ANZICS guiding principles for complex decision making during the COVID-19 pandemic.

The global 2019 coronavirus disease (COVID-19) pandemic has led to major challenges in clinical decision making when the demand for intensive care exceeds local capacity. In order to promote consistent, transparent, objective and ethical decision making, the Australian and New Zealand Intensive Care Society (ANZICS) formed a committee to urgently develop guidelines outlining key principles that should be utilised during the pandemic. This guidance is intended to support the practice of intensive care specialists during the COVID-19 pandemic and to promote the development of local admission policies that should be endorsed by health care organisations and relevant local authorities.

Admission to ICU "solely for possible organ donation"-audit of current New Zealand practice.

Aim: Admission of patients with likely fatal illness to ICU "solely for possible organ donation" has been a long-standing practice in New Zealand. This is advocated as a means of increasing the availability of organs for transplant. We sought to determine the extent and characteristics of current clinical practice.

Attitudes to Organ Donation and Knowledge of Donation and Transplantation among University of Auckland Medical Students.

Aims: •To explore organ donation and transplantation knowledge and attitudes among medical students at the University of Auckland.•To understand students' perception of the extent of training received prior to and during the medical program.

Method: A validated web-based questionnaire consisting of 42 questions in five categories was anonymously administered to all enrolled medical students at the Faculty of Medical and Health Sciences, University of Auckland, in September 2012.

End points for phase II trials in intensive care: recommendations from the Australian and New Zealand Clinical Trials Group consensus panel meeting.

Background: There is uncertainty about which end points should be used for Phase II trials in critically ill patients.

Objective: To systematically evaluate potential end points for Phase II trials in critically ill patients.

Design And Setting: A report outlining a process of literature review and recommendations from a consensus meeting conducted on behalf of the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) in October 2011.

Health economics and health technology assessment: perspectives from Australia and New Zealand.

Formal health economics and health technology assessment (HTA)processes, including cost-effectiveness and cost-utility analysis, are variably used to inform decisions about public and private health service funding and service provision. In general, pharmaceuticals have been subject to more sophisticated health economic analyses and HTAs and for a longer time than either devices or procedures. HTA has been performed by a number of different entities.

Pro/con ethics debate: when is dead really dead?

Contemporary intensive care unit (ICU) medicine has complicated the issue of what constitutes death in a life support environment. Not only is the distinction between sapient life and prolongation of vital signs blurred but the concept of death itself has been made more complex. The demand for organs to facilitate transplantation promotes a strong incentive to define clinical death in a manner that most effectively supplies that demand.

Clinical review: moral assumptions and the process of organ donation in the intensive care unit.

The objective of the present article is to review moral assumptions underlying organ donation in the intensive care unit. Data sources used include personal experience, and a Medline search and a non-Medline search of relevant English-language literature. The study selection included articles concerning organ donation.

Drotrecogin alfa (recombinant human activated protein C) in severe sepsis--a New Zealand viewpoint.

Aim: Sepsis is a serious and increasing worldwide intensive care problem. In response to intensivists' concerns over the benefits, risks and financial implications of the use of drotrecogin alfa (recombinant human activated protein C), the first adjunctive therapy for sepsis licensed in New Zealand, the New Zealand Region of the Australian and New Zealand Intensive Care Society (ANZICS) requested an advisory statement from a working party of New Zealand intensivists.

Methods: We reviewed (a) the PROWESS study of drotrecogin alfa recombinant; (b) the submission made by the sponsoring company to the FDA; (c) recent discussions and an economic evaluation of the use of the agent; (d) Australian pharmaceutical benefits scheme positive recommendations; (e) guidelines produced by the Eli Lilly Australian Advisory Board; (f) Australian hospital decisions on availability; and (g) New Zealand pricing and payment arrangements.

Ethics roundtable debate: should a sedated dying patient be wakened to say goodbye to family?

Intensivists have the potential to maintain vital signs almost indefinitely, but not necessarily the potential to make moribund patients whole. Current ethical and legal mandates push patient autonomy to the forefront of care plans. When patients are incapable of expressing their preferences, surrogates are given proxy.

Surgeons, intensivists, and the covenant of care: administrative models and values affecting care at the end of life--Updated.

Context: End-of-life care remains a challenging and complex activity in critical care units. There is little information concerning the influence of administrative models of care delivery on end-of-life care.

Objective: To compare and contrast end-of-life care delivery in intensive care units using "semiclosed," "open," and "closed" administrative models.

Surgeons, intensivists, and the covenant of care: administrative models and values affecting care at the end of life.

Context: End-of-life care remains a challenging and complex activity in critical care units. There is little information concerning the influence of administrative models of care delivery on end-of-life care.

Objective: To compare and contrast end-of-life care delivery in intensive care units using "semiclosed," "open," and "closed" administrative models.

Ethics roundtable: Using new, expensive drugs.

Costly genetically engineered therapies, which threaten to cripple the health care industry economy and undermine the common good if applied indiscriminately, loom on the horizon. The spectrum of applicable candidates include moribund nursing home patients at the end of life. They will be fair game for therapy that will ultimately send them back to nursing homes to return later with the same condition.

Liver transplantation in New Zealand: the first four years.

Aim: To summarise the transplant-related activity of the New Zealand Liver Transplant Unit over the first four years.

Methods: The records of all patients assessed for liver transplantation between 1 December 1997 and 30 December 2001 were examined. Listing criteria, demographics, waiting time, transplant-hospitalisation details and long-term outcome for those who underwent liver transplantation were recorded.