Ethical Controversies in Potential Organ Donors in the ED
Ethical Controversies in Potential Organ Donors in the ED
Background: On a daily basis, emergency physicians are confronted by patients with devastating neurological injuries and insults. Some of these patients, despite our best efforts, will not survive. However, from these tragedies, there may be benefit given to others who are awaiting organ transplantation. Steps taken in the emergency department (ED) can be critical to preserving the option of organ donation in patients whose neurologic insult places them on a potential path to declaration of brain death. Much of the literature on this subject has focused on the utilitarian value of clinical interventions in the potential organ donor to optimize the likelihood of effective organ procurement.
Case Presentation: In this article, we present an actual case that reveals additional ethical perspectives to consider in how emergency physicians manage patients in the ED who can be confidently predicted to progress to death, as attested by neurologic criteria, and become organ donors. The case involves a patient with a devastating, nonsurvivable intracerebral hemorrhage who rapidly progressed to hemodynamic instability.
Discussion: This case reveals how the current organ donor referral and maintenance system raises ethical tensions for emergency physicians and ED personnel.
Conclusion: This process imposes limitations on communication with patient surrogate decision-makers while calling for interventions with the primary purpose of benefiting off-site patients awaiting transplantation.
On a daily basis, emergency physicians are confronted with patients with devastating neurological injuries and insults. Despite our best efforts, some of these patients are destined to die from their intracerebral hemorrhage, ischemic stroke, or traumatic brain injury. Although the tragedy of this event is obvious for the patient and the patient's family, it may result in new hope for individuals awaiting organ transplantation. Emergency physicians commonly are the first doctors to encounter individuals at the interface between life and death, between trying to save the patient and preserving the option of organ donation in the patient who cannot be saved. This is especially true when considering donation after neurologic determination of death, which still represents the primary mechanism for deceased organ donation in the United States. Continuous hemodynamic management is required both to verifiably establish that brain death has taken place under established protocols and to maintain organ perfusion to allow effective procurement and transplantation.
It is estimated that every day, on average, 18 individuals die awaiting transplantation in the United States. There is retrospective evidence suggesting that early organ donor identification from the emergency department (ED) may be associated with increased organ procurement. However, this evidence does not take into account other ethical viewpoints beyond the utilitarian outcome of maximizing the number of organs procured. In this article, we present a case that reveals other ethical perspectives deserving consideration in how emergency physicians manage patients in the ED who may progress to death by neurologic criteria and become organ donors.
Abstract and Introduction
Abstract
Background: On a daily basis, emergency physicians are confronted by patients with devastating neurological injuries and insults. Some of these patients, despite our best efforts, will not survive. However, from these tragedies, there may be benefit given to others who are awaiting organ transplantation. Steps taken in the emergency department (ED) can be critical to preserving the option of organ donation in patients whose neurologic insult places them on a potential path to declaration of brain death. Much of the literature on this subject has focused on the utilitarian value of clinical interventions in the potential organ donor to optimize the likelihood of effective organ procurement.
Case Presentation: In this article, we present an actual case that reveals additional ethical perspectives to consider in how emergency physicians manage patients in the ED who can be confidently predicted to progress to death, as attested by neurologic criteria, and become organ donors. The case involves a patient with a devastating, nonsurvivable intracerebral hemorrhage who rapidly progressed to hemodynamic instability.
Discussion: This case reveals how the current organ donor referral and maintenance system raises ethical tensions for emergency physicians and ED personnel.
Conclusion: This process imposes limitations on communication with patient surrogate decision-makers while calling for interventions with the primary purpose of benefiting off-site patients awaiting transplantation.
Introduction
On a daily basis, emergency physicians are confronted with patients with devastating neurological injuries and insults. Despite our best efforts, some of these patients are destined to die from their intracerebral hemorrhage, ischemic stroke, or traumatic brain injury. Although the tragedy of this event is obvious for the patient and the patient's family, it may result in new hope for individuals awaiting organ transplantation. Emergency physicians commonly are the first doctors to encounter individuals at the interface between life and death, between trying to save the patient and preserving the option of organ donation in the patient who cannot be saved. This is especially true when considering donation after neurologic determination of death, which still represents the primary mechanism for deceased organ donation in the United States. Continuous hemodynamic management is required both to verifiably establish that brain death has taken place under established protocols and to maintain organ perfusion to allow effective procurement and transplantation.
It is estimated that every day, on average, 18 individuals die awaiting transplantation in the United States. There is retrospective evidence suggesting that early organ donor identification from the emergency department (ED) may be associated with increased organ procurement. However, this evidence does not take into account other ethical viewpoints beyond the utilitarian outcome of maximizing the number of organs procured. In this article, we present a case that reveals other ethical perspectives deserving consideration in how emergency physicians manage patients in the ED who may progress to death by neurologic criteria and become organ donors.
