240 M. Coombs and M. Woods
care is unable to bring about recovery. Death and dying is therefore
an integral part of intensive care practice (Truog et al. 2008 ) and the
skills of caring for the dying patient and supporting family/whānau^1 are
equally as important as the skills required to manage the intensive care
technology (Bion and Coombs 2015 ). The ability to communicate in
a skilled and compassionate manner is even more important, given the
sensitivity of the end-of-life decisions that need to be made.
This chapter aims to explore the key ethical and clinical challenges
that surround end-of-life care and organ donation by drawing on the
experience of three donor families in New Zealand. Each of these cases
illuminates a specific issue within organ donation and the ways in which
it relates to end-of-life care. As each of the cases involves brain death,
donation after cardiac death will not be explored in this chapter. Each
narrative in this chapter has been generously provided by the family/
whānau and can be read in full on the New Zealand Organ Donation
website (http://www.donor.co.nz/). Their accounts remind us of the
immense personal tragedy that lies behind any writing on organ dona-
tion and end-of-life care.
End of Life and Donation Matters in Intensive
Care
One in five patients admitted to intensive care will not live to be dis-
charged. For most of these patients, death will result from a planned
treatment withdrawal (Wunch et al. 2005 ). The process of removing
life-sustaining therapies occurs once consensus has been reached with all
clinical staff and family/whānau that it is not in the patient’s best inter-
ests to continue treatment. At this point, a shift from curative to pal-
liative measures occurs, and end-of-life care is instituted. Life-sustaining
treatments are withdrawn, and pain-relieving and sedative medications
are administered as required. Cardio-respiratory activity eventually
ceases, and the patient’s death is certified.
However, there is another circumstance that leads to a patient’s death
being certified in intensive care. Eleven percent of all deaths in this
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