Management of non-survivable head trauma: Opportunities for improvement - 23/09/26
, Mackenzie D. Castellanos a, Therese Murphy a, Pious D. Patel b, c, Sonia Ajmera a, Alex P. Vaz a, Connor A. Wathen a, Niels D. Martin d, Monisha A. Kumar e, James M. Schuster a, Dmitriy Petrov a, eHighlights |
• | Physicians offer more interventions when donor status is unknown than for non-donors |
• | Medical literacy, family conflict, and patient values are key communication barriers |
• | Physicians without institutional support more often offer care they personally oppose |
• | Practice varies widely with no clear guidelines for patients of unknown donor status |
• | Providing futile care and family conflict negatively affect physician mental health |
Abstract |
Background |
Managing patients with non-survivable head trauma who do not meet brain death criteria presents significant ethical and clinical challenges. Decisions frequently fall to surrogates with limited guidance, particularly when organ donation status is unknown. This study assessed physician perspectives on communication, interventions, and institutional factors.
Methods |
We conducted a national survey of academic neurosurgery, trauma surgery, and neurocritical care programs. Items examined communication barriers, interventions by donor status, institutional support, and a dissonance measure for interventions viewed as inappropriate.
Results |
A total of 133 physicians responded. Top communication barriers were medical literacy, unclear patient values, and intrafamily conflict. Physicians offered more interventions when donor status was unknown than when patients were confirmed non donors. Lack of institutional support was associated with higher dissonance scores.
Conclusion |
Care varies widely and is influenced by donor status and institutional culture, underscoring the need for clearer guidance and provider support.
Le texte complet de cet article est disponible en PDF.Keywords : Craniocerebral trauma, Brain injuries, Critical care, Prognosis, Organ procurement
Plan
Vol 72 - N° 6
Article 101879- novembre 2026 Retour au numéro
Article précédent
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