Organ Donation After Acute Brain Death: Addressing Limitations of
Time and Resources in the Emergency Department |
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Authors: | Thomas E Robey Evadne G Marcolini |
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Institution: | aEmergency Department, Waterbury Hospital, Waterbury, Connecticut;bDepartment of Emergency Medicine, Yale University, New Haven, Connecticut |
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Abstract: | It is not unusual for emergency physicians to quickly identify whether a patient
would have wanted to be resuscitated or intubated in a cardiac arrest situation,
but patients’ other preferences for end-of-life care or organ donation are less
commonly ascertained in the emergency department. Typically, the decision
process regarding such goals at end of life may be “deferred” to the intensive
care unit. We present a case illustrative of the complexity of discussing organ
donation in the emergency department and suggest that patients who die in the
emergency department should be afforded the respect and consideration provided
in other parts of the hospital, including facilitation of organ transplantation.
As circulatory determination of death becomes a more common antecedent to organ
transplantation, specific questions may arise in the emergency department
setting. When in the emergency department, how should organ donation be
addressed and by whom? Should temporary organ preservation be initiated in the
setting of uncertainty regarding a patient’s wishes? To better facilitate
discussions about organ donation when they arise in emergency settings, we
propose increased coordination between organ procurement organizations and
emergency physicians to improve awareness of organ transplantation. |
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Keywords: | transplant ethics emergency medicine bioethics |
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