AUTHOR=Le Dorze Matthieu , Martouzet Sara , Cassiani-Ingoni Etienne , Roussin France , Mebazaa Alexandre , Morin Lucas , Kentish-Barnes Nancy 

TITLE=“A Delicate balance”—Perceptions and Experiences of ICU Physicians and Nurses Regarding Controlled Donation After Circulatory Death. A Qualitative Study

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10648

DOI=10.3389/ti.2022.10648

ISSN=1432-2277

ABSTRACT=Controlled donation after circulatory death (cDCD) is considered by many as a potential response to the scarcity of donor organs in a context where decisions to withdraw life-sustaining treatments (LST) occur more and more frequently in intensive care units (ICU) worldwide. 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 ICU physicians and nurses regarding cDCD, including the decision-making process, end-of-life care, and the relationship with relatives. We used in-depth semi-structured interviews and 6-month field observation in a large teaching hospital. Interviews were analyzed using thematic analysis. 17 staff members (8 physicians and 9 nurses) with for the large majority at least 5-10 years of professional experience in the ICU and who were involved at least one situation of cDCD participated in the study. Thematic analysis showed there is 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 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 they experience in this context.  As cDCD remains entangled in a variety of ethical ambiguities, its implementation in routine practice requires a shared understanding of the tradeoff between end-of-life care and organ donation within ICU.