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

Revelly, Jean-Pierre ; Imperatori, Luca ; Maravic, Philippe ; Schaller, Marie-Denise ; Chioléro, René

In: Intensive Care Medicine, 2006, vol. 32, no. 5, p. 708-712

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    Title
    • Are terminally ill patients dying in the ICU suitable for non-heart beating organ donation?
    Author
    • Revelly, Jean-Pierre. Surgical Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland
    • Imperatori, Luca. Transplantation Centre, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland
    • Maravic, Philippe. Surgical Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland
    • Schaller, Marie-Denise. Medical Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland
    • Chioléro, René. Surgical Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:314640
    Summary
    Objective: To evaluate the feasibility of implementing aprogram of controlled non-heart beating organ donation, in patients undergoing the withdrawal of intensive care treatment. Design and setting: Prospective observational study. Medical and Surgical ICUs in atertiary university hospital. Patients: Consecutive patients younger than 70 years dying in the ICU after treatment withdrawal for dire neurological prognosis. Measurements and 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 moreclosely