Before families are offered the option of ICU admission solely for organ donation, it is crucial that they first understand and accept the following statements.
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The injury or disease is irreversible and not survivable.
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Intensive Care therapies (e.g. intubation, ventilatory support, inotropes and ICU admission) are not for the therapeutic benefit of the patient and will not alter the ultimate prognosis. They are solely to facilitate good end-of-life care and support the possibility of organ donation in the near future.
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There is no certainty that organ donation will actually occur. For example, contraindications to donation may be discovered, or the patient may not become brain dead within an acceptable time frame or may not die after withdrawal of therapy in a timeframe that permits DCD.
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The family’s wishes are always respected. They will be given time and information to make a decision that is right for them.
ODNZ recommends that these complex discussions should be conducted in person, by a health professional person who has knowledge of what organ donation involves. They must be familiar with the language and process of organ donation, including timeframes. The health professional should be able to have end-of-life discussions in the acute care setting and be able to answer questions regarding the ongoing care of the patient and the process of donation, which might take hours or sometimes days.
ODNZ recommends that this discussion should be conducted by an intensivist (or ICU fellow or other specialist with responsibility for the ICU), or jointly by the ICU specialist and ED specialist jointly, and not by the ED specialist alone.
Sometimes families may agree to admission to ICU to support possible donation but not agree to organ donation later when it is formally discussed.