Summary of current GUIDe proposals
Adult Intensive Care
• Futility will be determined by prolonged multiple organ system failure. The group is in the process of refining definitions of failure for each organ system. They anticipate that the subcommittee will agree that further intensive care for someone with four or more organ systems failing for over three days is futile. (Note: seven days has a better basis in the literature).
• Patients in a persistent vegetative state should not be transferred to the intensive care unit.
• Intensive care admissions should be limited for patients with end-stage dementia.
Long-Term Acute Care
• Patients with persistent vegetative state should not receive prolonged mechanical ventilation.
Long-Term Chronic Care
• Patients with end-stage dementia (patients who are bed- or chair-bound and cannot converse in a meaningful way) should be treated palliatively when they become acutely ill. Transfer to a hospital is only indicated for palliative care. Most often, however, palliative care will not include hospital transfer.
• There should be compelling reasons to start long-term enteral tube feedings for patients with end-stage dementia. For example, a patient should have made it clear in advance directives that he or she would want long-term enteral feedings.
Do-Not-Resuscitate Policies
• Cardiopulmonary resuscitation should not be provided to chronically ill patients who are near death.
Source: Crippen D. Inappropriate medical treatment for moribund patients: An international consensus on futility. Summary statement. International Critical Care Medicine Discussion Group. Pittsburgh; 2000.
RESOURCES
• National Transplant Action Committee, 1750 S.W. Skyline Blvd., Suite 103, Portland, OR 97221. Telephone: (888) 700-8812 or (503) 203-8812. Fax: (503) 203-8815. E-mail: [email protected]. Web site: http://www.teleport.com/~ntac/.
• United Network for Organ Sharing, 1100 Boulders Pkwy., Suite 500, P.O. Box 13770, Richmond, VA 23225-8770. Telephone: (888) 894-4636. Web site: www.unos.org. To receive a copy of the proposed scale to determine medical urgency, contact UNOS at (804) 330-8548.
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