Ethical Considerations and End-of-Life Care in Donor and Transplant Critical Care

Advances in organ transplantation and mechanical circulatory support technologies have deepened the ethical complexity of care for critically ill patients across the donation-transplant continuum, especially at the end-of-life. This narrative review is structured around four clinical scenarios faced by bedside intensivists: patients awaiting transplantation, patients for whom transplant is no longer an option, patients who may become organ donors, and transplant patients at the end-of-life. Across these contexts, clinicians must navigate prognostic uncertainty, steward scarce resources, and address potentially nonbeneficial treatment, while respecting patient values. Through case-based analysis, we offer practical ethical guidance and emphasize the critical role of skilled communication, ethics consultation, and palliative care in supporting bedside decision-making.