Determining the impact of timing and of clinical factors during end-of-life decision-making in potential controlled donation after circulatory death donors

Autor: Koen S. Simons, Hans P C Sonneveld, Ewald M. Bronkhorst, Jelle L. Epker, Meint Volbeda, Nichon E. Jansen, Hans van der Hoeven, Marloes Witjes, Wilson F. Abdo, Angela M M Kotsopoulos, Piet Vos
Přispěvatelé: Intensive Care
Rok vydání: 2020
Předmět:
medicine.medical_specialty
futility
Tissue and Organ Procurement
lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4]
donation after circulatory death
withdrawal of life‐sustaining treatment
030230 surgery
Brief Communication
End of life decision
03 medical and health sciences
0302 clinical medicine
consent to organ donation
Intensive care
medicine
Immunology and Allergy
Humans
Pharmacology (medical)
Organ donation
Prospective Studies
Transplantation
business.industry
Glasgow Coma Scale
Circulatory death
Tissue Donors
Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10]
Death
Intensive Care Units
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
Donation
Emergency medicine
Observational study
Active treatment
decision‐making
business
Brief Communications
Zdroj: American Journal of Transplantation
American Journal of Transplantation, 20, 3574-3581
American Journal of Transplantation, 20, 12, pp. 3574-3581
American Journal of Transplantation, 20(12), 3574-3581. Wiley-Blackwell Publishing Ltd
ISSN: 1600-6135
3574-3581
Popis: Controlled donation after circulatory death (cDCD) occurs after a decision to withdraw life‐sustaining treatment and subsequent family approach and approval for donation. We currently lack data on factors that impact the decision‐making process on withdraw life‐sustaining treatment and whether time from admission to family approach, influences family consent rates. Such insights could be important in improving the clinical practice of potential cDCD donors. In a prospective multicenter observational study, we evaluated the impact of timing and of the clinical factors during the end‐of‐life decision‐making process in potential cDCD donors. Characteristics and medication use of 409 potential cDCD donors admitted to the intensive care units (ICUs) were assessed. End‐of‐life decision‐making was made after a mean time of 97 hours after ICU admission and mostly during the day. Intracranial hemorrhage or ischemic stroke and a high APACHE IV score were associated with a short decision‐making process. Preserved brainstem reflexes, high Glasgow Coma Scale scores, or cerebral infections were associated with longer time to decision‐making. Our data also suggest that the organ donation request could be made shortly after the decision to stop active treatment and consent rates were not influenced by daytime or nighttime or by the duration of the ICU stay.
For potential donation after circulatory death donors, the authors assess the end‐of‐life decision‐making process from admission to the decision to withdraw life‐sustaining treatment and show that consent rates for organ donation are not associated with either intensive care unit stay duration or day‐ versus nighttime family approach.
Databáze: OpenAIRE
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