Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Feb 2014
[Attitude of intensive care specialists toward deceased organ donation in Germany. Results of a questionnaire at the 12th Congress of the German Interdisciplinary Association for Intensive and Emergency Medicine].
Organ transplantation is the only treatment option for many patients with end-organ failure. Due to lack of transplantable organs, patients already on the waiting list die every day. The number of organ donors in Germany fell in 2012 by 12.8 %, reaching its lowest level since 2002. The medical and nursing personnel in intensive care units have a key role in the recruitment of potential organ donors; therefore, a survey was conducted on this subject. ⋯ The vast majority of the intensive care personnel supports organ donation, but less than half of the respondents have an organ donor card. The reports of irregularities in the organ allocation were scrutinized, but had apparently no significant impact on the individual and collective fundamental donor decision.
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Death of intensive care unit (ICU) patients with cardiovascular implantable electronic devices (CIED) is a common scenario in the ICU. Given the demographic trends and the increasing implantation rate of such devices reinforces the fact that ICU physicians must be aware of the burden and consequences of these systems in the end of life care of dying patients. The possible deactivation of a CIED confronts the responsible physicians with particularly complex clinical, ethical, and legal problems. ⋯ It is therefore crucial to be aware of the legal situation in the jurisdiction in which the physician is practicing. The decision to deactivate CIEDs should be part of a well deliberated and transparent process. Ethical and legal guidance should be readily available to counsel and support these difficult decisions.
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Modern intensive care is responsible both for curative interventions in critical health situations and palliative terminal care for the dying ICU patient. By applying an integrated ethics approach, this article examines organizational and cultural factors shaping good terminal care in the ICU. ⋯ Among them, the article focuses on practices ensuring a dignified dying process, on the structured engagement of patients' families, on respecting cultural and spiritual values, and on a clinical pathway for terminal care as an institutional framework. In conclusion, it becomes evident that good terminal care in the ICU not only depends on ethically sound decisions on withholding or withdrawing medical interventions but also on organizational and cultural aspects which must be acknowledged and shaped.