Routine advance directive and organ donation questioning on admission to hospital

The purpose of this study is to determine whether routine questioning on admission to hospital can identify patients who do not want cardiopulmonary resuscitation (CPR) or intensive-care unit (ICU) admission. We also determined whether routine questioning can identify patients interested in organ donation. Finally, we determined whether routine questioning helps train housestaff to discuss end-of-life issues with patients.

The housestaff of an internal-medicine ward questioned admitted patients about previous discussions regarding resuscitation or organ donation, and about preferences regarding CPR, ICU, and organ donation.

Of 40 patients who had never discussed CPR and ICU issues, 25 per cent preferred no CPR, and 18 per cent preferred no ICU. Of 24 patients who had never discussed organ-donation issues, 67 per cent were interested in being donors. All housestaff felt more comfortable discussing end-of-life issues by the end of the study.

Routine questioning of patients on admission identifies a significant number who prefer no CPR or ICU. This information may help to avoid inappropriate resuscitation efforts and ICU admissions. Routine questioning also reveals many patients who are interested in organ donation. Encouraging these patients to identify themselves and to discuss their wishes with family members may increase the number of procurable organs. Housestaff benefit from the experience of discussing end-of-life issues.