Conflicts of interest in the context of end of life care for potential organ donors in Australia Professor Frank M.P. van Haren, MD, PhD, EDIC, FCICM, PGDipEcho a, ⁎, Dr Angus Carter, BAppSc, MBBS, FCICM b , Dr Elena Cavazzoni, MB ChB, B Med Sci, PhD, MRCPCH, FCICM c , Dr Michael Chapman, MBBS, FRACP, FAChPM, PhD d , Dr Rohit L. D'Costa, MBBS, FRACP, FCICM e , Dr Sarah L. Jones, BMedSc (Hons), MB ChB(Hons), MRCP(UK), DICM(UK), FCICM, FRACP, GDipClinUS f , Associate Professor Andrew McGee, PhD g , Dr Stewart Moodie, MB, ChB, FRCA, FCICM, MBioethics h , Dr Leo Nunnink, MBBS, FACEM, FCICM i , Dr Michael O'Leary, MD, FRCA, FCICM j , Dr Helen Opdam, MBBS, FRACP, FCICM k , Dr Sam Radford, MBBS (Hons), BMed Sci (Hons), FRACP, FCICM, PGCHPE l , Clinical Associate Professor Andrew J. Turner, MBBS, FRACP, FCICM m , Associate Professor Dominique Martin, MBBS, BA(Hons), PhD n a Australian National University, Medical School, University of Canberra, Faculty of Health, Intensive Care Unit, Canberra Hospital, Canberra, Australia b Cairns and Hinterland Hospital and Health Service, James Cook University School of Medicine and Dentistry, Cairns, Australia c University of Sydney, Children's Hospital at Westmead, Sydney, Australia d Australian National University, Medical School, University of Technology Sydney, ImPaCCT, Department of Palliative Care, Canberra Hospital, Canberra, Australia e Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia f Intensive Care Unit, the Northern Hospital, Epping, Australia g Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia h Department of Intensive Care, Royal Adelaide Hospital, Adelaide, Australia i University of Queensland, Brisbane, Australia j Intensive Care Service, Royal Prince Alfred Hospital, Sydney, Australia k Intensive Care Unit, Austin Health, Melbourne, Australia l Intensive Care Unit, Austin Health, Faculty of Medicine, Dentistry and Health Science, Melbourne University, Y, Australia m Department of Critical Care Medicine, Royal Hobart Hospital, Hobart, Australia n School of Medicine, Faculty of Health, Deakin University. Geelong, Australia abstract article info Keywords: Conflict of interest Organ donation Ethics Donation physician End of life Palliative care Dual roles End-of-life (EOL) care has become an integral part of intensive care medicine and includes the exploration of pos- sibilities for deceased organ and tissue donation. Donation physicians are specialist doctors with expertise in EOL processes encompassing organ and tissue donation, who contribute significantly to improvements in organ and tissue donation services in many countries around the world. Donation physicians are usually also intensive care physicians, and thus they may be faced with the dual obligation of caring for dying patients and their families in the intensive care unit (ICU), whilst at the same time ensuring organ and tissue donation is considered according to best practice. This dual obligation poses specific ethical challenges that need to be carefully understood by cli- nicians, institutions and health care networks. These obligations are complementary and provide a unique skillset to care for dying patients and their families in the ICU. In this paper we review current controversies around EOL care in the ICU, including the use of palliative analgesia and sedation specifically with regards to withdrawal of cardiorespiratory support, the usefulness of the so-called doctrine of double effect to guide ethical decision-making, and the management of potential or perceived con- flicts of interest in the context of dual professional roles. © 2020 Elsevier Inc. All rights reserved. Journal of Critical Care 59 (2020) 166–171 ⁎ Corresponding author. E-mail address: frank.vanharen@anu.edu.au (F.M.P. van Haren). https://doi.org/10.1016/j.jcrc.2020.06.016 0883-9441/© 2020 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Critical Care journal homepage: www.journals.elsevier.com/journal-of-critical-care