Cranioplasty with bandaging: New forms of limitation of life support and organ donation

Abstract

Abstract Most of the transplanted organs are obtained from brain death (BD) donors. In neurocritical patients with catastrophic injuries and decompressive craniectomy (DC), which show a dreadful development in spite of this treatment, DC could be a futile tool to avoid natural progress to BD. We propose whether cranial compressive bandage (cranioplasty with bandage) could be an ethically correct practice, similar to other life-sustaining treatment limitation (LSTL) common methods. Based on a clinical case, we had contacted the Assistance Ethics Committee and some of the bioethics professionals and asked them two questions: 1) Is ethically correct to perform a cranioplasty with bandage in those patients with LSTL indication? 2) Thinking in organ donation possibility, is this option preferable? Conclusions (1) Cranioplasty with bandage could be considered an ethically acceptable LSTL practice, similar to other procedures. (2) It facilitates organ donation for transplant, which provides for value-added proposition because of its own social good. (3) In these cases, it is necessary to know previous patient's will or, in absentia, to obtain family consent after a detailed procedure report.