Palliat Med. 2012 Jan;15(1):16-9
references.pmid: 22150063
references.citation: Intensive Care Med. 2013 Jun;39(6):1128-32
references.pmid: 23435951
references.citation: J Palliat Med. 2013 Aug;16(8):828-30
references.pmid: 23758501
references.citation: Am J Respir Crit Care Med. 2013 Jul 1;188(1):103-9
references.pmid: 23815722
references.citation: J Med Ethics. 2013 Mar;39(3):130-4
references.pmid: 23222143
references.citation: Intensive Care Med. 2012 Mar;38(3):404-12
references.pmid: 22222566
references.citation: Anesth Analg. 2011 Mar;112(3):628-34
references.pmid: 21304154
references.citation: Lancet Neurol. 2012 May;11(5):414-9
references.pmid: 22494955
references.citation: Intensive Care Med. 2013 Jun;39(6):1009-18
references.pmid: 23559079
references.citation: Intensive Care Med. 2013 Aug;39(8):1452-9
references.pmid: 23702637
references.citation: Ann Intensive Care. 2013 Nov 07;3(1):36
references.pmid: 24199966
references.citation: Med Law Rev. 2011 Winter;19(1):86-116
references.pmid: 21282148
references.citation: Bioethics. 2014 Mar;28(3):127-37
references.pmid: 22762352
references.citation: Chest. 2010 Aug;138(2):289-97
references.pmid: 20363840
references.citation: Intensive Care Med. 2013 Nov;39(11):2031-3
references.pmid: 23912380
references.citation: N Engl J Med. 2014 Jun 26;370(26):2506-14
references.pmid: 24963569
references.citation: Intensive Care Med. 2014 Jan;40(1):96-8
references.pmid: 24072329
references.citation: Transplant Proc. 1995 Oct;27(5):2893-4
references.pmid: 7482956
references.citation: Ann Intensive Care. 2012 Jul 02;2(1):23
references.pmid: 22747673
references.citation: Curr Opin Organ Transplant. 2013 Apr;18(2):133-9
references.pmid: 23425786
references.citation: Crit Care Med. 2013 Dec;41(12):2677-87
references.pmid: 23939359
references.citation: Am J Transplant. 2009 Sep;9(9):2157-65
references.pmid: 19681825
references.citation: Am J Transplant. 2008 Feb;8(2):432-41
references.pmid: 18190657
references.citation: Crit Care Med. 2012 Mar;40(3):766-9
references.pmid: 21983365
references.citation: Intensive Care Med. 2013 Aug;39(8):1492-4
references.pmid: 23760688
references.citation: Prog Transplant. 2003 Dec;13(4):265-73
references.pmid: 14765718
references.citation: Transplant Proc. 2010 Dec;42(10):3949-50
references.pmid: 21168595
references.citation: Crit Care Med. 2012 Jan;40(1):233-8
references.pmid: 21926586