1. END OF LIFE DECISIONS-THE IMPACT OF NEUROCRITICAL PATIENTS’ EVOLUTION ON ORGAN DONATION. A MULTICENTRIC STUDY IN CATALONIA, SPAIN.

LATE BREAKING MINI ORAL

T. Pont¹, J. Gener², E. Oliver³, M. Bodi⁴, M. Badia⁵, J. Mestre⁶, X. Esquirol⁷, S. Quintana⁸, N. Masnou¹, E. Muñoz⁴, R. Deulofeu^9
1Transplant Coordination Management, University Hospital Vall d'Hebron, Barcelona/SPAIN, ²Intensive Care Service, University Hospital Germans Trias, Barcelona/SPAIN, ³Transplant Coordination, University Hospital Bellvitge, Hospitalet de Llobregat/SPAIN, ⁴Transplant Coordination, UniversitY Hospital Joan XIII, Tarragona/SPAIN, ⁵Intensive Care Service, University Hospital Arnau de Vilanova, Lleida/SPAIN, ⁶Intensive Care Service, Corporacio Sanitaria Parc Taulí, Sabadell/SPAIN, ⁷Intensive Care Unit, Fundacio Hospital Asil de Granollers, Granollers/SPAIN, ⁸Intensive Care Unit, University Hospital Mútua de Terrassa, Terrrassa/SPAIN, ⁹Catalan Transplant Organization, OCATT, Barcelona/SPAIN

Body: Introduction: In Spain organ donation rates seem to have reached a limit which is difficult to exceed. Nevertheless, organ demand heavily exceeds supply. Despite all efforts, we still observe losses of donors due to lack of detection in the Intensive Care Units (ICU). This is partly the result of unfamiliarity with the process, but also of the establishment of a limitation of therapeutic effort (LTE), derived from the concept of futility, without taking into account the possibility of organ donation.

Objectives: 1) To analyse the evolution of patients with Critical Neurological Diseases (CND), defined by a Glasgow Coma Score ≤ 8 (GSC), and in particular to detect possible losses of organ donors. 2) To determine whether all families of potential organ and/or tissue donors had been informed about the possibility of donation. 3) To know the number of cases of CND to which a LTE (withdrawing and withholding treatment or non-admittance to an ICU) is applied. 4) To analyse the effects of LTE on organ donation.

Methods: Prospective, multicentre and observational study of all critical neurological patients with GCS ≤ 8. Study patients were followed until death (detailing the type of death, CA or BD), release from hospital or 30 days of in-hospital stay. A file was kept for each patient on a secure web database. Statistical analysis was descriptive. Results: 10 hospitals participated, with 286 patients included (range 1-72 cases per centre) during the last trimester of 2009. Mortality rate was 48.6% (139/286), and 42%(59/139) of deaths were brain deaths (BD). The average age of survivors is similar to that of BD patients (55 years) and significantly lower than that for deaths due to cardiac arrest (CA) (73 years). Nearly 60% (35/59) of BD patients became organ donors. In 35 cases (83.3%) the families of BD patients received information about organ donation. The remaining 10 families (16.3%) were not informed due to some existing medical contraindication. LTE was applied in 24% (71/286) of cases, with 3 patients surviving. Non-admittance to ICU accounted for 60% (42/71) of LTE cases. Over 80% (58/71)of families followed doctors’ advice regarding LTE. However, only 14% received information about donation (organs and tissues). In the group of deaths due to CA, 17% of patients were tissue donors, and 5% of them came from the LTE group. Conclusions: Mortality rates in CND are high, and 40% of our patients evolved to brain death. More than half of them became organ donors. LTE was applied to 25% of the CND patients, the majority of whom were located in areas outside the ICU. Tissue donation rates were very low (17%) in both groups (BD and cardiac arrest). Donation is not sufficiently considered as an option in end of life decisions.

Disclosure: All authors have declared no conflicts of interest.