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The transplantation program in the US is an altruistic program based on the premise that organ donation is a gift, and relying on ethical principles of autonomy, respect for persons (beneficence, nonmaleficence), and justice. Organ donation after cardiac death (DCD) is controversial because it combines two ethically complex events: withdrawal of life-supportive therapies as part of end-of-life care of the dying patient, and the altruistic gift of organ donation. Firewalls should separate the three key decisions involved in DCD: the decision to forgo resuscitation, the decision to withdraw life-sustaining therapies, and the decision to donate organs after death. The dead donor rule presents ethical problems for expansions of DCD, and some legislative and practice changes to counteract these limitations may have presented even greater ethical problems than the dead donor rule itself. Resolving conflicts in the DCD process may require revisiting the dead donor rule.
Utilize current concepts of elderly trauma outcomes to support triage decisions.
Apply knowledge of those aspects of aging required to design and execute an anesthetic plan for an elderly trauma victim.
When an elderly patient enters the trauma room, what is your first thought? Do you rush to be more aggressive because elderly patients are more fragile and need more immediate and intensive trauma care? Do you question whether the resources and effort necessary to treat such a patient are likely to provide benefit to the patient or society because the functional outcome for such patients is so poor? This chapter seeks to summarize the current knowledge regarding the best approach to elderly trauma victims.
Life expectancy in the United States continues to rise. Persons reaching the age of 65 years have an average life expectancy of an additional 18.1 years (19.4 years for females and 16 years for males) . The retiring baby boomer population is more active than previous generations of elderly, many driving into their 90s and pursuing a variety of activities that increase their exposure to traumatic injury. Unintentional injury is the sixth leading cause of death among patients 65–74 years of age. This and other information can be accessed from the Web-based Injury Statistics Query and Reporting System supported by the Centers for Disease Control and Prevention (http://www.cdc.gov/ncipc/wisqars/)
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