HEART-TRANSPLANTATION WITHOUT INFORMED CONSENT - DISCUSSION OF A CASE

Objective: To discuss informed consent to heart transplantation in the case of an intensive care unit (ICU) patient: relatives' informed con sent was refused by the patient himself whose cognitive ability appear ed to be reasonable for the purpose. Setting: ICU of a university teac hing hospital. Patient: a 62-year-old man who underwent myocardial rev ascularization had in the immediate post-operative hemodynamic instabi lity, continuous serious arrhythmias, ventilatory support, fentanyl in fusion. Heart transplantation could be the only chance for his surviva l. Intervention: heart transplantation. Results: despite patient's ref usal, we decided to hold the relative's consent as valid, and transpla ntation was accordingly performed, to the subsequent satisfaction of t he patient. Conclusions: Our decision was based on two beliefs: (1) th e severity of the patient's clinical condition may have impaired his c ognitive abilities; (2) the very same conditions may mask impairment a nd certainly make reliable assessment of cognition and judgment imposs ible. This being so, the preservation of life assumes priority.