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The majority of deaths in neonatal, pediatric, and adult intensive care are related to irrecoverable illness and are preceded by withdrawal or withholding of life-sustaining treatment (WLST). This is unacceptable ICU practice in most countries throughout the world, although there is considerable practice variation.
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One of the principle obstacles to donation after circulatory death (DCD) development has been a concern about real and perceived conflicts of interests between providing care for a dying patient and facilitating donation before death has been established.
Decisions regarding life-sustaining treatment should be made on their own merit, in consideration of organ donation.
Transplant physicians must be involved in the decision to withdrawal or withholding of life-sustaining treatment (WLST)or in death determination. This minimizes both real and perceived conflicts of interest for ICU staff between their therapeutic duty to the critically ill patient and their non-therapeutic relationship to potential organ transplant recipients.
Under the circumstances where the ICU may concurrently care for end-stage organ failure patients who are potential transplant recipients, physicians and caregivers who may be in conflict should not voluntarily withdraw from the care of a potential donor or the potential recipient.
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