Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Oct 9;25(1):110.
doi: 10.1186/s12910-024-01093-1.

Tensions between end-of-life care and organ donation in controlled donation after circulatory death: ICU healthcare professionals experiences

Matthieu Le Dorze  1   2   3 , Romain Barthélémy  4   5 , Olivier Lesieur  6 , Gérard Audibert  7 , Marie-Ange Azais  8 , Dorothée Carpentier  9 , Charles Cerf  10 , Gaëlle Cheisson  11 , Renaud Chouquer  12 , Vincent Degos  13   14   15 , Marion Fresco  16 , Fabien Lambiotte  17 , Emmanuelle Mercier  18 , Jérôme Morel  19 , Laurent Muller  20   21 , Erika Parmentier-Decrucq  22 , Sébastien Prin  23 , Armine Rouhani  24 , France Roussin  4   5 , Jean-Christophe Venhard  25 , Mathieu Willig  26 , Catherine Vernay  12 , Benjamin Chousterman  4   5 , Nancy Kentish-Barnes  27 ; CARE-M3 Research Group
Collaborators, Affiliations
Observational Study

Tensions between end-of-life care and organ donation in controlled donation after circulatory death: ICU healthcare professionals experiences

Matthieu Le Dorze et al. BMC Med Ethics. .

Abstract

Background: The development of controlled donation after circulatory death (cDCD) is both important and challenging. The tension between end-of-life care and organ donation raises significant ethical issues for healthcare professionals in the intensive care unit (ICU). The aim of this prospective, multicenter, observational study is to better understand ICU physicians' and nurses' experiences with cDCD.

Methods: In 32 ICUs in France, ICU physicians and nurses were invited to complete a questionnaire after the death of end-of-life ICU patients identified as potential cDCD donors who had either experienced the withdrawal of life-sustaining therapies alone or with planned organ donation (OD(-) and OD( +) groups). The primary objective was to assess their anxiety (State Anxiety Inventory STAI Y-A) following the death of a potential cDCD donor. Secondary objectives were to explore potential tensions experienced between end-of-life care and organ donation.

Results: Two hundred six ICU healthcare professionals (79 physicians and 127 nurses) were included in the course of 79 potential cDCD donor situations. STAI Y-A did not differ between the OD(-) and OD( +) groups for either physicians or nurses (STAI Y-A were 34 (27-38) in OD(-) vs. 32 (27-40) in OD( +), p = 0.911, for physicians and 32 (25-37) in OD(-) vs. 39 (26-37) in OD( +), p = 0.875, for nurses). The possibility of organ donation was a factor influencing the WLST decision for nurses only, and a factor influencing the WLST implementation for both nurses and physicians. cDCD experience is perceived positively by ICU healthcare professionals overall.

Conclusions: cDCD does not increase anxiety in ICU healthcare professionals compared to other situations of WLST. WLST and cDCD procedures could further be improved by supporting professionals in making their intentions clear between end-of-life support and the success of organ donation, and when needed, by enhancing communication between ICU physician and nurses.

Trial registration: This research was registered in ClinicalTrials.gov (Identifier: NCT05041023, September 10, 2021).

Keywords: Controlled donation after circulatory death; End-of-life care; Intensive Care Units; Organ donation; Withdrawal of life sustaining therapies.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Situations of potential cDCD donors and ICU Healthcare Professionals included. cDCD: controlled donation after circulatory death, WLST: withdrawal of life sustaining therapies, OD(-): WLST after OD had already been excluded, OD( +): WLST while OD is still under consideration
Fig. 2
Fig. 2
State-Anxiety (STAI Y-A) of ICU Healthcare Professionals (n = 206). STAI Y-A: State Anxiety Inventory, WLST: withdrawal of life sustaining therapies, OD(-): WLST after OD had already been excluded, OD( +): WLST while OD is still under consideration
See this image and copyright information in PMC

References

    1. Thuong M, Ruiz A, Evrard P, Kuiper M, Boffa C, Akhtar MZ, et al. New classification of donation after circulatory death donors definitions and terminology. Transpl Int. 2016;29(7):749–59. - PubMed
    1. Lomero M, Gardiner D, Coll E, Haase-Kromwijk B, Procaccio F, Immer F, et al. Donation after circulatory death today: an updated overview of the European landscape. Transpl Int. 2020;33(1):76–88. - PubMed
    1. Smith M, Dominguez-Gil B, Greer DM, Manara AR, Souter MJ. Organ donation after circulatory death: current status and future potential. Intensive Care Med. 2019;45(3):310–21. - PubMed
    1. Sprung CL, Ricou B, Hartog CS, Maia P, Mentzelopoulos SD, Weiss M, et al. Changes in end-of-life practices in European intensive care units from 1999 to 2016. JAMA. 2019;2:1–12. - PMC - PubMed
    1. Savoye E, Legeai C, Branchereau J, Gay S, Riou B, Gaudez F, et al. Optimal donation of kidney transplants after controlled circulatory death. Am J Transplant. 2021;21(7):2424–36. - PubMed

Publication types

Associated data

LinkOut - more resources