Clinicians’ Attitudes and Perspectives on Ante-Mortem Interventions in Deceased Organ Donation

Abstract

Introduction Deceased donation does not meet the current need for organ transplantation, and in some counties, medical interventions on patients before the declaration of death for organ donation is legal and performed. However, this practice involves ethical and legal challenges. The purpose of the present study was to describe the attitudes, perspectives and values of clinicians on the acceptability of ante-mortem interventions. Materials and Methods Thirty clinicians (ICU physicians, donor coordinators, transplant physicians, transplant surgeons and policy makers) from eight countries (Australia, New Zealand, United States, United Kingdom, Italy, Japan, Korea and Vietnam) participated in semi-structured interviews on ante-mortem interventions including heparinization, femoral cannulation, donor cooling, ECMO and location of withdrawal. We used thematic analysis to analyse the data. Results Four major themes were identified: the death experience (protection of donor dignity as paramount, reduction of family distress in the context of donation, fear regarding influencing the process and speed of dying), respect for autonomy (supporting the individual desire to donate when it conflicts with family or clinician views, family choice in how donation proceeds, clinician roles in practicing beneficence and non-maleficence in the context of donation done for the benefit of a third party), education and understanding about the practices of organ donation (concern about misunderstandings and distrust in organ donation, clinician and family tensions in accepting brain death or cardiac death, ramifications of miscommunication with families for organ donation in general) and desire for optimising evidence based practice (desire for clear evidence of efficacy to discuss with families, desire for evidence of lack of harm prior to implementation). Conclusions Clinicians involved in organ donation and transplantation believe that ante-mortem interventions are only appropriate in instances where the distress of the death experience for the family and donor are not increased. Both the family and donor must have a strong drive to successful donation, and research must show that interventions are beneficial and do not cause harm to donors. As donation after circulatory death increases in prevalence, international discussion among policymakers will need to take place to determine the role of these practices.