Related Experiment Video
Updated: Aug 27, 2025
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
"A Delicate balance"-Perceptions and Experiences of ICU Physicians and Nurses Regarding Controlled Donation After
Matthieu Le Dorze1,2, Sara Martouzet3, Etienne Cassiani-Ingoni1
1AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France.
Insights
Controlled donation after circulatory death (cDCD) presents ethical challenges for healthcare teams, balancing end-of-life care with organ donation. Addressing these tensions is crucial for successful cDCD implementation in intensive care units.
Area of Science:
- Medical Ethics
- Transplantation Medicine
- Critical Care Medicine
Background:
- Organ donor scarcity necessitates exploring alternative strategies like controlled donation after circulatory death (cDCD).
- The overlap of end-of-life care and organ donation in cDCD raises ethical concerns for healthcare professionals.
- Understanding staff perceptions is vital for overcoming barriers to cDCD implementation.
Purpose of the Study:
- To explore intensive care unit (ICU) physicians' and nurses' perceptions and experiences with cDCD.
- To identify ethical tensions and coping strategies related to cDCD in clinical practice.
Main Methods:
- Qualitative study utilizing thematic analysis.
- In-depth semi-structured interviews with 17 ICU staff members (8 physicians, 9 nurses).
- Six-month field observation in a large teaching hospital.
Main Results:
- A gap exists between ethical principles and clinical practice in cDCD.
- Ethical tensions arise during withdrawal of life-sustaining treatments (LST) decision-making, implementation, and the dying process.
- Healthcare professionals develop strategies to manage ethical and emotional complexities of cDCD.
Conclusions:
- Successful cDCD implementation requires a shared understanding of the balance between end-of-life care and organ donation.
- Addressing ethical ambiguities and providing support for healthcare professionals is essential for cDCD programs.
Abstract:
Controlled donation after circulatory death (cDCD) is considered by many as a potential response to the scarcity of donor organs. However, healthcare professionals may feel uncomfortable as end-of-life care and organ donation overlap in cDCD, creating a potential barrier to its development. The aim of this qualitative study was to gain insight on the perceptions and experiences of intensive care units (ICU) physicians and nurses regarding cDCD. We used thematic analysis of in-depth semi-structured interviews and 6-month field observation in a large teaching hospital. 17 staff members (8 physicians and 9 nurses) participated in the study. Analysis showed a gap between ethical principles and routine clinical practice, with a delicate balance between end-of-life care and organ donation. This tension arises at three critical moments: during the decision-making process leading to the withdrawal of life-sustaining treatments (LST), during the period between the decision to withdraw LST and its actual implementation, and during the dying and death process. Our findings shed light on the strategies developed by healthcare professionals to solve these ethical tensions and to cope with the emotional ambiguities. cDCD implementation in routine practice requires a shared understanding of the tradeoff between end-of-life care and organ donation within ICU.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:27Ethical Issues
Ethical Concerns in Healthcare: