Start | Browse by Day | Author Index | Keyword Index

The Power of a Potential Liver Transplantation: Life-Sustaining Treatment Decisions, One Family's Journey

Monday, 7 July 2008
Lissi Hansen, PhD, RN , Undergraduate Program, Oregon Health & Science University, Portland, OR
Mark S. Chesnutt, MD , Critical Care, Portland Veteran Affairs Medical Center, Portland, OR
Judith Kendall, PhD, RN , Graduate Program, Oregon Health & Science University, Portland, OR
Judith G. Baggs, PhD, RN , Academic Affairs, Oregon Health & Science University, Portland, OR
Nancy Press, PhD , Graduate Program, Oregon Health & Science University, Portland, OR

Learning Objective 1: describe the power a potential liver transplantation may have in life-sustaining treatment decision-making

Learning Objective 2: describe 3 or more different life-sustaining treatments

Background: In the United States, up to 29 percent of patients with end-stage liver disease (ESLD) who are listed on the transplant waiting list die without a transplant each year. These patients frequently develop complications before an organ becomes available and are often admitted to an intensive care unit (ICU) for life-sustaining treatments (LST). Research on LST decision-making has considered decisions about LST as discrete events, rather than looking over time at how these decisions may be guided by multiple LST decisions. There has been no attention to LST decisions involving transplant patients and end-of-life during their entire ICU stay.

Purpose: The purpose of the study was to describe the longitudinal process during which decisions were made about LST, transplantation, and end-of-life from family members' perspectives for one patient.

Methods: A case study design and ethnographic methods were used. Data were collected from 24 hours after the patient's ICU admission to the patient was transferred out of the unit 4 days later. The study involved 38 hours of participant observation, nine interviews with six family members, and daily medical chart reviews.

Results: Decisions were made for seven LST: blood products, intubation, endoscopy, Minnesota tube, transjugular intrahepatic portosystemic shunt, vasopressors, and feeding tube. The LST decision between life and immediate death was more important than others like decisions about vasopressors. Although the death of the patient was a high probability, the goal of all LST decisions was to get the patient re-listed on the transplant waiting list.

Implications: This case study provided information that is essential for health care providers who care for family members faced with multiple LST decisions during a patient's same ICU stay.

Funding: NINR/NIH # 1 R21 NR009845-01A2

See more of: POSTERS: Critical Care
See more of: Research Sessions – Oral Paper & Posters