Rev Neurol France
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Stroke can produce irreversible brain damage of massive proportion leading to severe disability and poor quality of life. Resuscitation and mechanical ventilation of these patients remain controversial because of the high mortality and severe disability involved. ⋯ Decisions for life-sustaining therapies in severe stroke are always difficult and often based on subjective and uncertain criteria. We have to improve prognosis estimation and our understanding of patient preferences to promote patient-centered care. An ethical approach may guide these complex decisions.
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Organ procurement practices are tending towards the use of older or more borderline donors. In the current context of steadily decreasing availability of traumatic donors, stroke victims make up the majority of donors. In France, where organ procurement activity has stabilized following a period of growth, the possibility of organ donation after a cerebral stroke is variable and uncertain. ⋯ This approach allows both support for end-of-life patients, and fulfillment of their wishes with regards to organ donation. It enables case-by-case decision-making, after relatives have agreed on transfer to the intensive care unit for organ removal. Thus, each hospital should institute a fully cooperative care procedure where all therapeutic possibilities are evaluated in order to enable the most appropriate therapeutic approach, and, if applicable, organ procurement.