title: Palliative ICU beds for potential organ donors: an effective use of resources based on quality-adjusted life-years gained.
abstract: OBJECTIVE
  To evaluate whether the admission of a palliative patient to the intensive care unit for end-of-life care and consideration of organ donation provides an equivalent net benefit in quality-adjusted life-years (QALYs) compared with the admission of a non-palliative patient for active management.
  
  
  METHODS
  Relevant publications from the period 1995-2015 were reviewed to estimate the mean QALYs gained from ICU admission of a critically ill patient and mean QALYs gained from transplantation of solid organs from an organ donor. Australian audit data were used to estimate the likelihood of a palliative patient admitted to the ICU progressing to organ donation. We calculated probabilities of each outcome and developed an algorithm to illustrate possible pathways for a patient who may progress to organ donation.
  
  
  RESULTS
  A non-palliative ICU admission provides to the patient about 1.0 QALY per ICU bed-day. An ICU bed provided to a patient admitted to the ICU for palliation and consideration of organ donation results in 7.3 QALYs gained for the community per ICU bed-day.
  
  
  CONCLUSIONS
  The admission of a dying patient to the ICU when organ donation may be possible is of considerable community benefit, yielding an average of over seven times the QALYs per ICU bed-day compared with the average benefit for ICU patients expected to survive. When it is possible to offer end-of-life care in the ICU, it should not be denied on the basis of concerns about lack of benefit or inappropriate use of resources.
authors.affiliation: PA-Southside Clinical School, Faculty of Health Sciences, University of Queensland, Brisbane, QLD, Australia. l.nunnink@uq.edu.au.
authors.forename: Leo
authors.initials: L
authors.lastname: Nunnink
authors.affiliation: PA-Southside Clinical School, Faculty of Health Sciences, University of Queensland, Brisbane, QLD, Australia.
authors.forename: David A
authors.initials: DA
authors.lastname: Cook
mesh_terms: D001315:Australia; D003422:Critical Care; D006760:Hospitalization; D006801:Humans; D010166:Palliative Care; D019057:Quality-Adjusted Life Years; D013727:Terminal Care; D009927:Tissue and Organ Procurement