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Decision MakingNCT04131140

Organ Donation and End-of-life Decisions

An observational study of Decision Making and Terminal Illness, run by Swedish Intensive Care Registry at 1 site in Sweden.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Variation in organ donation after brain death (DBD) per million population varies markedly between countries, within country regions, between and within intensive care units (ICU). These circumstances also apply to end-of-life decisions in the ICU. Read more about this study

Who is it for?
Any age
How many people
12,072 participants
Where
1 siteSweden
Study dates
1 Jan 2014to 22 Mar 2018
How long will I take part?
60 Days
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Study population: The study population consisted of all ICU deaths (12,072) between 2014-2017 in general and neurological intensive care units which all recorded treatment strategy in their daily routine work. Special units like paediatric, burn and thoracic intensive care units were excluded

Who may be able to join

  • All ICU deaths in Sweden between 1/1 2014 and 31/12 2017 from
  • general and neurological intensive care units,
  • which recorded treatment strategy according to national guidelines and
  • send data according to SIR's protocol for the follow-up of all deceased intensive care patients (DBD).

Who cannot join

  • Special units like paediatric (N=4), burn (N=2) and thoracic (N=8) intensive care units, due to low coverage ratio of documented treatment plan decisions in combination with a low ICU mortality rate.
  • General (N=3) ICUs that do not register documented treatment plan.

Trial locations and contacts

1 site in 1 country.

Sweden1 site

  • The Swedish Intensive Care Registry

    Karlstad

Other trials in Sweden

About this study

Official title: Differences Across ICUs in Organ Donation After Brain Death: A Nationwide Study of Relationship With Variation in End-of-life Decisions

Variation in organ donation after brain death (DBD) per million population varies markedly between countries, within country regions, between and within intensive care units (ICU). These circumstances also apply to end-of-life decisions in the ICU.

The investigators studied all ICU deaths in Sweden between 2014-2017 in ICUs that, as routine, registered treatment plan (no treatment limitation and/or treatment limitation) and DBD.

The investigators hypothesized that ICUs with high proportion of treatment limitation (withholding or withdrawing life sustaining treatment) also had less proportion of DBD.

Read the detailed description

The Swedish Intensive Care Registry (SIR) collects a comprehensive data set of patient characteristics, intensive care procedures, severity of illness scores, workload and outcomes using detailed guidelines.

Continuous data are collected as raw data, validated locally and transferred electronically to the registry for central validation (confirmed to be within prespecified limits and inconsistencies and illogical entries identified). If necessary, data are returned for correction and revalidation before being accepted and added to the master database. No data are changed by SIR. At SIR's homepage there are numerous open reports, updated as soon as new incoming data are processed by SIR.

SIR has an annual 2-day course for all ICU's in registration techniques and problems and daily telephone support possibilities concerning registration questions, problems and guidance. SIR has, however not yet a systematic on-site auditing program.

Missing data regarding treatment strategy are registered and are accounted for in the study. There are no missing data regarding organ donation.

The investigators calculate the proportion of treatment limitations per ICU as the number of deaths with any treatment limitation divided by all deaths in the same ICU.

Continuous variables are expressed as mean (standard deviations) or median (interquartile range).

Differences in proportions are analysed using the χ2-test. Changes over time are analysed using the non-parametric trend test. Survival are examined using the Kaplan-Meier estimate and differences in survival are analysed with the log-rank test.

Logistic regression is used to examine associations between patient and ICU characteristics and DBD as dependent variable. Mixed-effects logistic regression clustered per ICU is used to assess associations between treatment limitation and DBD after adjusting for patient age, sex, comorbidities, the Simplified Acute Physiology Score III (SAPS3) probability of death, principal diagnostic category, presence of treatment limitation and type of hospital.

Significance was assumed if P < 0.05.

Keywords
Advance Care Planning, Resuscitation Orders, Palliative Care, Brain Death, Organ Donation, Critical Illness, Intensive Care Units
Medical subject headings
Brain Death, Critical Illness

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Rate of organ donations after brain death (DBD)

    Documented decision to carry out organ donation

    Measured: The estimated period of time to the ICU death is assessed up to 5 months after patient admission time to the ICU, with a median of 1.6 days. The event is determined by clinical examination or, in some cases cerebral angiography.

Secondary outcomes (2)

  1. Rate of documented treatment limitations during ICU stay

    Documented decision of treatment plan

    Measured: The estimated period of time to the ICU documentation of treatment plan is assessed up to 5 months after patient admission time to the ICU, with a median of 14 hours. The event is determined by the note in patients medical record.

  2. Incidence and type of a documented treatment limitation during ICU stay

    Documented treatment plan is either 1) no treatment limitation or 2) treatment limitation, which then is specified as a) withholding (WH) and/or b) withdrawing (WD) of either mechanical ventilation (MV) and/or non-invasive ventilation (NIV) and/or continuous renal replacement therapy (CRRT) and/or vasoactive drugs.

    Measured: The estimated period of time to the ICU documentation of WH and/or WD medical treatment is assessed up to 5 months after patient admission time to the ICU, with a median of 14 hours. The event is determined by the note in patients medical record.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Oct 2019
  2. Study start1 Jan 2014
  3. Primary completion31 Dec 2017
  4. Study completion22 Mar 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
12,072 participants (actual)
Target duration
60 Days
IDs, dates and publications
ClinicalTrials.gov ID
NCT04131140
Sponsor's protocol ID
EPN2017/247-32
Status last verified
Oct 2019
First submitted
11 Sep 2019
Last updated
18 Oct 2019
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Bendorf A, Kerridge IH, Stewart C. Intimacy or utility? Organ donation and the choice between palliation and ventilation. Crit Care. 2013 May 23;17(3):316. doi: 10.1186/cc12553.

    PubMed 23714404

  • Parker M, Shemie SD. Pro/con ethics debate: should mechanical ventilation be continued to allow for progression to brain death so that organs can be donated? Crit Care. 2002 Oct;6(5):399-402. doi: 10.1186/cc1542. Epub 2002 Aug 15.

    PubMed 12398776

  • Mark NM, Rayner SG, Lee NJ, Curtis JR. Global variability in withholding and withdrawal of life-sustaining treatment in the intensive care unit: a systematic review. Intensive Care Med. 2015 Sep;41(9):1572-85. doi: 10.1007/s00134-015-3810-5. Epub 2015 Apr 23.

    PubMed 25904183

  • Citerio G, Cypel M, Dobb GJ, Dominguez-Gil B, Frontera JA, Greer DM, Manara AR, Shemie SD, Smith M, Valenza F, Wijdicks EFM. Organ donation in adults: a critical care perspective. Intensive Care Med. 2016 Mar;42(3):305-315. doi: 10.1007/s00134-015-4191-5. Epub 2016 Jan 11.

    PubMed 26754754

  • Citerio G, Crippa IA, Bronco A, Vargiolu A, Smith M. Variability in brain death determination in europe: looking for a solution. Neurocrit Care. 2014 Dec;21(3):376-82. doi: 10.1007/s12028-014-9983-x.

    PubMed 24865268

  • Neitzke G, Rogge A, Lucking KM, Boll B, Burchardi H, Dannenberg K, Duttge G, Dutzmann J, Erchinger R, Gretenkort P, Hartog C, Jobges S, Knochel K, Liebig M, Meier S, Michalsen A, Michels G, Mohr M, Nauck F, Salomon F, Seidlein AH, Soffker G, Stopfkuchen H, Janssens U. [Decision-making support in Intensive Care to facilitate organ donation : Position paper of the Ethics Section and the Organ Donation and Transplantation Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) in collaboration with the Ethics Section of the German Society of Medical Intensive Care Medicine and Emergency Medicine (DGIIN)]. Med Klin Intensivmed Notfmed. 2019 May;114(4):319-326. doi: 10.1007/s00063-019-0578-3. German.

    PubMed 30976838

  • Long AC, Brumback LC, Curtis JR, Avidan A, Baras M, De Robertis E, Efferen L, Engelberg RA, Kross EK, Michalsen A, Mularski RA, Sprung CL; Worldwide End-of-Life Practice for Patients in ICUs (WELPICUS) Investigators. Agreement With Consensus Statements on End-of-Life Care: A Description of Variability at the Level of the Provider, Hospital, and Country. Crit Care Med. 2019 Oct;47(10):1396-1401. doi: 10.1097/CCM.0000000000003922.

    PubMed 31305497

Questions about this trial

What is this clinical trial studying?

An observational study of Decision Making and Terminal Illness, run by Swedish Intensive Care Registry at 1 site in Sweden.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Oct 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of organ donations after brain death (DBD) (time frame: The estimated period of time to the ICU death is assessed up to 5 months after patient admission time to the ICU, with a median of 1.6 days. The event is determined by clinical examination or, in some cases cerebral angiography.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04131140, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Oct 2019.

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