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Peetz AB, Kuzemchak MD, Streams JR, Patel MB, Guillamondegui OD, Dennis BM, Betzold RD, Gunter OL, Karp SJ, Beskow LM. Regional ethics of surgeon resuscitation for organ transplantation after lethal injury. Surgery 2021; 169:1532-1535. [PMID: 33436273 PMCID: PMC8631573 DOI: 10.1016/j.surg.2020.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/04/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma patients may present with nonsurvivable injuries, which could be resuscitated for future organ transplantation. Trauma surgeons face an ethical dilemma of deciding whether, when, and how to resuscitate a patient who will not directly benefit from it. As there are no established guidelines to follow, we aimed to describe resuscitation practices for organ transplantation; we hypothesized that resuscitation practices vary regionally. METHOD Over a 3-month period, we surveyed trauma surgeons practicing in Levels I and II trauma centers within a single state using an instrument to measure resuscitation attitudes and practices for organ preservation. Descriptive statistics were calculated for practice patterns. RESULTS The survey response rate was 51% (31/60). Many (81%) had experience with resuscitations where the primary goal was to preserve potential for organ transplantation. Many (90%) said they encountered this dilemma at least monthly. All respondents were willing to intubate; most were willing to start vasopressors (94%) and to transfuse blood (84%) (range, 1 unit to >10 units). Of respondents, 29% would resuscitate for ≥24 hours, and 6% would perform a resuscitative thoracotomy. Respect for patients' dying process and future organ quality were the factors most frequently considered very important or important when deciding to stop or forgo resuscitation, followed closely by concerns about excessive resource use. CONCLUSION Trauma surgeons' regional resuscitation practices vary widely for this patient population. This variation implies a lack of professional consensus regarding initiation and extent of resuscitations in this setting. These data suggest this is a common clinical challenge, which would benefit from further study to determine national variability, areas of equipoise, and features amenable to practice guidelines.
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Affiliation(s)
- Allan B Peetz
- Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN; Surgical Services, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN; Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN.
| | | | - Jill R Streams
- Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN
| | - Mayur B Patel
- Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN; Surgical Services, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN; Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt Center for Health Services Research, Nashville, TN
| | - Oscar D Guillamondegui
- Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN
| | - Bradley M Dennis
- Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Surgical Services, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
| | - Richard D Betzold
- Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN
| | - Oliver L Gunter
- Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN
| | - Seth J Karp
- Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN; Surgical Services, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN; Division of Hepatobiliary Surgery & Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
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Abstract
Palliative and end-of-life care, once the purview of oncologists and intensivists, has also become the responsibility of the emergency physician. As our population ages and medical technology enables increased longevity, it is essential that all medical professionals know how to help patients negotiate the balance between quantity and quality of life. Emergency physicians have the opportunity to educate patients and their loved ones on how to best accomplish their goals of care while also enhancing quality of life through treatment of symptoms. The emergency physician must be aware of the ethical and medico-legal parameters that govern decision making.
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Rady MY, McGregor JL, Verheijde JL. Transparency and accountability in mass media campaigns about organ donation: a response to Morgan and Feeley. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:869-876. [PMID: 23354495 DOI: 10.1007/s11019-013-9466-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We respond to Morgan and Feeley's critique on our article "Mass Media in Organ Donation: Managing Conflicting Messages and Interests." We noted that Morgan and Feeley agree with the position that the primary aims of media campaigns are: "to educate the general public about organ donation process" and "help individuals make informed decisions" about organ donation. For those reasons, the educational messages in media campaigns should not be restricted to "information from pilot work or focus groups" but should include evidence-based facts resulting from a comprehensive literature research. We consider the controversial aspects about organ donation to be relevant, if not necessary, educational materials that must be disclosed in media campaigns to comply with the legal and moral requirements of informed consent. With that perspective in mind, we address the validity of Morgan and Feeley's claim that media campaigns have no need for informing the public about the controversial nature of death determination in organ donation. Scientific evidence has proven that the criteria for death determination are inconsistent with the Uniform Determination of Death Act and therefore potentially harmful to donors. The decision by campaign designers to use the statutory definition of death without disclosing the current controversies surrounding that definition does not contribute to improved informed decision making. We argue that if Morgan and Feeley accept the important role of media campaigns to enhance informed decision making, then critical controversies should be disclosed. In support of that premise, we will outline: (1) the wide-spread scientific challenges to brain death as a concept of death; (2) the influence of the donor registry and team-huddling on the medical care of potential donors; (3) the use of authorization rather than informed consent for donor registration; (4) the contemporary religious controversy; and (5) the effects of training desk clerks as organ requestors at the Department of Motor Vehicles offices. We conclude that organ donation is a medical procedure subject to all the ethical obligations that the medical profession must uphold including that of transparency and truthfulness.
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Affiliation(s)
- Mohamed Y Rady
- Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA,
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