Leo Nunnink1, David A Cook2. 1. PA-Southside Clinical School, Faculty of Health Sciences, University of Queensland, Brisbane, QLD, Australia. l.nunnink@uq.edu.au. 2. PA-Southside Clinical School, Faculty of Health Sciences, University of Queensland, Brisbane, QLD, Australia.
Abstract
OBJECTIVE: To evaluate whether the admission of a palliative patient to the intensive care unit for end-of-life care and consideration of organ donation provides an equivalent net benefit in quality-adjusted life-years (QALYs) compared with the admission of a non-palliative patient for active management. DESIGN: Relevant publications from the period 1995-2015 were reviewed to estimate the mean QALYs gained from ICU admission of a critically ill patient and mean QALYs gained from transplantation of solid organs from an organ donor. Australian audit data were used to estimate the likelihood of a palliative patient admitted to the ICU progressing to organ donation. We calculated probabilities of each outcome and developed an algorithm to illustrate possible pathways for a patient who may progress to organ donation. RESULTS: A non-palliative ICU admission provides to the patient about 1.0 QALY per ICU bed-day. An ICU bed provided to a patient admitted to the ICU for palliation and consideration of organ donation results in 7.3 QALYs gained for the community per ICU bed-day. CONCLUSION: The admission of a dying patient to the ICU when organ donation may be possible is of considerable community benefit, yielding an average of over seven times the QALYs per ICU bed-day compared with the average benefit for ICU patients expected to survive. When it is possible to offer end-of-life care in the ICU, it should not be denied on the basis of concerns about lack of benefit or inappropriate use of resources.
OBJECTIVE: To evaluate whether the admission of a palliative patient to the intensive care unit for end-of-life care and consideration of organ donation provides an equivalent net benefit in quality-adjusted life-years (QALYs) compared with the admission of a non-palliative patient for active management. DESIGN: Relevant publications from the period 1995-2015 were reviewed to estimate the mean QALYs gained from ICU admission of a critically ill patient and mean QALYs gained from transplantation of solid organs from an organ donor. Australian audit data were used to estimate the likelihood of a palliative patient admitted to the ICU progressing to organ donation. We calculated probabilities of each outcome and developed an algorithm to illustrate possible pathways for a patient who may progress to organ donation. RESULTS: A non-palliative ICU admission provides to the patient about 1.0 QALY per ICU bed-day. An ICU bed provided to a patient admitted to the ICU for palliation and consideration of organ donation results in 7.3 QALYs gained for the community per ICU bed-day. CONCLUSION: The admission of a dying patient to the ICU when organ donation may be possible is of considerable community benefit, yielding an average of over seven times the QALYs per ICU bed-day compared with the average benefit for ICU patients expected to survive. When it is possible to offer end-of-life care in the ICU, it should not be denied on the basis of concerns about lack of benefit or inappropriate use of resources.
Authors: Anne Trabitzsch; Konrad Pleul; Kristian Barlinn; Volkmar Franz; Markus Dengl; Monica Götze; Andreas Güldner; Maria Eberlein-Gonska; Detlev Michael Albrecht; Christian Hugo Journal: Dtsch Arztebl Int Date: 2021-10-15 Impact factor: 8.251
Authors: Janet E Squires; Nicole Graham; Mary Coughlin; Michaël Chassé; Stefanie Linklater; Megan Greenough; Jeremy M Grimshaw; Sam D Shemie; Sonny Dhanani; Gregory A Knoll Journal: Transplant Direct Date: 2018-06-27