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Kim SH, Jang JH, Kim YZ, Kim KH, Nam TM. Recent Trends in the Withdrawal of Life-Sustaining Treatment in Patients with Acute Cerebrovascular Disease : 2017-2021. J Korean Neurosurg Soc 2024; 67:73-83. [PMID: 37454676 PMCID: PMC10788555 DOI: 10.3340/jkns.2023.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/07/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE The Act on Life-Sustaining Treatment (LST) decisions for end-of-life patients has been effective since February 2018. An increasing number of patients and their families want to withhold or withdraw from LST when medical futility is expected. This study aimed to investigate the status of the Act on LST decisions for patients with acute cerebrovascular disease at a single hospital. METHODS Between January 2017 and December 2021, 227 patients with acute cerebrovascular diseases, including hemorrhagic stroke (n=184) and ischemic stroke (n=43), died at the hospital. The study period was divided into the periods before and after the Act. RESULTS The duration of hospitalization decreased after the Act was implemented compared to before (15.9±16.1 vs. 11.2±18.6 days, p=0.127). The rate of obtaining consent for the LST plan tended to increase after the Act (139/183 [76.0%] vs. 27/44 [61.4%], p=0.077). Notably, none of the patients made an LST decision independently. Ventilator withdrawal was more frequently performed after the Act than before (52/183 [28.4%] vs. 0/44 [0%], p<0.001). Conversely, the rate of organ donation decreased after the Act was implemented (5/183 [2.7%] vs. 6/44 [13.6%], p=0.008). Refusal to undergo surgery was more common after the Act was implemented than before (87/149 [58.4%] vs. 15/41 [36.6%], p=0.021) among the 190 patients who required surgery. CONCLUSION After the Act on LST decisions was implemented, the rate of LST withdrawal increased in patients with acute cerebrovascular disease. However, the decision to withdraw LST was made by the patient's family rather than the patient themselves. After the execution of the Act, we also observed an increased rate of refusal to undergo surgery and a decreased rate of organ donation. The Act on LST decisions may reduce unnecessary treatments that prolong end-of-life processes without a curative effect. However, the widespread application of this law may also reduce beneficial treatments and contribute to a decline in organ donation.
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Affiliation(s)
- Seung Hwan Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ji Hwan Jang
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kyu Hong Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Taek Min Nam
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Cattaneo C, Urakcheeva I, Giacomini G, Stazi MA, Lana S, Arnofi A, Salemi M, Toccaceli V. Attitude and concerns of healthy individuals regarding post-mortem brain donation. A qualitative study on a nation-wide sample in Italy. BMC Med Ethics 2023; 24:104. [PMID: 38012766 PMCID: PMC10683267 DOI: 10.1186/s12910-023-00980-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Collecting post-mortem brain tissue is essential, especially from healthy "control" individuals, to advance knowledge on increasingly common neurological and mental disorders. Yet, healthy individuals, on which this study is focused, are still understudied. The aim of the study was to explore, among healthy potential brain donors and/or donors' relatives, attitude, concerns and opinion about post-mortem brain donation (PMBD). METHODS A convenience sampling of the general population (twins and their non-twin contacts) was adopted. From June 2018 to February 2019, 12 focus groups were conducted in four Italian cities: Milan, Turin, Rome and Naples, stratified according to twin and non-twin status. A qualitative content analysis was performed with both deductive and inductive approaches. Emotional interactions analysis corroborated results. RESULTS One hundred and three individuals (49-91 yrs of age) participated. Female were 60%. Participants had scarse knowledge regarding PMBD. Factors affecting attitude towards donation were: concerns, emotions, and misconceptions about donation and research. Religion, spirituality and secular attitude were implied, as well as trust towards research and medical institutions and a high degree of uncertainty about brain death ascertainment. Family had a very multifaceted central role in decision making. A previous experience with neurodegenerative diseases seems among factors able to favour brain donation. CONCLUSIONS The study sheds light on healthy individuals' attitudes about PMBD. Brain had a special significance for participants, and the ascertainment of brain death was a source of debate and doubt. Our findings emphasise the importance of targeted communication and thorough information to promote this kind of donation, within an ethical framework of conduct. Trust in research and health professionals emerged as an essential factor for a collaborative attitude towards donation and informed decision making in PMBD.
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Affiliation(s)
- Chiara Cattaneo
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | | | - Gianmarco Giacomini
- Centre of Reference for Mental Health and Behavioural Sciences, Istituto Superiore di Sanità, Rome, Italy
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - Maria Antonietta Stazi
- Centre of Reference for Mental Health and Behavioural Sciences, Istituto Superiore di Sanità, Rome, Italy
| | - Susanna Lana
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Antonio Arnofi
- Centre of Reference for Mental Health and Behavioural Sciences, Istituto Superiore di Sanità, Rome, Italy
| | - Miriam Salemi
- Centre of Reference for Mental Health and Behavioural Sciences, Istituto Superiore di Sanità, Rome, Italy
| | - Virgilia Toccaceli
- Centre of Reference for Mental Health and Behavioural Sciences, Istituto Superiore di Sanità, Rome, Italy.
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Brain Donation Decisions as Disease Specific Behaviors: An Elucidation of the Donation Process in the Context of Essential Tremor. Tremor Other Hyperkinet Mov (N Y) 2022; 12:25. [PMID: 36072893 PMCID: PMC9414733 DOI: 10.5334/tohm.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022] Open
Abstract
Brain donation is a challenging process, comprising four sequential stages: (1) the brain donation decision, (2) pre-mortem arrangements and follow up, (3) specimen collection and (4) tissue processing. It is important to understand the factors that are pertinent to each stage. Currently, there is extensive information on factors that involve donor’s personal and cultural backgrounds and how these could affect the process. However, little is known about disease-specific factors that influence the process. The Essential Tremor Centralized Brain Repository was established in 2003, and after nearly 20 years of collecting essential tremor (ET) brain tissue, we are well-positioned to discuss the brain donation process from a disease-specific standpoint. In the current manuscript, we discuss ET disease-specific factors that influence the first two stages of the brain donation process. We center our discussion around three points: (1) factors that influence the patient’s decision to donate, (2) the involvement of next of kin in the donation, and (3) the rationale for enrolling patients prospectively and evaluating them longitudinally before the anatomical gift takes place. This discussion shares our understanding of the background from which our repository operates and may be of value for other brain banks that study similar neurodegenerative diseases.
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Song H, Oh SH, Woo HR. Brain Death and Its Prediction in Out-of-Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management. Diagnostics (Basel) 2022; 12:diagnostics12051190. [PMID: 35626345 PMCID: PMC9140750 DOI: 10.3390/diagnostics12051190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023] Open
Abstract
Evolution toward brain death (BD) in out-of-hospital cardiac arrest patients with targeted temperature management (TTM) provides opportunities for organ donation. However, knowledge regarding BD in these patients is limited. We retrospectively analyzed the TTM registry of one hospital where life-sustaining therapy was not withdrawn. In-hospital death patients were categorized into BD and non-BD groups. We explored the process of evolution toward BD and its predictors by comparing the serial measurements of clinical variables and the results of various prognostic tests between the two groups. Of the 121 patients who died before hospital discharge, 19 patients (15.7%) developed BD at a median of 6 (interquartile range, 5.0–7.0) days after cardiac arrest. Four patients with pupillary light reflexes at 48 h eventually developed BD. The area under the curves of the gray-to-white matter ratio (GWR) on early brain computed tomography images and the level of S100 calcium-binding protein B (S100B) at 72 h were 0.67 (95% CI, 0.55–0.77) and 0.70 (95% CI, 0.55–0.83), respectively. In conclusion, approximately one-sixth of all in-hospital deaths were diagnosed with BD at a median of 6 days after cardiac arrest. The use of GWR and serial S100B measurements may help to screen potential BD.
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Affiliation(s)
- Hwan Song
- Department of Emergency Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Sang Hoon Oh
- Department of Emergency Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-2-2258-1988; Fax: +82-2-2258-1997
| | - Hye Rim Woo
- Department of Emergency Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
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Park SY, Kim H, Park KH, Park SM, Lee DE, Jung YH, Jeong W, Park KH. Exploring the experiences and perspectives of emergency physicians on brain death organ tissue donation after the Life-Sustaining Treatment Decision Act. KOREAN JOURNAL OF TRANSPLANTATION 2022; 36:29-36. [PMID: 35769432 PMCID: PMC9235530 DOI: 10.4285/kjt.22.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/03/2022] [Accepted: 03/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background This study explored emergency physicians' experiences and perspectives related to brain death organ tissue donation (OTD) after the enforcement of the Life-Sustaining Treatment (LST) Decision Act in Korea. Methods Using the Braun and Clarke thematic analysis method, this qualitative study analyzed interview data-comprising experiences and perspectives of brain death OTD since the LST Decision Act-of 10 emergency physicians who specialized in targeted temperature management (TTM) and cared for post-cardiac arrest patients. Results Data analysis revealed 13 subthemes and 5 themes the LST Decision Act is easier to explain to family members than brain death OTD, but it does not fit well in an emergency medical setting; many family members decide to stop LST even before physicians mention brain death or OTD; family members view stopping LST as being about comforting patients without bothering them, and decision-makers are therefore no longer willing to choose OTD; stopping LST does not always result in brain death, but cases of brain death are preceded by stopping LST; and since the LST Decision Act, the number of TTM cases and potential brain death donors has decreased. Conclusions Unless a supplementary policy that connects stopping LST to brain death OTD is prepared, the withdrawal of LST in patients resuscitated after cardiac arrest is expected to continue, and brain death OTD is expected to decrease.
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Affiliation(s)
- Song Yi Park
- Department of Emergency Medicine, Dong-A University College of Medicine, Busan, Korea
- Department of Medical Education, Dong-A University College of Medicine, Busan, Korea
| | - Hyun Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kwi Hwa Park
- Department of Medical Education, Gachon University College of Medicine, Incheon, Korea
| | - Seung Min Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dong Eun Lee
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Wonjoon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hye Park
- Department of Medical Education, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Emergency Medicine, Wonju Severance Christian Hospital, Wonju, Korea
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Lee DE, Kim H, Park KH, Park SY, Park SM, Jung YH, Jeong W, Park KH. Analysis of Factors Affecting Emergency Physicians' Attitudes toward Deceased Organ & Tissue Donation. J Korean Med Sci 2021; 36:e329. [PMID: 34931495 PMCID: PMC8688344 DOI: 10.3346/jkms.2021.36.e329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study aimed to investigate differences in knowledge, and attitudes toward deceased organ and tissue donation of emergency physicians. Additionally, we analyzed factors affecting the attitudes toward deceased organ and tissue donation. METHODS We conducted a survey of specialists and residents registered with the Korean Society of Emergency Medicine in December 2020. The respondents' sex, age, position, personal registration for organ donation, experience of soliciting organ donation, participation in related education, knowledge, and attitude about brain death organ donation, and attitude toward stopping life-sustaining treatments were investigated. According to the characteristics of the respondents (specialists or residents, experience and education on organ and tissue donation), their knowledge and attitude toward deceased organ donation were compared. Stepwise hierarchical multiple regression analysis was used to investigate the factors affecting the attitudes toward deceased organ and tissue donation. RESULTS Of the total 428 respondents, there were 292 emergency medicine specialists and 136 medical residents. Specialists and those who registered or wished to donate organs had higher knowledge and attitude scores regarding deceased organ and tissue donation. Those who had experience recommending organ and tissue donation more than 6 times had higher knowledge scores on deceased organ and tissue donation and higher overall scores in attitude. Those who received education from the Korean Organ Donation Agency had higher knowledge scores. Specialists, and those who wished to donate or had registered as organ donors and had a higher life-sustaining treatment attitude score and knowledge about deceased organ and tissue donation, had more positive attitudes toward deceased organ and tissue donation. CONCLUSION For more potential deceased organ and tissue donors to be referred for donation, there should be continuous education for emergency physicians on brain-dead organ and tissue donation-related knowledge and procedures. In addition, institutional or systematic improvements that can lead to organ donation when deciding on the withdrawal of life-sustaining treatment should be considered.
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Affiliation(s)
- Dong Eun Lee
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Kwi Hwa Park
- Department of Medical Education, Gachon University College of Medicine, Incheon, Korea
| | - Song Yi Park
- Department of Emergency Medicine, College of Medicine, Dong-A University, Busan, Korea
- Department of Medical Education, College of Medicine, Dong-A University, Busan, Korea
| | - Seung Min Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University, Gwangju, Korea
| | - Wonjoon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hye Park
- Department of Medical Education, Yonsei University, Wonju College of Medicine, Wonju, Korea
- Department of Emergency Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
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Effect of a multidisciplinary program to improve organ donation in the emergency department. Eur J Emerg Med 2021; 28:58-63. [PMID: 32976312 DOI: 10.1097/mej.0000000000000752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND IMPORTANCE As the emergency department (ED) is an important source of potential organ donors, it may play an important role in the organ donation process. OBJECTIVE To assess the effectiveness of the multidisciplinary organ donation improvement program (ODIP) on identifying potential donors and improving organ donation in South Korean EDs. DESIGN, SETTINGS, AND PARTICIPANTS This study was a retrospective, observational study of the ED-inclusive ODIP implemented in 55 tertiary teaching hospitals contracted with the Korea Organ Donation Agency (KODA) since 2014. The inclusion criteria were: patients in the ED with a serious brain injury and futile prognosis or expected death of the patient within a few days, no contraindications for organ donation, and no objections registered in the donor registry. INTERVENTION The ED-inclusive multidisciplinary approach was implemented to improve organ donation. It included regular meetings of the ODIP committee, hospital visits and staff education, improvement of notifications, and support of a coordination team. OUTCOMES MEASURE AND ANALYSIS We assessed the changes in the number of deceased organ donors per year and notifications of potential brain-dead donors by medical staff after the implementation of the new ED-inclusive ODIP. The entire organ donation process was monitored and measured. RESULTS There was a significant increase in deceased organ donors per million population after the implementation of the ED-inclusive multidisciplinary ODIP of KODA compared to the pre-intervention period: 5.21 vs. 9.72, difference 4.51 (95% confidence interval 2.11-6.91). During the study period, the proportion of deceased organ donors occurred from KODA-contracted hospitals increased from 25.3 to 50.3% in South Korea's total deceased organ donors. Emergency physicians of KODA-contracted hospitals notified increasingly more potential brain-dead donors each year throughout the study period (36 in 2014 vs. 135 in 2018). The longer the period contracted with KODA, the higher the potential brain-death identification rates (P < 0.001). CONCLUSION In this retrospective study, the implementation of multidisciplinary ODIP in the ED led to significantly higher deceased organ donors per million population and awareness of potential brain-dead donors in South Korea.
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