Let ’ s now look at some ancient history. In the Neolithic period – around 5000 BC, mean human life expectancy was only around 20. Although some individuals certainly lived into their 40s and even 50s infant, child and young adult mortality was very high – such that the mean age at death was only 20. It even declined a little during the Bronze Age around 2000 BC – farmers were exposed to animal-borne diseases and probably had inferior nutrition to Neolithic hunter-gatherers. By the time of the ancient Greek and Roman empires, mean life expectancy had risen to 28, but it is salutary to reflect on the implications of the fact that the average Roman woman had to have 4.4 babies to maintain a constant population of Roman citizens. There was only a slight improvement during the Middle Ages and even into late Victorian times mean life expectancy was still under 40 years. However, there have been spectacular changes in life expectancy in the last century, most of them pre-dating the technological advances in medicine in the late 20 th century.
The aging of the population and the trends toward overeating and a more sedentary lifestyle (which lead to a dramatic increase in obeSinglety) are leading to an increase in the incidence and prevalence of type 2 diabetes. [Passa, p.S5] Reference 1. Passa P. Diabetes trends in Europe. Diabetes Metab Res Rev. 2002;18:S3-S8. Passa, p.S5
We conclude that the mortality rate is high in neurocritical patients and around 21% die in brain death . LTE is applied in 25% of neurocritical cases. The majority of families accept doctors recommendation regarding LTE . Donation information is received in 81% of brain death and 16% of other deaths
But what do they get instead ? What fraction of all deaths take place in the ICU ? In NZ it is 5%, Malcolm tells me that it is 10% in NSW and US data vary widely by state between 10 and 25%. Dying is increasingly being managed as a negotiated business transaction between legally designated surrogates and health-care service providers. Although this modus operandi is American, it is surely metastasising across the Pacific, more rapidly I think into Australia than New Zealand.
Quality indicators in ICU and organ donation Rui Maio MD, PhD, CETC, FEBS ETCO Past-President 2011 Organ Donation Congress Buenos Aires, November 2011
B. Patients with terminal and irreversible illness facing imminent death ( too sick to benefit from ICU care ).
For example: severe irreversible brain damage, irreversible multiorgan system failure, metastatic cancer unresponsive to chemotherapy and/or radiation therapy (unless the patient is on a specific treatment protocol), patients with decision-making capacity who decline intensive care and/or invasive monitoring and who receive comfort care only, brain-dead non-organ donors, patients in a persistent vegetative state, patients who are permanently unconscious, etc.
ICU ADMISSION PRIORITY 4 (Guidelines for ICU admission, Discharge, and Triage Task Force of the ACCCM/SCCM, 1999) AND ABOUT PATIENTS WITH BRAIN DEATH DIAGNOSED OR ANTECIPATED?
T. Pont , J. Gener, E. Oliver, M. Bodí, M. Badia, J.Mestre, E. Muñoz, X. Esquirol, P. López, N. Masnou, S. Quintana, R. Deulofeu. Working Group of Catalan Transplant Organization. Barcelona. Spain The Impact of Neurocritical Patients ’ Evolution on Organ Donation. A Multicentric Study in Catalonia, Spain. Preliminary Results
How can we increase the interactions between intensive care medicine and organ transplantation organizations?
How can we reimburse the ICUs for the work involved in organ harvesting?
Finding the best balance between the treatment of a patient as a potential organ donor and a potential survivor.
“ ...they still have my body on the ventilator! ” ANY POSSIBLE DECEASED ORGAN DONOR A patient with a devastating brain injury or lesion OR a patient with circulatory failure AND apparently medically suitable for organ donation Potential donor Start donor treatment Contact the Transplant Coordinator Organ donation is a quality indicator in Intensive Care Medicine
“ Teamwork is the ability to work together toward a common vision. It is the fuel that allows common people to attain uncommon results.” Andrew Carnegie ICU staff and Donor Coordinators Thank you