An exploration of the variables involved when instituting a do-not-resuscitate order for patients undergoing bone...

Written do-not-resuscitate (DNR) orders can facilitate the transition from aggressive care to supportive care in patients undergoing bone marrow transplantation who are critically ill. The DNR decision often is complicated by clinical and ethical problems. To assist nurses in analyzing these complex situations, a retrospective review was conducted on medical records of 40 patients who died on an eight-bed bone marrow transplant unit in which a formal DNR policy was in place. A review of specific variables for patients designated DNR and non-DNR showed that the groups did not vary in age, diagnosis, disease, or type of transplant. The non-DNR group developed life-threatening complications earlier in their transplant course, whereas multisystem failure was the common factor among the patients with DNR designation. The few ethical problems documented in the medical records did not appear to reflect the complexity of the DNR decision.