Nearly half of patients rushed to intensive care units with the sole goal of using their organs, were sent without their family's knowing they couldn't be saved.
That was one finding from New Zealand's first study to quantify the practice of admitting patients with "acute fatal illnesses", such as becoming brain dead, to ICU solely for the possibility of using their organs to save others.
It comes after some intensive-care specialists raised concerns about the morals of the practice, the impact it may have on family of the patient and the effect it could have on the ability of the ICU to provide care to other critically ill patients.
An Organ Donation New Zealand spokesman stressed sometimes conversations with families about potential organ donation was not possible before the patient was taken to hospital but they always happened before a donation was made.
In an article published in the New Zealand Medical Journal today, researchers found that over a two-year period - between July 2017 and June 2019 - 49 patients were admitted to ICU under this practice. That equates to more than two patients a month.
Of that, on 23 occasions (43 per cent) a discussion with the patient's family about possible organ donation did not occur before they were admitted to ICU.
Organ Donation New Zealand (ODNZ) recommends this practice should not happen without "explicit discussion" with the family, where possible, about the reasons for admitting the patient.
"Where discussions did not take place with the family, this is most likely because the family were in transit to the hospital and unavailable for discussion at the time," the ODNZ spokesman said.
All 49 patients identified in the study died at hospital between five minutes and 15 days of being admitted. Of the 49 patients, 20 donated 430 organs. The remaining 29 didn't donate any organs.
The total cost of all 49 patient's ICU stay was $330,000 - $6735 per patient, authors of the study said.
Lead author Stephen Streat - who is clinical director of Organ Donation New Zealand (ODNZ) and a intensive care specialist - wanted to stress that before July 2017 this practice already existed and contributed significantly to the number of organs that are transplanted.
"We are all very grateful to the work of the hospital staff and the generosity of the donor family, and that are possibility of increasing that practice within the bounds what is acceptable ethical and political practice and we support that," Streat said.
But, he said, that was all before the Covid-19 pandemic and intensive care specialists were now working in very different times.
Streat said he would not comment further, saying "a broader discussion of these matters is best left for another time".
Another finding of the research found "considerable" disparities between New Zealand's 24 ICUs in terms of frequency of which this practice occurred and whether discussion with family took place before admission.
"This is likely to reflect both hospital size and services, and also aspects of both
ICU and ED culture and communication around patients at the end of life," authors said in the paper.