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

IF 3 1区哲学 Q1 ETHICS BMC Medical Ethics Pub Date : 2024-10-09 DOI:10.1186/s12910-024-01093-1

Matthieu Le Dorze, Romain Barthélémy, Olivier Lesieur, Gérard Audibert, Marie-Ange Azais, Dorothée Carpentier, Charles Cerf, Gaëlle Cheisson, Renaud Chouquer, Vincent Degos, Marion Fresco, Fabien Lambiotte, Emmanuelle Mercier, Jérôme Morel, Laurent Muller, Erika Parmentier-Decrucq, Sébastien Prin, Armine Rouhani, France Roussin, Jean-Christophe Venhard, Mathieu Willig, Catherine Vernay, Benjamin Chousterman, Nancy Kentish-Barnes

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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).

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循环死亡后控制性捐献中临终关怀与器官捐献之间的紧张关系：ICU医护人员的经验。

背景：循环死亡后控制性捐献（cDCD）的发展既重要又具有挑战性。临终关怀与器官捐献之间的矛盾给重症监护室（ICU）的医护人员带来了重大的伦理问题。这项前瞻性、多中心、观察性研究旨在更好地了解重症监护室医生和护士在 cDCD 方面的经验：在法国的 32 个 ICU 中，ICU 的医生和护士受邀在被确定为潜在 cDCD 捐赠者的 ICU 临终患者死亡后填写一份调查问卷，这些患者要么经历了单独的生命维持疗法的撤消，要么经历了有计划的器官捐赠（OD(-) 组和 OD( +) 组）。首要目标是评估潜在 cDCD 捐赠者死亡后他们的焦虑程度（国家焦虑量表 STAI Y-A）。次要目标是探讨临终关怀与器官捐献之间可能存在的紧张关系：共有 26 名 ICU 医护人员（79 名医生和 127 名护士）参与了 79 例潜在 cDCD 捐献者的研究。医生和护士的STAI Y-A在OD（-）组和OD（+）组之间没有差异（医生的STAI Y-A在OD（-）组为34（27-38），在OD（+）组为32（27-40），P = 0.911；护士的STAI Y-A在OD（-）组为32（25-37），在OD（+）组为39（26-37），P = 0.875）。器官捐献的可能性仅是影响护士做出 WLST 决定的一个因素，也是影响护士和医生实施 WLST 的一个因素。ICU 医护人员总体上对 cDCD 体验持积极态度。WLST和cDCD程序可通过支持专业人员明确其在生命末期支持和器官捐献成功之间的意图，以及在必要时通过加强ICU医生和护士之间的沟通来进一步改善：本研究已在ClinicalTrials.gov注册（标识符：NCT05041023，2021年9月10日）。

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来源期刊

BMC Medical Ethics MEDICAL ETHICS-

CiteScore

5.20

自引率

7.40%

发文量

108

审稿时长

>12 weeks

期刊介绍： BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.