Eligibility for organ donation following end-of-life decisions: a study performed in 43 French intensive care units

Abstract

Purpose: A persistent shortage of available organs for transplantation has driven French medical authorities to focus on organ retrieval from patients who die following the withdrawal of life-sustaining therapy. This study was designed to assess the theoretical eligibility of patients who have died in French intensive care units (ICUs) after a decision to withhold or withdraw life-sustaining therapy to organ donation.

Methods: This was an observational multi-center study in which data were collected on all consecutive patients admitted to any of the 43 participating ICUs during the study period who qualified for a withholding/withdrawal procedure according to French law. The theoretical organ donor eligibility of the patients once deceased was determined a posteriori according to current medical criteria for graft selection, as well as according to the withholding/withdrawal measures implemented and their impact on the time of death.

Results: A total of 5,589 patients were admitted to the ICU during the study period, of whom 777 (14 %) underwent withholding/withdrawal measures. Of the 557 patients who died following a foreseeable circulatory arrest, 278 (50 %) presented a contraindication ruling out organ retrieval. Of the 279 patients who would have been eligible as organ donors regardless of measures implemented, cardiopulmonary support was withdrawn in only 154 of these patients, 70 of whom died within 120 min of the withdrawal of life-sustaining treatment. Brain-injured patients accounted for 29 % of all patients who qualified for the withholding/withdrawal of treatment, and 57 % of those died within 120 min of the withdrawal/withholding of treatment.

Conclusion: A significant number of patients who died during the study period in French ICUs under withholding/withdrawal conditions would have been eligible for organ donation. Brain-injured patients were more likely to die in circumstances which would have been compatible with such practice.