緩和ケアと医学

抽象的な

Tissue Donation after Withdrawal of Life-Sustaining Treatment as an Advanced Care Plan is One of the Options in End-of-Life Care

Chih-Chuan Hsieh, Chiao-Zhu Li, Meng-Chi Li, Yun-Ju Yang, Kun-Ting Hong, Chi-Tun Tang, Tzu-Tsao Chung, Da-Tong Ju, Chun-Chang Yeh, Yuan- Hao Chen and Dueng-Yuan Hueng

Background: Withdrawal of life-sustaining treatment (WLST) is an option in end-of-life of critical illness in a surgical/neurosurgical intensive care unit (SNICU). In addition to lessen the patient’s suffering and to comfort the surrogates’ grief, there is something meaningful, such as tissue donation, for others to pursue. Aim: The aim of this study is to investigate the relationship between surgical intervention and the willingness of patients and/or their surrogates to donate tissue after WLST. Design: Retrospective cohort study of 368 patients who died in a SNICU in the past 3 years Setting/participants: Twenty-eight adult patients had life-sustaining treatment withdrawn from a total of 368 patients. We analyzed patient demographics and time courses of WLST in SNICU using the Student t-test. Results: Fourteen patients (50%) received surgical interventions, and 19 patients (67.86%) were admitted due to neuro-critical diseases. Tissue procurement for donation is significantly higher in patients underwent surgery than patients without surgery (21% vs. 0%, P=0.041) after the scheduled WLST and consequent verification of cardiac death. Conclusions: Our study uniquely demonstrates that patients who underwent surgical intervention with sufficient time for bidirectional discussions between physicians and the patients’ families were more likely to have tissues donated after WLST. Importantly, tissue donation after WLST is one of the options for end-of-life care in advanced care plan of SNICU.