Supporting the Neonatal and Pediatric Donor. Breakout Session A. Presenters: Jeffrey Johnson, MD, LAC + USC Medical Center Mudit Mather, MD, Loma Linda University Medical Center Moderator: Marcia Penido , LCSW, MPH, Huntington Hospital. Objectives:.
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Breakout Session A
Jeffrey Johnson, MD, LAC + USC Medical Center
Mudit Mather, MD, Loma Linda University Medical Center
Marcia Penido, LCSW, MPH, Huntington Hospital
Jeffrey L. Johnson, MD, MA, FAAP
Associate Chief of Pediatrics
Director of Pediatric Inpatient and
Critical Care Services LAC+USC Medical Center
Assistant Professor of Clinical Pediatrics Keck USC
I have no financial conflicts of interest to report
A good end is desired, eg. providing for his family before he dies.
But the way the end is achieved, the means he chooses to make money, is the basis for all the mayhem the show delivers
In this talk I want to focus on the means by which we in ICUs preserve the opportunity for donation, by focusing on objective actions and intentions
“For me personally, human life requires the ability of the person to intellectually connect to, and interact with, the environment.”
Floden et al, J Clinical Nursing, Nov 2011
Are there potential
conflicts of interest
in these statements?
“Neither the physician making the determination of brain death nor the physician making the independent confirmation may participate in procedures for the removal or transplanting of organs after death”
ASA 106: LAC+USC Policy on determination of death
That policy’s fundamental purpose is to minimize conflict of interest
Rational agents recognize themselves as “ends-in-themselves” and because they are rational, recognize other rational beings as belonging to the same kingdom and therefore respect them as such
Their loved ones are not going to be treated as just sources of organs for someone else
“Full court press”: I pity the fool that makes a decision to withhold care before this pt has a full chance at resuscitation
“Nothing”: there is no point, this pt will die. Damn it Jim, I am a doctor not a miracle worker
But how do we justify one choice or another?
If God does not exist, one will lose nothing
by believing in him, while if he does exist,
one will lose everything by not believing.
Blaise Pascal (1623-1662)
I believe it is because focusing on
optimizing the care of the injured person will avoid the
temptation to view the injured as only a means
to another end while also
optimizing the conditions needed to
maximize donations should that choice come to pass
This means the end
Mudit Mathur, MD
Associate Professor, Pediatrics/Critical Care
Loma Linda University Children’s Hospital
Pediatric Intensivist, Huntington Hospital
Bhayana et al. Transplantation 2010; 90 (3): 248-54
Butani et al. Outcomes of children receiving en bloc renal transplants from small pediatric donors. PediatrTranspl2013; 17: 55-58
Shore et al. Potential for Liver and Kidney Donation After Circulatory Death in Infants and Children. Pediatrics 2011; 128 (3)
(based on 68% PICU brain death consent rate over the study period)