The European Society of Intensive Care Medicine, through its multi-disciplinary panel, is to be congratulated for developing fairly comprehensive guidelines on end-of-life and palliative care in the intensive care unit, which highlight the poor quality of evidence and the need for research in these domains [1]. Unfortunately, there is a significant and important omission in these guidelines which is both surprising and disappointing. This is the failure to mention at all the importance of considering the possibility of organ donation in all patients at the time that a decision to transition to planned end-of-life care is being considered. Organ donation preferences are an integral component in evaluating patients’ holistic end-of-life care preferences. To ensure that opportunities for organ donation are preserved, it is necessary to ensure that the potential for donation is recognized early in the transition to end-of-life care and that planning for end-of-life conversations includes the consideration of donation and how this will be integrated into patient and family conversations. Although more research is also needed in this area, available evidence suggests that organ donation discussions do not add to family distress at end-of-life [2] and moreover, families consenting to donation may demonstrate lower levels of regret and complicated grief than those that do not [3, 4].

中文翻译：

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评论： 欧洲重症监护医学会关于重症监护病房临终和姑息治疗的指南。


欧洲重症监护医学会（European Society of Intensive Care Medicine）通过其多学科小组，制定了关于重症监护病房临终关怀和姑息治疗的相当全面的指南，该指南强调了证据质量差以及这些领域研究的必要性[1]。不幸的是，这些指南中有一个重大且重要的遗漏，这既令人惊讶又令人失望。这是在考虑决定过渡到有计划的临终关怀时，根本没有提到考虑所有患者器官捐献可能性的重要性。器官捐献偏好是评估患者整体临终关怀偏好的一个组成部分。为确保保留器官捐献的机会，有必要确保在过渡到临终关怀的早期就认识到捐献的潜力，并且临终对话的计划包括考虑捐献以及如何将其纳入患者和家庭对话。尽管该领域还需要更多的研究，但现有证据表明，器官捐献的讨论不会增加临终时的家庭痛苦 [2]，此外，同意捐献的家庭可能比不同意捐献的家庭表现出更轻的遗憾和复杂悲伤 [3， 4]。