Palliative ICU beds for potential organ donors: an effective use of resources based on quality adjusted life years gained.
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.
Critical care and resuscitation journal of the Australasian Academy of Critical Care Medicine