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Case report
Vaginal delivery in the 30+4 weeks of pregnancy and organ donation after brain death in early pregnancy
  1. Ann Kristin Reinhold,
  2. Markus Kredel,
  3. Christian K Markus and
  4. Peter Kranke
  1. Department of Anaesthesiology and Intensive Care, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
  1. Correspondence to Professor Peter Kranke, Kranke_P{at}ukw.de

Abstract

A 28-year-old woman suffered a traffic accident resulting in severe head injuries with deleterious prognosis. Diagnostics further revealed a hitherto unknown pregnancy, at suspected week 9. Based on the patient’s wish to donate organs, brain death protocol confirmed irreversible loss of brain function. Yet, vital pregnancy rendered organ transplantation impossible. Multiple ethical and legal issues arose, from invalidation of established legal care after brain death to the delivery of a healthy child after trauma and long-term critical care. After medicolegal and ethical counselling, pregnancy was sustained, and the goal of organ donation postponed. Critical care focused on foetal homeostasis. At 30+4 weeks, a viable girl was born via assisted vaginal delivery. Postpartal organ donation resulted in heart, kidney and pancreas transplantation. The case emphasises the medical, legal and ethical challenges to combine two apparently diametrical goals: the successful full-term pregnancy and the fulfilment of a patient’s wish to donate organs.

  • pregnancy
  • trauma
  • ethics
  • adult intensive care
  • trauma CNS/PNS
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Footnotes

  • Contributors AKR, MK, CKM and PK were involved in the patient’s treatment and wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Next of kin consent obtained.

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