Caring for Patients or Organs: New Therapies Raise New Dilemmas in the Emergency Department

• Published in: American journal of bioethics Vol. 17; no. 5; pp. 6 - 16
• Main Authors: Prabhu, Arjun, Parker, Lisa S., DeVita, Michael A.
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 04-05-2017
• Subjects: Bioethical Issues; Bioethics; Cardiopulmonary Resuscitation; Clinical Competence; Clinical Protocols; Conflict of Interest; Death; decision making; Emergency Service, Hospital - ethics; end-of-life issues; Ethical Analysis; Goals; Heart Arrest - surgery; Humans; Informed Consent; Motivation; organ transplantation; organizational ethics; Policy; Practice Guidelines as Topic; professional-patient relationship; race and culture/ethnicity; Tissue and Organ Procurement - ethics; Trust; United States; United States; organizational ethics; professional–patient relationship; organ transplantation; race and culture/ethnicity; decision making; end-of-life issues
• ISSN: 1526-5161; 1536-0075
• DOI: 10.1080/15265161.2017.1299239

Two potentially lifesaving protocols, emergency preservation and resuscitation (EPR) and uncontrolled donation after circulatory determination of death (uDCDD), currently implemented in some U.S. emergency departments (EDs), have similar eligibility criteria and initial technical procedures, but critically different goals. Both follow unsuccessful cardiopulmonary resuscitation and induce hypothermia to "buy time": one in trauma patients suffering cardiac arrest, to enable surgical repair, and the other in patients who unexpectedly die in the ED, to enable organ donation. This article argues that to fulfill patient-focused fiduciary obligations and maintain community trust, institutions implementing both protocols should adopt and publicize policies to guide ED physicians to utilize either protocol for particular patients, in order to address the appearance of conflict of interest arising from the protocols' similarities. It concludes by analyzing ethical implications of incentives that may influence institutions to develop the expertise required for uDCDD but not EPR.