Regarding Estella et al. interesting editorial published in Medicina Intensiva on palliative care in the critically ill patient, we would like to make a few comments.1
It has been a while since healthcare providers accepted that the goals of medicine go far beyond healing our patients and include end of life care as well. We believe it is interesting to deal with this goal in the Intensive Medicine setting.
It is widely known that a high percentage of our patients do not have any healing options and their therapies are oriented towards comfort and wellbeing.2 A high percentage of these patients remain on life support whose futility at a given point leads to withdrawing this therapy. This inevitably leads to the patient's death in a short span of time as a consequence of the natural course of his disease. When the irreversible cessation of the cardiocirculatory function has been certified these patients—if possible—and their families are proposed to become organ and tissue donors. To this day, this new way to donate organs and tissues amounts to almost 25% of the overall organ donors in Spain, and according to our community registries this year it amounts to 28.3% of all donors already.
With the end of life organ and tissue donation plan of our patients—in cases where medical conditions allow it—we are preserving the right of our patients to become organ and tissue donors. We are also making transplants available for thousands of people who need them to stay alive or improve their quality of life significantly. The option of end of life donation should be offered to all citizens; however, as subject matter experts, healthcare providers should inform, advise, and incorporate this option within our patients’ anticipated life planning.
Intensive medicine services (IMS) in our country are the true makers of the Spanish model of organ and tissue transplants. This is so because they allow thousands of patients exercise their right to donation. Thanks to this multidisciplinary effort, our patients find themselves in the country with the highest chances of accessing transplant programs when needed. If we want to remain being the cornerstone of the Spanish model of donation and transplants on top of maintaining the excellent process of detection, diagnosis, and maintenance of brain death in the IMS, we need to incorporate: intensive care to donation, controlled and uncontrolled asystole donation of extra-hospital EMS, and the detection of multi-tissue donors.3–5
Lastly, we should have a few words for the healthcare personnel that provide end of life care to patients. The patients right to donate should go hand in hand with the healthcare providers obligation to offer this option in all possible healthcare settings. By doing this we will be respecting our patients’ autonomy and facilitating much needed therapies.
We wish to acknowledge and thank the work done by all Spanish intensivists in the process of donation and transplants. They are the backbone of the “Spanish model” of transplants.
Please cite this article as: Daga-Ruiz D, Perez-Villares JM, Martín-Villén L, Egea-Guerrero JJ. El derecho a ser donante de órganos y tejidos al final de la vida del paciente crítico. Med Intensiva. 2020;44:59–60.
