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Perceptions of organ donation after circulatory determination of death among critical care physicians and nurses: A national survey*

Hart, Joanna L. MD; Kohn, Rachel MD; Halpern, Scott D. MD, PhD

doi: 10.1097/CCM.0b013e3182590098
Clinical Investigations
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Objective: We sought to identify factors related to critical care physicians’ and nurses’ willingness to help manage potential donors after circulatory determination of death, and to elicit opinions on the presence of role conflict in donors after circulatory determination of death and its impact on end-of-life care.

Design and Setting Randomized trial administered by Web or post of four donors after circulatory determination of death vignettes. Response rates were 31.0% and 44.3%, respectively.

Subjects: Two thousand two hundred and six academic inten­sive care unit physicians and 988 intensive care unit nurses in the United States.

Measurements and Main Results: Majorities of intensive care unit physicians (72.5%; 95% confidence interval 69.2–75.9) and nurses (74.3%; 95% confidence interval 70.2–78.5) believed they should help manage potential donors after circulatory determination of death. 14.7% (95% confidence interval 12.0–17.4) of physicians and 14.3% (95% confidence interval 11.0–17.6) of nurses believed that management of donors after circulatory determination of death would create professional role conflicts. 33.8% (95% confidence interval 30.0–37.4) of physicians and 55.1% (95% confidence interval 50.3–59.7) of nurses believed that preserving opportunities for donors after circulatory determination of death could improve end-of-life care. More favorable views of donors after circulatory determination of death were provided by clinicians randomly assigned to vignettes depicting donors with previously denoted preferences for organ donation; similar effects were not introduced by vignettes in which surrogates actively initiated donation discussions.

Conclusions: These findings suggest that critical care physicians and nurses are generally supportive of managing donors after circulatory determination of death, particularly when patients were registered organ donors. However, minorities of clinicians harbor concerns regarding conflicts of interest, and many are uncertain of the practice’s impact on end-of-life care.

From the Department of Medicine (JLH, SDH), Fostering Improvement in End-of-Life Decision Science (FIELDS) program (JLH, SDH), Leonard Davis Institute of Health Economics Center for Health Incentives and Behavioral Economics (SDH), and Center for Clinical Epidemiology and Biostatistics (SDH), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Department of Medicine (RK), Massachusetts General Hospital, Boston, MA.

* See also p. 2718.

Supported, in part, by Greenwall Foundation Faculty Scholar Award in Bioethics (SDH).

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The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: shalpern@exchange.upenn.edu

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins