Abstract Introduction The necessity of organ-procurement cardiopulmonary resuscitation (OP-CPR) in a legally brain dead patient designated as an organ donor is a rare occurrence and an interesting ethical debate from multiple facets of the situation. Most brain dead patients proceeding to donorship required an in-depth death evaluation prior to being pronounced due to their hemodynamic stability. However, what is required of the physician- ethically, legally, and emotionally- when asked to run a code on their dead patient? Who is the patient’s decision maker if they are a registered donor- the family or the organ procurement agency? Is OP-CPR futile or effective and what is the international consensus on this controversial measure? Case The patient is a 58 year old female who presented to the emergency department after being found comatose. As she was listed as a Full Code without an ability to protect her airway, she was intubated and admitted to the medical intensive care unit. CT head showed cerebral edema and tonsillar herniation. CT angiogram Head and neck showed lack of diffusion consistent with brain death. She had no brainstem reflexes. No etiology for this cerebral edema and lack of cerebral flow was found after extensive workup. She underwent cEEG, a perfusion scan, and two apnea tests due to the odd nature of her presentation prior to being pronounced legally brain dead. She was a registered organ donor. She was hemodynamically stable throughout admission, until approximately 16 hours after being pronounced. She began to experience multiple dysarthymias, and the Organ Procurement Organization requested ACLS measures be performed. The family had initially been asked if they wanted to proceed with organ donation, however,now the OPO stated they legally did not need family approval. Patient was stabilized and underwent successful organ donation after several meetings between the ICU, legal, the OPO, and family. Conclusion The National Conference of Commissioners on Uniform State Laws Revised Uniform Anatomical Gift Act in 2006 to strengthen the principle that the body is an anatomical gift to the OPO upon death. Family has no decision-making power. OP-CPR remains controversial world-wide, with either a lack of recommendation made due to lack of data in predicting futility and moral distress on the provider while some societies recommend its usage in an effort to save more lives by preserving viable organs. This abstract is funded by: None
Romano et al. (Fri,) studied this question.