Abstract Details

Title Ethical Issues in Patients Being Evaluated for Organ Donation After Circulatory Death

Topic Practice, Policy, and Ethics

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 14-002

Objective To systematically evaluate and describe the ethical issues identified in patients who are being evaluated for possible organ donation after circulatory death (DCD).

Background DCD refers to the procurement of organs for transplantation from patients whose death is diagnosed using cardio-respiratory criteria. Patients who are potential donors through a DCD pathway often have primary neurologic diagnoses and may lack decision-making capacity, and thus this is relevant for neurologists. Our local DCD policy requires a clinical ethics consultation (CEC) for all patients being evaluated for DCD.

Design/Methods Retrospective analysis of all adult patients who had a CEC and were evaluated for DCD. The cohort was identified using three databases (a neurocritical care clinical database, a bioethics consultation database, and the organ procurement organization’s database). Demographics, details of the CEC, and details about organ donation outcomes were extracted from the electronic medical record and databases.

Results 103 patients had a CEC about DCD. Average age was 46.9 years (range 18-65) and 45% were women. Diagnoses at time of death were stroke (44.3%; including 17.5% subarachnoid hemorrhage,14.6% ischemic stroke, 12.6% hemorrhagic stroke), post-cardiac arrest hypoxic-ischemic brain injury (18.4%), traumatic brain injury (17.5%), and cardiopulmonary disease (17.5%). Of 159 ethical issues identified, the most common included: treatment planning/end of life decision making (n=13); possible medically ineffective care/futility (n=12); and issues surround surrogate decision making or lack of surrogates (n=12). Additional ethical concerns included possible organ donation after brain death and conflict mediation within a patient’s family or between the team and the surrogate(s).

Conclusions In this cohort of patients being evaluated for DCD, >80% of the patients had primary neurologic diagnoses. Ethical challenges were common and three main categories were identified: making decisions about treatment and end-of-life care for critically ill patients; determining surrogate decision maker; and conflict among family members or between family members and medical teams.

Authors/Disclosures
Karen Hirsch, MD (Stanford University) PRESENTER	Dr. Hirsch has nothing to disclose.
Megan Cvitanovic, BS	Ms. Cvitanovic has nothing to disclose.
Holly K. Tabor, PhD	An immediate family member of Dr. Tabor has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Special Olympics Northern California. An immediate family member of Dr. Tabor has stock in IDD Empower AI LLC. The institution of Dr. Tabor has received research support from NIH. The institution of Dr. Tabor has received research support from WITH Foundation. The institution of Dr. Tabor has received research support from NIH.

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