Tensions between end-of-life care and organ donation in controlled donation after circulatory death: ICU healthcare professionals experiences.

Autor: Le Dorze M; Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France. matthieu.ledorze@aphp.fr.; INSERM, MASCOT, U942, Université Paris Cité, Paris, France. matthieu.ledorze@aphp.fr.; INSERM, CESP, U1018, Université Paris-Saclay, UVSQ, Villejuif, France. matthieu.ledorze@aphp.fr., Barthélémy R; Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France.; INSERM, MASCOT, U942, Université Paris Cité, Paris, France., Lesieur O; Médecine Intensive Réanimation, CH La Rochelle, La Rochelle, France., Audibert G; Department of Anaesthesia and Intensive Care, CHRU, Nancy, France., Azais MA; Médecine Intensive Réanimation, CHD Vendée, La Roche-Sur-Yon, France., Carpentier D; Department of Medical Intensive Care, Rouen University Hospital, Rouen, France., Cerf C; Department of Intensive Care, Foch Hospital, Suresnes, France., Cheisson G; Département d'anesthésie Réanimation Chirurgicale - Coordination Des Prélèvements d'organes Et de Tissus - Hôpital de Bicêtre - GHU Paris Saclay - APHP, Kremlin-Bicêtre, France., Chouquer R; Medical and Surgical Intensive Care, Annecy Hospital, Annecy, France., Degos V; APHP, Department of Anesthesia, Critical Care and Peri-Operative Medicine, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.; Clinical Research Group ARPE, Sorbonne University, Paris, France.; INSERM UMR 1141, PROTECT, Paris, France., Fresco M; Department of Anesthesia and Critical Care Medicine, Hôpital Laënnec, CHU Nantes, Nantes, France., Lambiotte F; Service de Réanimation Polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France., Mercier E; Médecine Intensive Et Réanimation, CHU de Tours, CRICS-TRIGGERSEP Network, Tours, France., Morel J; Département d'anesthésie Et Réanimation, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France., Muller L; Department of Anaesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.; UR UM 103 IMAGINE, Faculty of Medicine, University of Montpellier, Nîmes, France., Parmentier-Decrucq E; Intensive Care Unit and Hyperbaric Center, Lille University Hospital, 59037, Lille Cedex, Lille, France., Prin S; CHU Dijon-Bourgogne, Service de Médecine Intensive Et Réanimation, Coordination Hospitalière de Prélèvement d'organes Et de Tissus, Dijon, France., Rouhani A; Service d'Anesthésie Réanimation Chirurgicale, CHU Nantes, Nantes, France., Roussin F; Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France.; INSERM, MASCOT, U942, Université Paris Cité, Paris, France., Venhard JC; Pôle Anesthésie Réanimations - Coordination PMOT, CHRU Tours, Tours, France., Willig M; Departement of Anesthesiology and Intensive Care Medecine, Dijon University Hospital, Dijon, France., Vernay C; Medical and Surgical Intensive Care, Annecy Hospital, Annecy, France., Chousterman B; Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France.; INSERM, MASCOT, U942, Université Paris Cité, Paris, France., Kentish-Barnes N; Famiréa Research Group, Medical Intensive Care Unit, APHP, Hospital Saint-Louis, Paris, France.
Jazyk: angličtina
Zdroj: BMC medical ethics [BMC Med Ethics] 2024 Oct 09; Vol. 25 (1), pp. 110. Date of Electronic Publication: 2024 Oct 09.
DOI: 10.1186/s12910-024-01093-1
Abstrakt: Background: The development of controlled donation after circulatory death (cDCD) is both important and challenging. The tension between end-of-life care and organ donation raises significant ethical issues for healthcare professionals in the intensive care unit (ICU). The aim of this prospective, multicenter, observational study is to better understand ICU physicians' and nurses' experiences with cDCD.
Methods: In 32 ICUs in France, ICU physicians and nurses were invited to complete a questionnaire after the death of end-of-life ICU patients identified as potential cDCD donors who had either experienced the withdrawal of life-sustaining therapies alone or with planned organ donation (OD(-) and OD( +) groups). The primary objective was to assess their anxiety (State Anxiety Inventory STAI Y-A) following the death of a potential cDCD donor. Secondary objectives were to explore potential tensions experienced between end-of-life care and organ donation.
Results: Two hundred six ICU healthcare professionals (79 physicians and 127 nurses) were included in the course of 79 potential cDCD donor situations. STAI Y-A did not differ between the OD(-) and OD( +) groups for either physicians or nurses (STAI Y-A were 34 (27-38) in OD(-) vs. 32 (27-40) in OD( +), p = 0.911, for physicians and 32 (25-37) in OD(-) vs. 39 (26-37) in OD( +), p = 0.875, for nurses). The possibility of organ donation was a factor influencing the WLST decision for nurses only, and a factor influencing the WLST implementation for both nurses and physicians. cDCD experience is perceived positively by ICU healthcare professionals overall.
Conclusions: cDCD does not increase anxiety in ICU healthcare professionals compared to other situations of WLST. WLST and cDCD procedures could further be improved by supporting professionals in making their intentions clear between end-of-life support and the success of organ donation, and when needed, by enhancing communication between ICU physician and nurses.
Trial Registration: This research was registered in ClinicalTrials.gov (Identifier: NCT05041023, September 10, 2021).
(© 2024. The Author(s).)
Databáze: MEDLINE
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