physicians must obtain separate consent for living donor bronchoscopy
- related: Pulmonary Diseases
- tags: #literature #pulmonology
There are three classes of patients who can serve as donors for organ transplant: living donors, not considered here; donors who are dead according to determination of death by neurological criteria (DNC; or brain-dead donors); and donors with catastrophic illnesses who agree (by virtue of donor registries) or whose family agrees that donation is the patient’s wishes as they convert their care to a focus of comfort and withholding life-sustaining therapies.
Donation after circulatory death (DCD) donors undergo extubation in or near a surgery suite for recovery of organs after they die. In the case of the brain-dead donor, procedures that are performed to evaluate the organs, regardless of how invasive they are, carry no risk because the patient is dead. On the contrary, even when consent is given for organ donation after the patient dies, the patient remains alive during the evaluation phase of the organs to be donated. Unlike with the dead donor, procedures carry risk, including pain and suffering, as well as death before prepared withdrawal of life-sustaining therapies. The OPO representatives who are specially trained to obtain consent for organ donation are not qualified, by virtue of not performing the procedure in question, to obtain informed consent from the family or patient for a procedure, in this case bronchoscopy, that carries risk of pain, discomfort, hypoxia, pneumothorax, and hemorrhage. The practitioner is therefore obligated to obtain separate consent for the procedure.
This patient is breathing spontaneously, so brain death testing is not appropriate. Lowering PEEP is likely to have little effect for the patient or transplantability of the organs and is not necessary. Organ allocation is not typically completed until the workup is complete, including the bronchoscopy. Regardless, organ allocation is not the paramount focus of the ICU team caring for the potential donor patient. Understanding the roles of the ICU care team, the OPO, and the transplant surgery team regarding patients who are dead and those still alive is critical for ethical practice.12