Abstract
Public opinion associates Intensive Care Units (ICUs) with extraordinary stories of recovery against the odds, but also with an understanding that intensive care is a place where sick patients may die. With one in five patients dying in intensive care, end-of-life care is an important area for doctors and nurses who work in this area. However, due to New Zealand’s low organ donation rates compared to other developed countries, recent initiatives have been established to increase tissue and organ donation rates in these units. To date, there has been little exploration of whether promoting donation practices into ICUs challenge or support end-of-life care. Using case studies, this chapter examines bioethical principles around deceased donation practices within end-of-life care, to propose recommendations for practice and policy.
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References
Australian and New Zealand Intensive Care Society. (2013). The ANZICS statement on death and organ donation. Edition 3.2. Australian and New Zealand Intensive Care Society.
Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics (7th ed.). Oxford: Oxford University Press.
Bernat, J. L., Capron, A. M., Bleck, T. P., Blosser, S., Bratton, S. L., et al. (2010). The circulatory-respiratory determination of death in organ donation. Critical Care Medicine, 38, 963–970.
Berntzen, H., & Bjørk, I. T. (2014). Experiences of donor families after consenting to organ donation: A qualitative study. Intensive and Critical Care Nursing, 30, 266–274.
Bion, J., & Coombs, M. (2015). Balancing cure with comfort: Palliative care in critical care. Palliative Medicine, 29, 288–290.
Brinkman, S., de Jonge, E., Abu-Hanna, A., Arbous, M. S., de Lange, D. W., et al. (2013). Mortality after hospital discharge in ICU patients. Critical Care Medicine, 41, 1229–1236.
Cohen, E. (2006). Organ transplantation: Defining the ethical and policy issues. Staff discussion paper, The President’s Council on Bioethics. https://bioethicsarchive.georgetown.edu/pcbe/background/staff_cohen.html.
Cook, D., & Rocker, G. (2014). Dying with dignity in the intensive care unit. New England Journal of Medicine, 370, 2506–2514.
Cooper, J., & Kierans, C. (2016). Organ donation, ethnicity and the negotiation of death: Ethnographic insights from the UK. Mortality, 21, 1–18.
deGroot, J., Vernooij-Dassen, M., Hoedemaekers, C., Hoitsma, A., Smeets, W., et al. (2012). Decision making by relatives about brain death organ donation: An integrative review. Transplantation, 93, 1196–1211.
DonateLife. (2008). World’s best practice reform package: Measure 2: Organ and tissue authority. http://www.donatelife.gov.au/the-authoity/national-reform-agenda.
Escudero, D., Valentın, M. O., Escalante, J. L., Sanmartın, A., Perez-Basterrechea, M., et al. (2015). Intensive care practices in brain death diagnosis and organ donation. Anaesthesia. doi:10.1111/anae.13065.
Forsberg, A., Flodén, A., Lennerling, A., Karlsson, V., Nilsson, M., et al. (2014). The core of after death care in relation to organ donation—a grounded theory study. Intensive and Critical Care Nursing, 30, 275–282.
Flory, J., Young-Xu, Y., Gurol, I., Levinsky, N., Ash, H., et al. (2004). Place of death: US trends since 1980. Health Affairs, 23, 194–200.
Gardiner, D., Shemie, S., Manara, A., & Opdam, H. (2012). International perspective on the diagnosis of death. British Journal of Anaesthesia, 108(Suppl. 1), i14–i28.
Grace, B. S., Kara, T., Kennedy, S. E., & McDonald, S. P. (2014). Racial disparities in pediatric kidney transplantation in New Zealand. Pediatric Transplantation, 18, 689–697.
Hazlett, A. (2016). Epistemic goods. In G. Fletcher (Ed.), The Routledge handbook of philosophy of well-being (pp. 259–270). London: Routledge.
Howarth, G. (2007). Death and dying: A sociological introduction. Cambridge: Polity Press.
International Registry in Organ Donation and Transplantation. (2014). International registry in organ donation and transplantation. Final numbers 2013. Barcelona: International Registry in Organ Donation and Transplantation.
International Summit on Transplant Tourism and Organ Trafficking. (2008). The declaration of Istanbul on organ trafficking and transplant tourism. Clinical Journal of the American Society of Nephrology, 3, 1227–1231.
Kesselring, A., Kainzb, M., & Kiss, A. (2007). Traumatic memories of relatives regarding brain death, request for organ donation and interactions with professionals in the ICU. American Journal of Transplantation, 7, 211–217.
Lazar, N. M., Shemie, S., Webster, G. C., & Dickens, B. M. (2001). Brain death. Canadian Medical Association Journal, 164, 833–836.
Long, T., Sque, M., & Addington-Hall, J. (2008). Conflict rationalisation: How family members cope with a diagnosis of brain stem death. Social Science and Medicine, 67, 253–261.
Marks, W. H., Wagner, D., Pearson, T. C., Orlowski, J. P., Nelson, P. W., et al. (2006). Organ donation and utilisation 1995–2004: Entering the collaborative era. American Journal of Transplantation, 6, 1101–1110.
Mauri Ora Associates. (n.d.). Māori Pacific attitudes towards transplantation: Professional perspectives: A report commissioned by the Ministry of Health for Renal Services, Wellington: National Renal Service Improvement Project. Mauri Ora Associates. Retrieved from https://www.health.govt.nz/system/files/documents/pages/maori-pacific-attitudes-towards-transplantation.pdf.
Mauss, M. (1990). The gift: The form and reason for exchange in archaic societies (W. D. Halls, Trans.). New York: W.W. Norton.
McKeown, D. W., Bonser, R. S., & Kellum, J. A. (2012). Management of the heart beating brain-dead organ donor. British Journal of Anaesthesia, 108(Suppl. 1), i96–i107.
Mullins, G. C., Simes, D., & Yuen, K. J. (2012). Approaching families for organ donation–intensivists’ perspectives. Anaesthesia and Intensive Care, 40, 1035–1039.
Ngahooro, J. (2010). Farewelling Body Parts “Would Help Maori Donors”, Dominion Post. Retrieved from http://www.stuff.co.nz/national/politics/3563310/Farewelling-body-parts-would-help-Maori-donors.
Nikora, L. W., Masters, B., & Te Awekotuku, N. (2012). Final arrangements following death: Maori indigenous decision making and tangi. Journal of Community and Applied Social Psychology, 22, 400–413.
Organ Donation New Zealand. (2014). Annual report. Organ Donation New Zealand. Auckland: Organ Donation New Zealand.
Persad, G., Wertheimer, A., & Emanuel, E. J. (2009). Principles for allocation of scarce medical interventions. The Lancet, 373, 423–431.
Sanner, M. A. (2007). Two perspectives on organ donation: Experiences of potential donor families and intensive care physicians of the same event. Journal of Critical Care, 22, 296–304.
Scheunemann, L. P., McDevitt, M., Carson, S. S., & Hanson, L. C. (2011). Randomized, controlled trials of interventions to improve communication in intensive care: A systematic review. Chest, 139, 543–554.
Senouci, K., Guerrini, P., Diene, E., Atinault, A., Claquin, J., et al. (2004). A survey on patients admitted with severe coma: Implications for brain death and organ donation. Intensive Care Medicine, 30, 38–44.
Shaw, R. M., & Webb, R. (2015). Multiple meanings of “gift” and its value for organ donation. Qualitative Health Research, 25(5), 600–611.
Shemie, S. D., Hornby, L., Baker, A., Teitelbaum, J., Torrance, S., Young, K., Capron, A. M., Bernat, J. L., Noel, N. & The International Guidelines for Determination of Death phase 1 participants, in collaboration with the World Health Organization. (2014). International guideline development for the determination of death. Intensive Care Medicine, 40, 788–797.
Simmerling, M. (2007). Beyond scarcity: Poverty as a contraindication for organ transplantation. AMA Journal of Ethics, 6, 441–445.
Siminoff, L. A., & Lawrence, R. H. (2002). ‘Knowing patients’ preferences abut organ donation: Does it make a difference? Journal of Trauma, 53, 754–760.
Siminoff, L. A., Lawrence, R. H., & Zhang, A. (2002). Decoupling: What it is and does it really help increase consent to organ donation? Progress in Transplantation, 12, 52–60.
Statistics New Zealand. (2015). National population estimates: At June 30, 2015. Retrieved from http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/NationalPopulationEstimates_HOTPAt30Jun15.aspx.
Truog, R. D., Campbell, M. L., Curtis, J. R., Haas, C. E., Luce, J. M., et al. (2008). Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine. Critical Care Medicine, 36, 953–963.
Vathsala, A. (2004). Improving cadaveric organ donation rates in kidney and liver transplantation in Asia. Transplantation Proceedings, 36, 1873–1875.
Waitematā District Health Board. (2003). Maori values and concepts (tikanga). Māori health services. Takapuna: Waitematā District Health Board.
Watson, C. J. E., & Dark, J. H. (2012). Organ transplantation: Historical perspective and current practice. British Journal of Anaesthesia, 108(Suppl. 1), i29–i42.
Webb, R., & Shaw, R. (2011). Whanau, whakapapa and identity in experiences of organ donation and transplantation. Sites: A Journal of Social Anthropology and Cultural Studies, 8(1), 40–58.
Wijdicks, E. F. M. (2002). Brain death worldwide: Accepted fact but no global consensus in diagnostic criteria. Neurology, 58, 20–25.
Wilkinson, M., & Wilkinson, S. (2015). The donation of human organs. In E. N. Zalta (Ed.), The Stanford encyclopedia of philosophy. http://plato.stanford.edu/archives/spr2015/entries/organ-donation/.
Woods, M. (2010). Cultural safety and the socio-ethical nurse. Nursing Ethics, 17, 715–725.
Woods, M. (2012). Exploring the relevance of social justice within a relational nursing ethic. Nursing Philosophy, 13, 56–65.
Woods, M. (2014). Tronto’s legacy: The socioethical practitioner in contemporary health care. In G. Olthius, H. Kohlen, & J. Heier (Eds.), Moral boundaries redrawn: The significance of Joan Tronto’s argument for political theory, professional ethics, and care as practice: Ethics of care 3 (pp. 93–112). Leuven: Peeters.
Wunsch, H., Harrison, D. A., Harvey, S., & Rowan, K. (2005). End-of-life decisions: A cohort study of the withdrawal of all active treatment in intensive care units in the United Kingdom. Intensive Care Medicine, 31, 823–831.
Acknowledgements
We would like to thank the donor families for so generously allowing the telling of their stories. Thanks are also extended to Janice Langlands from Organ Donation New Zealand for facilitating and gaining consent from the families. In addition, we thank Mrs Belinda Tuari-Toma, Policy Analysis, State Sector Effectiveness, Te Puni Kōkiri Iwi: Ngati Porou, Tuwharetoa and Te whānau Apanui for her advice on discussion of the last case in this chapter.
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Coombs, M., Woods, M. (2017). Organ Donation Practices and End-of-life Care: Unusual Bedfellows or Comfortable Companions?. In: Shaw, R. (eds) Bioethics Beyond Altruism. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-55532-4_10
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