Abstract Rationale Resuscitation aimed at organ preservation and transplantation in patients with lethal injuries is increasingly practiced in trauma care. However, the ethical and decision-making frameworks guiding this approach remain poorly defined. This study explored trauma surgeons’ perspectives on the ethical, clinical, and financial dimensions of resuscitation for organ preservation. Methods We conducted semi-structured qualitative interviews with seven trauma surgeons at a single academic medical center. Interviews were audio-recorded, transcribed verbatim, and analyzed using grounded theory methodology. Two independent blinded coders systematically coded the transcripts and collaboratively identified recurrent themes through iterative comparison and consensus building. Results Grounded theory analysis identified five overarching domains—autonomy, beneficence, nonmaleficence, justice, and practical/system issues—reflecting the ethical and operational complexity of resuscitation for organ preservation. The most frequent codes involved institutional culture and protocols (5.1), family involvement and trust (1.2), and communication and transparency (1.3). Surgeons described ongoing tension in balancing resource utilization, clinical outcomes, and patient or family preferences, while striving to preserve patient dignity, maximize organ availability, and reconcile professional identity during the transition from life-saving to organ-preserving care. One participant noted that “that patient’s autonomy is sort of lost, and we’re thinking about beneficence—eight potential recipients is the overwhelming piece,” highlighting the ethical weight of shifting goals of care. Another emphasized the moral complexity of consent, explaining, “when there’s an absence of primary consent, that’s when it gets nuanced⋯To what extent are you willing to subject this patient to potentially additional invasive procedures or⋯discomfort in this potentially end-stage portion of their life?” Persistent uncertainty surrounded the financial implications of these cases; as one surgeon reflected, “when I order a unit of blood, I don’t know⋯ how that cost ends up being used—can this person afford that cost, can they not?” Collectively, participants called for institutional frameworks, interdisciplinary communication, and transparent financial responsibility to support ethical and equitable decision-making in organ-preserving resuscitation. Conclusions Trauma surgeons universally recognize the societal value of organ donation but face substantial ethical, operational, and financial uncertainty when resuscitation is directed toward organ preservation. Findings reveal a lack of standardized guidance and unclear financial accountability, leading to inconsistent decision-making and provider discomfort. Addressing these gaps presents actionable opportunities for both trauma and transplant systems: developing evidence-based institutional protocols, clarifying cost responsibility across hospitals and organ procurement organizations, and establishing national ethical frameworks to guide decision-making at the end of life. This abstract is funded by: None
Hilvert et al. (Fri,) studied this question.