'Rule of Rescue' Trumps Societal Benefits in ICU

More than a third of clinicians prioritize critically ill patients over potential organ donors

THURSDAY, July 14 (HealthDay News) -- More than one-third of intensive care unit (ICU) clinicians are willing to forego societal benefits to prioritize ICU allocation to a living, critically ill patient over a dead or dying patient who would be a potential organ donor, according to a study published in the July issue of Intensive Care Medicine.

Rachel Kohn, M.D., from the University of Pennsylvania School of Medicine in Philadelphia, and colleagues examined the readiness of physicians and nurses to prioritize ICU bed allotment to a critically ill but living patient with a small chance of survival over a dead or dying patient who could provide societal benefits through organ donation. A national sample of U.S. ICU clinicians were sampled using mixed-method questionnaires, of whom 684 physicians and 438 nurses gave a complete response.

The investigators found that, among the respondents, 45.9 percent of the physicians and 32.6 percent of the nurses were found to favor the "rule of rescue" by giving the last ICU bed to the critically ill but living patient. The benefit of five or 30 additional life-years for donor transplant recipients had a small and inconsistent impact on the readiness of clinicians to give priority to the potential donor. The most common reason cited for adhering to the rule of rescue by 65 percent of the physicians and 75 percent of the nurses was a strong obligation to an identifiable living patient.

"Many ICU clinicians feel compelled to provide salvage critical care for identifiable patients with grave prognoses, even when doing so measurably contravenes society's interests," the authors write.

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