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Organ donation by Maastricht-III pediatric patients: Recommendations of the Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP) and Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF). Part II: Specific organizational and technical considerations.
Arch Pediatr
October 2022
Service de Médecine Intensive-Réanimation Pédiatriques, Hôpital Robert-Debré, Assistance Publique-Hôpitaux de Paris, Université de Paris, France.
A panel of pediatric experts met to develop recommendations on the technical requirements specific to pediatric controlled donation after planned withdrawal of life-sustaining therapies (Maastricht category III). The panel recommends following the withdrawal of life-sustaining therapies protocol usually applied in each unit, which may or may not include immediate extubation. The organ retrieval process should be halted if death does not occur within 3 h of life-support discontinuation.
View Article and Find Full Text PDFOrgan donation by Maastricht-III pediatric patients: Recommendations of the Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP) and Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF) Part I: Ethical considerations and family care.
Arch Pediatr
October 2022
Service de Médecine Intensive-Réanimation Pédiatriques, Hôpital Robert-Debré, Assistance Publique-Hôpitaux de Paris, Université de Paris, France.
The French Transplant Health Authority (Agence de la Biomédecine) has broadened its organ- and tissue-donation criteria to include pediatric patients whose death is defined by circulatory criteria and after the planned withdrawal of life-sustaining therapies (WLST) (Maastricht category III). A panel of pediatric experts convened to translate data in the international literature into recommendations for organ and tissue donation in this patient subgroup. The panel estimated that, among children aged 5 years or over with severe irreversible neurological injury (due to primary neurological injury or post-anoxic brain injury) and no progression to brain death, the number of potential donors, although small, deserves attention.
View Article and Find Full Text PDFThe Challenges of Apnea Tests in the Determination of Brain Death in Child Patient on Extracorporeal Membrane Oxygenation.
Front Pediatr
July 2020
Department of Pediatric Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Extracorporeal membrane oxygenation (ECMO) is a life-support modality used in patients with refractory cardiac and/or respiratory failure. ECMO is linked with high risk of neurological complications including brain death. Neurological monitoring during ECMO is important for identifying patients who are suspected of brain death and allows to discontinue ineffective medical treatments.
View Article and Find Full Text PDFEnd-of-life decisions in surgical intensive care medicine - the relevance of blood transfusions.
Transfus Apher Sci
June 2016
Department of Anesthesiology and Intensive Care Medicine, HELIOS Klinikum Hildesheim, Germany.
Background: End-of-life decisions (EOLDs) are common in the intensive care unit (ICU). EOLDs underlie a dynamic process and limitation of ICU-therapies is often done sequentially. Questionnaire-based and observational studies on medical ICUs and in palliative care reveal blood transfusions as the first therapy physicians withhold as an EOLD.
View Article and Find Full Text PDFThe future of decision-making in critical care after Cuthbertson v. Rasouli.
Can J Anaesth
October 2014
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Purpose: The Supreme Court of Canada (SCC) ruling on Cuthbertson v. Rasouli has implications for all acute healthcare providers. This well-publicized case involved a disagreement between healthcare providers and a patient's family regarding the principles surrounding withdrawal of life support, which the physicians involved considered no longer of medical benefit and outside the standard of care, and whether consent was required for such withdrawals.
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