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

Humans Tissue and Organ Procurement / ethics Terminal Care / ethics Intensive Care Units Male Female Prospective Studies France Adult Middle Aged Surveys and Questionnaires Attitude of Health Personnel Death Anxiety Physicians / psychology Tissue Donors Health Personnel / psychology Nurses / psychology Withholding Treatment / ethics
Controlled donation after circulatory death End-of-life care Intensive Care Units Organ donation Withdrawal of life sustaining therapies

Journal

BMC medical ethics
ISSN: 1472-6939
Titre abrégé: BMC Med Ethics
Pays: England
ID NLM: 101088680

Informations de publication

Date de publication:
09 Oct 2024
Historique:
received: 16 02 2024
accepted: 23 08 2024
medline: 10 10 2024
pubmed: 10 10 2024
entrez: 10 10 2024
Statut: epublish

Résumé

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

Sections du résumé

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

Identifiants

DOI: 10.1186/s12910-024-01093-1 PMID: 39385217
pubmed: 39385217
doi: 10.1186/s12910-024-01093-1
pii: 10.1186/s12910-024-01093-1
doi:

Banques de données

ClinicalTrials.gov
['NCT05041023']

Types de publication

Journal Article Observational Study Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

110

Investigateurs

Julien Charpentier (J)
Martin Cour (M)
Philippe Gouin (P)
Pierre-Grégoire Guinot (PG)
Florence Lallemant (F)
Benjamin Lebas (B)
Anne-Claire Lukaszewicz (AC)
Julien Mayaux (J)
Bruno Megarbane (B)
Pierre Perez (P)
Benjamin Rohaut (B)
Hodane Yonis (H)

Informations de copyright

© 2024. The Author(s).

Références

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.
doi: 10.1111/tri.12776
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.
doi: 10.1111/tri.13506
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.
doi: 10.1007/s00134-019-05533-0
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.
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.
Antoine C, Jasseron C, Dondero F, Savier E. French National Steering Committee of donors after circulatory death. Liver transplantation from controlled donors after circulatory death using normothermic regional perfusion: an initial French experience. Liver Transpl. 2020;26(11):1516–21.
doi: 10.1002/lt.25818
De Wolf J, Fadel G, Olland A, et al. Controlled donation after circulatory death lung transplantation: Results of the French protocol including in situ abdominal normothermic regional perfusion and ex vivo lung perfusion. J Heart Lung Transpl. 2023;42(8):1093–100.
doi: 10.1016/j.healun.2023.03.003
Lesieur O, Genteuil L, Leloup M. A few realistic questions raised by organ retrieval in the intensive care unit. Ann Transl Med. 2017;5(Suppl 4):S44.
doi: 10.21037/atm.2017.05.08
Da Silva IRF, Frontera JA. Worldwide barriers to organ donation. JAMA Neurol. 2015;72(1):112–8.
doi: 10.1001/jamaneurol.2014.3083
Le Dorze M, Martin-Lefèvre L, Santin G, Robert R, Audibert G, Megarbane B, et al. Critical pathways for controlled donation after circulatory death in France. Anaesth Crit Care Pain Med. 2022;41(2):101029.
Le Dorze M, Martouzet S, Cassiani-Ingoni E, Roussin F, Mebazaa A, Morin L, et al. “A delicate balance”-Perceptions and experiences of ICU physicians and nurses regarding controlled donation after circulatory death. A qualitative study. Transpl Int. 2022;35:10648.
doi: 10.3389/ti.2022.10648
Mandell MS, Zamudio S, Seem D, McGaw LJ, Wood G, Liehr P, et al. National evaluation of healthcare provider attitudes toward organ donation after cardiac death. Crit Care Med. 2006;34(12):2952–8.
doi: 10.1097/01.CCM.0000247718.27324.65
D’Alessandro AM, Peltier JW, Phelps JE. Understanding the antecedents of the acceptance of donation after cardiac death by healthcare professionals. Crit Care Med. 2008;36(4):1075–81.
doi: 10.1097/CCM.0b013e3181691b2b
Hart JL, Kohn R, Halpern SD. Perceptions of organ donation after circulatory determination of death among critical care physicians and nurses: a national survey. Crit Care Med. 2012;40(9):2595–600.
doi: 10.1097/CCM.0b013e3182590098
Bastami S, Matthes O, Krones T, Biller-Andorno N. Systematic review of attitudes toward donation after cardiac death among healthcare providers and the general public. Crit Care Med. 2013;41(3):897–905.
doi: 10.1097/CCM.0b013e31827585fe
Goudet V, Albouy-Llaty M, Migeot V, Pain B, Dayhot-Fizelier C, Pinsard M, et al. Does uncontrolled cardiac death for organ donation raise ethical questions? An opinion survey. Acta Anaesthesiol Scand. 2013;57(10):1230–6.
doi: 10.1111/aas.12179
Coleman NL, Bonner A. Exploring Australian intensive care physicians clinical judgement during donation after cardiac death: an exploratory qualitative study. Aust Crit Care. 2014;27(4):172–6.
doi: 10.1016/j.aucc.2014.04.007
Lee YY, Ranse K, Silvester W, Mehta A, Van Haren F. Attitudes and self-reported end-of-life care of Australian and New Zealand intensive care doctors in the context of organ donation after circulatory death. Anaesth Intensive Care. 2018;46(5):488–97.
doi: 10.1177/0310057X1804600510
Squires JE, Graham N, Coughlin M, Chassé M, Linklater S, Greenough M, et al. Barriers and enablers to organ donation after circulatory determination of death: a qualitative study exploring the beliefs of frontline intensive care unit professionals and organ donor coordinators. Transplant Direct. 2018;4(7):e368.
doi: 10.1097/TXD.0000000000000805
Milross LA, O’Donnell TG, Bucknall TK, Pilcher DV, Ihle JF. Exploring staff perceptions of organ donation after circulatory death. Aust Crit Care. 2020;33(2):175–80.
doi: 10.1016/j.aucc.2019.05.001
Milross L, O’Donnell T, Bucknall T, Pilcher D, Poole A, Reddi B, et al. Perceptions held by healthcare professionals concerning organ donation after circulatory death in an Australian intensive care unit without a local thoracic transplant service: A descriptive exploratory study. Aust Crit Care. 2022;35(4):430–7.
doi: 10.1016/j.aucc.2021.06.013
Antoine C, Bronchard R, Durin L and the members of the steering committee. Conditions for recovery of organs by donation after circulatory death in a health care facility authorized to recover organs. Agence de la biomédecine 2019. https://www.agence-biomedecine.fr/IMG/pdf/v7_guide_ddac_miii_novembre_2019_eng.pdf
Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the state-trait anxiety inventory 1983. Palo Alto: Consulting Psychologists Press; 1983.
Gauthier J, Bouchard S. A French-Canadian adaptation of the revised version of Spielberger’s State-Trait Anxiety Inventory. Can J Behaviour Sci. 1993;25(4):559–78.
Voultsos P, Koungali M, Psaroulis K, Boutou AK. Burnout syndrome and its association with anxiety and fear of medical errors among intensive care unit physicians: A cross-sectional study. Anaesth Intensive Care. 2020;48(2):134–42.
doi: 10.1177/0310057X20902780
Karabulut N, Gürçayır D, Yaman Aktaş Y, Kara A, Kızıloğlu B, Arslan B, et al. The effect of perceived stress on anxiety and sleep quality among healthcare professionals in intensive care units during the coronavirus pandemic. Psychol Health Med. 2021;26(1):119–30.
doi: 10.1080/13548506.2020.1856897
Lazar AE, Szederjesi J, Coman O, Elekes A, Suciaghi M, Grigorescu BL. Survey on anxiety and post-traumatic stress disorder in intensive care personnel during the COVID-19 pandemic in a medically under-resourced country. Healthcare (Basel). 2022;10(7):1160.
doi: 10.3390/healthcare10071160
Fenzke MN, Viante WJM, Aguiar BF, Gama B da S, Pimenta AM, Miranda FMD. Trait and state anxiety in healthcare professionals of intensive care unit. Rev Gaucha Enferm. 2023;44:e20230028.
Manara A, Shemie SD, Large S, Healey A, Baker A, Badiwala M, et al. Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery: A United Kingdom and Canadian proposal. Am J Transplant. 2020;20(8):2017–25.
doi: 10.1111/ajt.15775
Puybasset L, Bazin JE, Beloucif S, Bizouarn P, Crozier S, Devalois B, et al. Critical appraisal of organ procurement under Maastricht 3 condition. Ann Fr Anesth Reanim. 2014;33(2):120–7.
doi: 10.1016/j.annfar.2013.11.004
Graftieaux JP, Bollaert PE, Haddad L, Kentish-Barnes N, Nitenberg G, Robert R, et al. Contribution of the ethics committee of the French society of intensive care medicine to a scenario for the implementation of organ donation after Maastricht III-type cardiac death in France. Ann Fr Anesth Reanim. 2014;33(2):128–34.
doi: 10.1016/j.annfar.2014.01.003
Le Dorze M, Barthélémy R, Giabicani M, Audibert G, Cousin F, Gakuba C, et al. Continuous and deep sedation until death after a decision to withdraw life-sustaining therapies in intensive care units: A national survey. Palliat Med. 2023;37(8):1202–09.
Witjes M, Jansen NE, van der Hoeven JG, Abdo WF. Interventions aimed at healthcare professionals to increase the number of organ donors: a systematic review. Crit Care. 2019;23(1):227.
doi: 10.1186/s13054-019-2509-3

Auteurs

Matthieu Le Dorze (M)

Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France. matthieu.ledorze@aphp.fr.
INSERM, MASCOT, U942, Université Paris Cité, Paris, France. matthieu.ledorze@aphp.fr.
INSERM, CESP, U1018, Université Paris-Saclay, UVSQ, Villejuif, France. matthieu.ledorze@aphp.fr.

Romain Barthélémy (R)

Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France.
INSERM, MASCOT, U942, Université Paris Cité, Paris, France.

Olivier Lesieur (O)

Médecine Intensive Réanimation, CH La Rochelle, La Rochelle, France.

Gérard Audibert (G)

Department of Anaesthesia and Intensive Care, CHRU, Nancy, France.

Marie-Ange Azais (MA)

Médecine Intensive Réanimation, CHD Vendée, La Roche-Sur-Yon, France.

Dorothée Carpentier (D)

Department of Medical Intensive Care, Rouen University Hospital, Rouen, France.

Charles Cerf (C)

Department of Intensive Care, Foch Hospital, Suresnes, France.

Gaëlle Cheisson (G)

Département d'anesthésie Réanimation Chirurgicale - Coordination Des Prélèvements d'organes Et de Tissus - Hôpital de Bicêtre - GHU Paris Saclay - APHP, Kremlin-Bicêtre, France.

Renaud Chouquer (R)

Medical and Surgical Intensive Care, Annecy Hospital, Annecy, France.

Vincent Degos (V)

APHP, Department of Anesthesia, Critical Care and Peri-Operative Medicine, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
Clinical Research Group ARPE, Sorbonne University, Paris, France.
INSERM UMR 1141, PROTECT, Paris, France.

Marion Fresco (M)

Department of Anesthesia and Critical Care Medicine, Hôpital Laënnec, CHU Nantes, Nantes, France.

Fabien Lambiotte (F)

Service de Réanimation Polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France.

Emmanuelle Mercier (E)

Médecine Intensive Et Réanimation, CHU de Tours, CRICS-TRIGGERSEP Network, Tours, France.

Jérôme Morel (J)

Département d'anesthésie Et Réanimation, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France.

Laurent Muller (L)

Department of Anaesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France.
UR UM 103 IMAGINE, Faculty of Medicine, University of Montpellier, Nîmes, France.

Erika Parmentier-Decrucq (E)

Intensive Care Unit and Hyperbaric Center, Lille University Hospital, 59037, Lille Cedex, Lille, France.

Sébastien Prin (S)

CHU Dijon-Bourgogne, Service de Médecine Intensive Et Réanimation, Coordination Hospitalière de Prélèvement d'organes Et de Tissus, Dijon, France.

Armine Rouhani (A)

Service d'Anesthésie Réanimation Chirurgicale, CHU Nantes, Nantes, France.

France Roussin (F)

Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France.
INSERM, MASCOT, U942, Université Paris Cité, Paris, France.

Jean-Christophe Venhard (JC)

Pôle Anesthésie Réanimations - Coordination PMOT, CHRU Tours, Tours, France.

Mathieu Willig (M)

Departement of Anesthesiology and Intensive Care Medecine, Dijon University Hospital, Dijon, France.

Catherine Vernay (C)

Medical and Surgical Intensive Care, Annecy Hospital, Annecy, France.

Benjamin Chousterman (B)

Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France.
INSERM, MASCOT, U942, Université Paris Cité, Paris, France.

Nancy Kentish-Barnes (N)

Famiréa Research Group, Medical Intensive Care Unit, APHP, Hospital Saint-Louis, Paris, France.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Tensions between end-of-life care and organ...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Acquisition d'organes et de tissus › Tensions between end-of-life care and organ...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins terminaux › Tensions between end-of-life care and organ...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › Tensions between end-of-life care and organ...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Tensions between end-of-life care and organ...
questionsmedicales.fr › Régions géographiques › Europe › France › Tensions between end-of-life care and organ...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Tensions between end-of-life care and organ...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Tensions between end-of-life care and organ...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enquêtes et questionnaires › Tensions between end-of-life care and organ...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Attitude du personnel soignant › Tensions between end-of-life care and organ...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Mort › Tensions between end-of-life care and organ...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Émotions › Anxiété › Tensions between end-of-life care and organ...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Médecins › Tensions between end-of-life care and organ...
questionsmedicales.fr › Personnes › Donneurs de tissus › Tensions between end-of-life care and organ...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Tensions between end-of-life care and organ...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Infirmières et infirmiers › Tensions between end-of-life care and organ...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Abstention thérapeutique › Tensions between end-of-life care and organ...