Abstract:
:Last year, >28,000 people received organ transplants from >14,000 donors in the United States. Unfortunately, the wait list now tops 91,000, with the gap between recipient needs and available donor organs at around 60,000. This has motivated a host of efforts to increase organ supply, including driver's license and donor registry initiatives, educational and advertising campaigns, and "required request" and mandatory Organ Procurement Organization notification when a patient's death is imminent. Other more controversial efforts to increase the donor pool include expanded criteria for cadaveric donors, such as older or sicker donors and so-called non-heart-beating donation, now referred to as donation after cardiac death. Perhaps the most controversial of all efforts to address the organ shortage have focused on increasing the number of living organ donors, which in 2001 for the first time exceeded the number of cadaveric donors. Critical care professionals know the sad reality behind the statistical scarcity of organ supply. They must manage anxious patients and family members who may be waiting for an organ that never comes, triage patients into and out of the intensive care unit, and work through the propriety of shifting goals from cure to comfort when those same patients deteriorate to the point that transplant may no longer be an appropriate medical option or when a transplant fails. Equally significant ethical challenges arise on the donor side, whether it is working through difficult end-of-life decisions, identifying when to call the organ procurement organization, caring for brain-dead patients, managing a candidate for donation after cardiac death, or caring for a living donor postoperatively. This article discusses some of the difficult ethical challenges raised by organ donation and transplantation for critical care professionals, focusing on end-of-life decision making, donation after cardiac death, and living organ donation.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Aulisio MP,Devita M,Luebke Ddoi
10.1097/01.CCM.0000252915.76019.19subject
Has Abstractpub_date
2007-02-01 00:00:00pages
S95-101issue
2 Suppleissn
0090-3493issn
1530-0293pii
00003246-200702001-00012journal_volume
35pub_type
杂志文章,评审abstract:OBJECTIVE:To comparatively evaluate cerebral metabolic rate of oxygen consumption and a modification of it, cerebral consumption of oxygen, in patients with acute brain injury with acute anemia. DESIGN:Prospective, observational study. SETTING:Neuroscience intensive care unit (ICU) of a university hospital. PATIENTS...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199308000-00024
更新日期:1993-08-01 00:00:00
abstract:OBJECTIVES:To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the ICU, a physical function measure designed for the ICU. DESIGN:Clinimetric analysis. SETTINGS:Five international datasets from the United States, Australia, and Brazil. PA...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001949
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVES:Increasing age is a well-recognized risk factor for in-hospital mortality in patients receiving extracorporeal membrane oxygenation for cardiogenic shock, but the shape of this relationship is unknown. In addition, the impact of age on hospital length of stay, patterns of patient disposition, and costs has b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003631
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVES:Although the mortality of severe sepsis is easily quantified, the actual cause and timing of death from severe sepsis are less defined. We used the INDEPTH (International Integrated Database for the Evaluation of Severe Sepsis and Drotrecogin alfa activated) database to investigate the reported cause of deat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31820eda29
更新日期:2011-05-01 00:00:00
abstract:OBJECTIVE:To compare four different methods of endotracheal lidocaine administration with respect to the site of administration. DESIGN:Randomized controlled trial. SETTING:University hospital. PATIENTS:Thirty-two female patients (43.6 +/- 11.5 years old) undergoing elective gynecologic operations with an anesthesio...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199107000-00015
更新日期:1991-07-01 00:00:00
abstract::With the thermodilution technique, repeated determination of cardiac index (CI) has become a rapid, easily accomplished, safe procedure. We paired 77 CI determinations measured by direct Fick and thermodilution techniques in 21 patients who underwent myocardial revascularization. Commercially available thermistor-tipp...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197509000-00002
更新日期:1975-09-01 00:00:00
abstract:OBJECTIVE:To discuss the potential therapeutic value of intraluminal oxygenation of the gut in critical illness. DATA SOURCES:Relevant articles published in the English language literature. STUDY SELECTION:No special study has been carried out for the present presentation. DATA EXTRACTION:Information from the litera...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199302001-00012
更新日期:1993-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of treatment with murine recombinant interleukin-1 beta on inflammatory infiltrate and tissue damage after experimental endotoxic challenge. DESIGN:Randomized, controlled study. SETTING:Experimental Unit, Virgen de las Nieves University Hospital. SUBJECTS:Seventy-two female CBA/H mic...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200208000-00025
更新日期:2002-08-01 00:00:00
abstract:OBJECTIVES:Over 2,500 children undergo hematopoietic stem cell transplantation in the United States each year, and up to 35% require PICU support for life-threatening complications. PICU mortality has dropped from 85% to 44%, but interpretation is confounded by significant cohort heterogeneity. Reports conflict regardi...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001085
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:To derive a target range of optimal sedation for the COMFORT Scale and to prospectively test that target range against intensivist assessment of adequacy of sedation. DESIGN:Serial prospective agreement cohort studies. SETTING:Twelve-bed pediatric intensive care unit in an urban academic teaching hospital. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199401000-00029
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:Initial success with chimeric antigen receptor-modified T cell therapy for relapsed/refractory acute lymphoblastic leukemia is leading to expanded use through multicenter trials. Cytokine release syndrome, the most severe toxicity, presents a novel critical illness syndrome with limited data regarding diagnos...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002053
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVES:Delirium occurs in approximately 30% of critically ill patients, and the risk of dying during admission doubles in those patients. Molecular mechanisms causing delirium are largely unknown. However, critical illness and the ICU environment consistently disrupt circadian rhythms, and circadian disruptions are...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003077
更新日期:2018-06-01 00:00:00
abstract::The recommended rates for closed-chest cardiac compressions during CPR are based on physiologic variations with increasing age rather than experimental data. Using puppies, we compared mean arterial pressure, cardiac index (CI), and cerebral blood flow (CBF) at a slow (40/min, group 1) and a rapid (120/min, group 2) r...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198710000-00009
更新日期:1987-10-01 00:00:00
abstract:OBJECTIVES:To compare usual care with a proactive case-finding approach for critically ill patients with terminal dementia using an inpatient palliative care service. DESIGN:Prospective comparison to historical control. SETTING:Urban, university-affiliated hospital. PATIENTS:Total of 52 men and women with end-stage ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000138560.56577.88
更新日期:2004-09-01 00:00:00
abstract:OBJECTIVE:Our aim was to determine the frequency and the clinical and epidemiologic characteristics of sepsis in a hospital-based population in Colombia. DESIGN:Prospective cohort. SETTING:Ten general hospitals in the four main cities of Colombia. PATIENTS:Consecutive patients admitted in emergency rooms, intensive ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318218a35e
更新日期:2011-07-01 00:00:00
abstract::To achieve synchronized differential pulmonary ventilation, an Ohio 560 ventilator was modified through separation of the outputs of the deep breath bellows and the tidal volume bellows and providing independent volume, flow rate, PEEP, oxygen-humidification, and alarm systems. The described ventilator modification is...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198106000-00012
更新日期:1981-06-01 00:00:00
abstract:OBJECTIVE:The objective of the present study was to determine whether selective inflammatory cytokine concentrations within cerebrospinal fluid are useful markers for the differential diagnosis of aseptic and bacterial meningitis within neurosurgical patients. DESIGN:Prospective, open-label, observational, cohort stud...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001188
更新日期:2015-11-01 00:00:00
abstract::Thirty-three patients underwent extensive cardiorespiratory monitoring during cardiac surgery. Recordings of measurements, with derived variables, were made preoperatively, postoperatively, and after extubation approximately 3 h after operation. The data provide a reference that allows decisions on whether the conditi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1981-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the use of enriched thioglycolate as a transport medium of protected specimen brush samples, in particular its value in direct examination of respiratory specimens and in guiding initial antibiotic prescription. DESIGN:Prospective, randomized, pilot study. SETTING:Medical-surgical teaching inten...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200202000-00008
更新日期:2002-02-01 00:00:00
abstract::Pulmonary artery wedge pressure (PAWP) will only reflect left atrial pressure (LAP) if continuity of fluid exists from the catheter tip to the left atrium. Either increased airway pressure or decreased hydrostatic pressure may lead to discontinuity of the fluid column and midinterpretation of PAWP. Simultaneous measur...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197801000-00009
更新日期:1978-01-01 00:00:00
abstract::Measuring gas exchange in critically ill patients can provide valuable information on their nutritional status and energy expenditure. Several semiautomated machines are available for measuring oxygen consumption (VO2) and carbon dioxide production (VCO2). This study evaluated, under controlled laboratory conditions, ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198609000-00010
更新日期:1986-09-01 00:00:00
abstract:OBJECTIVES:Light chains κ and λ are immunoglobulin constituents but also circulate independently in blood as free light chains. We investigated whether a concomitant abnormality in free light chain and immunoglobulin levels could identify a high risk of death sepsis subpopulation to inform future IV immunoglobulin tria...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002627
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:To test whether spectral indices derived from the electroencephalogram (EEG), and especially the bispectral index (BIS), can be used as measures of neurologic status in unsedated, critically ill patients. DESIGN:Prospective, observational study. SETTING:Medical intensive care unit (ICU) of a university-affi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200110000-00024
更新日期:2001-10-01 00:00:00
abstract::Ten infants with acquired subglottic stenosis were treated successfully using the anterior cricoid split operation. Eight had been preterm infants who required endotracheal intubation and assisted ventilation for the respiratory distress syndrome. Two had been born at term; 1 required mechanical ventilation for aspira...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198404000-00012
更新日期:1984-04-01 00:00:00
abstract:OBJECTIVE:Myofibroblasts express alpha-smooth muscle actin (alphaSMA), are important in tissue repair, and are present in the early phase of acute lung injury/acute respiratory distress syndrome (ALI/ARDS). We wished to determine whether bronchoalveolar lavage fluid (BALF) from ALI/ARDS patients can induce myofibroblas...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000257254.87984.69
更新日期:2007-03-01 00:00:00
abstract:OBJECTIVES:Hepatic ischemia-reperfusion is a major clinical problem with limited treatment options. The pathophysiology of hepatic ischemia-reperfusion is characterized by mitochondrial dysfunction and cellular energy deficits. Sirtuin 1 is an energy-sensing enzyme known to modulate mitochondrial biogenesis. We hypothe...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001637
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To assess the effects of dopexamine on splanchnic blood flow and splanchnic oxygen uptake in septic patients. DESIGN:A prospective, controlled trial. SETTING:A ten-bed intensive care unit (ICU) in a university hospital. PATIENTS:Twelve patients with severe sepsis (according to the criteria of the 1992 Amer...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199910000-00015
更新日期:1999-10-01 00:00:00
abstract::As of October 1985, 37 candidates have passed the final examination in intensive care for the Diploma of Fellow of the Faculty of Anaesthetists, Royal Australasian College of Surgeons (FFARACS). In September 1984, 23 of these successful candidates responded to a questionnaire seeking information on their educational e...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198606000-00015
更新日期:1986-06-01 00:00:00
abstract:OBJECTIVE:Information booklets have not been assessed by the families of intensive care unit (ICU) patients. This study explored the information that the relatives of adult ICU patients wanted to find in the information booklets. DESIGN:Multicenter survey. SETTING:Twenty-three French ICUs. SUBJECTS:One close relativ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e3181a03063
更新日期:2009-07-01 00:00:00
abstract::Gastric mucosal damage produced by topical application of necrotizing agents is diminished by topical or systemic pretreatment with a variety of E and F prostaglandins. The rat restraint model of gastric mucosal injury is more analogous to clinical stress ulceration than are models using intragastric application of to...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198901000-00011
更新日期:1989-01-01 00:00:00