Advertisement

Emergency Medicine and Transplantation

  • Matjaž Zwitter
Chapter

Abstract

The world of an intensive care unit is a volatile mixture of rapid decisions and actions, great hopes and frequent disappointments, bringing the severely ill back to life and facing death, limited communication with patients, and difficult communication with family members. While some patients recover from severe injuries and apparently hopeless situations, others deteriorate despite all efforts of the medical team. A moment when further intensive treatment is considered to be futile should preferably be made by consensus of the medical team and then communicated to the family. In such a situation, the withholding or withdrawal of intensive medical procedures is justified. Only after confirmation of death are the relatives approached with information on potential organ donation. In the absence of a person’s advance directives, some countries allow removal of organs for transplantation regardless of the opinion of family members; nevertheless, a compassionate explanation is preferable and will most often result in consent.

Keywords

Withholding intensive care Withdrawal of intensive care Futile intensive care Determining death Organ transplantation 

Reference

  1. 1.

Suggested Reading

  1. de Groot J, van Hoek M, Hoedemaekers C, Hoitsma A, Smeets W, Vernooij-Dassen M, van Leeuwen E. Decision making on organ donation: the dilemmas of relatives of potential brain dead donors. BMC Med Ethics. 2015;16:64.  https://doi.org/10.1186/s12910-015-0057-1.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Godfrey G, Hilton A, Bellomo R. To treat or not to treat: withholding treatment in the ICU. Curr Opin Crit Care. 2013;19:624–9.  https://doi.org/10.1097/MCC.0000000000000036.CrossRefPubMedGoogle Scholar
  3. Goede M, Wheeler M. Advance directives, living wills, and futility in perioperative care. Surg Clin North Am. 2015;95:443–51.  https://doi.org/10.1016/j.suc.2014.10.005.CrossRefPubMedGoogle Scholar
  4. Kostakou E, Rovina N, Kyriakopoulou M, Koulouris NG, Koutsoukou A. Critically ill cancer patient in intensive care unit: issues that arise. J Crit Care. 2014;29:817–22.  https://doi.org/10.1016/j.jcrc.2014.04.007.CrossRefPubMedGoogle Scholar
  5. Lindberg C, Sivberg B, Willman A, Fagerström C. A trajectory towards partnership in care—patient experiences of autonomy in intensive care: a qualitative study. Intensive Crit Care Nurs. 2015;31:294–302.  https://doi.org/10.1016/j.iccn.2015.04.003.CrossRefPubMedGoogle Scholar
  6. Mentzelopoulos SD, Mantzanas M, van Belle G, Nichol G. Evolution of European Union legislation on emergency research. Resuscitation. 2015;91:84–91.  https://doi.org/10.1016/j.resuscitation.2015.03.006.CrossRefPubMedGoogle Scholar
  7. Price S, Haxby E. Managing futility in critically ill patients with cardiac disease. Nat Rev Cardiol. 2013;10:723–31.  https://doi.org/10.1038/nrcardio.2013.161.CrossRefPubMedGoogle Scholar
  8. Quenot JP, Ecarnot F, Meunier-Beillard N, Dargent A, Large A, Andreu P, Rigaud JP. What are the ethical aspects surrounding the collegial decisional process in limiting and withdrawing treatment in intensive care? Ann Transl Med. 2017;5(Suppl 4):S43.  https://doi.org/10.21037/atm.2017.04.15.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Rincon F, Lee K. Ethical considerations in consenting critically ill patients for bedside clinical care and research. J Intensive Care Med. 2015;30:141–50.  https://doi.org/10.1177/0885066613503279.CrossRefPubMedGoogle Scholar
  10. Takaschima AK, Sakae TM, Takaschima AK, Takaschima RD, Lima BJ, Benedetti RH. Ethical and legal duty of anesthesiologists regarding Jehovah’s Witness patient: care protocol. Braz J Anesthesiol. 2016;66:637–41.  https://doi.org/10.1016/j.bjane.2015.03.012.CrossRefPubMedGoogle Scholar
  11. Thys K, Van Assche K, Nobile H, Siebelink M, Aujoulat I, Schotsmans P, Dobbels F, Borry P. Could minors be living kidney donors? A systematic review of guidelines, position papers and reports. Transpl Int. 2013;26:949–60.  https://doi.org/10.1111/tri.12097.CrossRefPubMedGoogle Scholar
  12. Walton-Moss BJ, Taylor L, Nolan MT. Ethical analysis of living organ donation. Prog Transplant. 2005;15:303–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Matjaž Zwitter
    • 1
    • 2
  1. 1.Faculty of MedicineUniversity of MariborMariborSlovenia
  2. 2.Institute of OncologyLjubljanaSlovenia

Personalised recommendations