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

OBJECTIVE

To evaluate the feasibility of implementing a program 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 a tertiary 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 more closely.