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.
Chokshi et al. (Tue,) studied this question.