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End-of-life care in a COPD patient awaiting lung transplantation a case report.doc

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End-of-life care in a COPD patient awaiting lung transplantation a case report

Janssen et al. BMC Palliative Care 2010, 9:6 /1472-684X/9/6 CASE REPORT Open Access End-of-life care in a COPD patient awaiting lung Case report transplantation: a case report Daisy JA Janssen*1,2,3, Martijn A Spruit1, Joan D Does1, Jos MGA Schols4 and Emiel FM Wouters1,5 Abstract COPD is nowadays the main indication for lung transplantation. In appropriately selected patients with end stage COPD, lung transplantation may improve quality of life and prognosis of survival. However, patients with end stage COPD may die while waiting for lung transplantation. Palliative care is important to address the needs of patients with end stage COPD. This case report shows that in a patient with end stage COPD listed for lung transplantation offering palliative care and curative-restorative care concurrently may be problematic. If the requirements to remain a transplantation candidate need to be met, the possibilities for palliative care may be limited. Discussing the possibilities of palliative care and the patients treatment preferences is necessary to prevent that end-of-life care needs of COPD patients dying while listed for lung transplantation are not optimally addressed. The patients end-of-life care preferences may ask for a clear distinction between the period in which palliative and curative-restorative care are offered concurrently and the end-of-life care period. This may be necessary to allow a patient to spend the last stage of life according to his or her wishes, even when this implicates that lung transplantation is not possible anymore and the patient will die because of end stage COPD. Background surgical treatment, if possible [4]. Listing for lung trans- plantation should occur when the expected prognosis of survival is significantly reduced, but exceeds the expected The prevalence and burden of Chronic Obstructive Pul- monary Disease (COPD) are expected to increase in the coming decades [1]. By 2020, COPD will rank third as waiting t