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Murphy NB, Weijer C, Slessarev M, Chandler JA, Gofton T. Implications of the updated Canadian Death Determination Guidelines for organ donation interventions that restore circulation after determination of death by circulatory criteria. Can J Anaesth 2023; 70:591-595. [PMID: 37131028 PMCID: PMC10203003 DOI: 10.1007/s12630-023-02413-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 05/04/2023] Open
Affiliation(s)
- Nicholas B Murphy
- Departments of Medicine and Philosophy, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Charles Weijer
- Departments of Medicine, Epidemiology & Biostatistics, and Philosophy, Western University, London, ON, Canada
| | - Marat Slessarev
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Trillium Gift of Life Network, London, ON, Canada
| | | | - Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Castro PP, Salas SP. Ethical issues of organ donation after circulatory death: Considerations for a successful implementation in Chile. Dev World Bioeth 2022; 22:259-266. [PMID: 34773430 PMCID: PMC9886168 DOI: 10.1111/dewb.12338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 02/01/2023]
Abstract
Organ transplantation is a lifesaving procedure for end-organ damage and remains up to today as the most cost-effective alternative to treat these conditions. However, the main limitation to performing organ transplants is the availability of donor organs suitable for transplantation. To increase the donor pool, expanding organ donation from the conventional neurologic determination of death (NDD) to include circulatory determination of death (DCD) has been a well-established method of increasing donors in other countries. In this article, we discuss the clinical and ethical considerations for introducing DCD in Chile. The concepts we have used could very well be translatable to other similar countries which have not implemented this donation system yet. The most relevant issue to date is that DCD needs to alter the care of dying patients to obtain quality donor organs. In some countries, including Chile, there are some cultural barriers regarding withdrawal-of-care. These barriers include confusing withdrawal of care with acceleration of death, which leads to many practitioners refusing to remove artificial life support, and in turn only minimize ventilatory support or switch to a T-tube (without extubation). This cultural barrier could be overcome with careful consideration of the opinions of healthcare workers, family members, community and policy-based stakeholders. We also identified ethical issues related to informed consent of both donor and recipients, among other relevant ethical considerations. In conclusion, DCD donation in Chile can increase organ donation numbers in one of Latin America's countries with the lowest effective donor rate. However, this opportunity must be taken with caution to avoid the opposite effect if this policy is not well implemented, respecting the sound ethical principles mentioned in this paper.
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Affiliation(s)
- Pablo Pérez Castro
- Transplant Center, Clinica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile,Department of Surgery, Universidad de Chile, Santiago, Chile,Master of Public Health Program, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sofía P. Salas
- Department of Bioethics, Universidad del Desarrollo, Santiago, Chile
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Murphy N, Lingard L, Blackstock L, Ott M, Slessarev M, Basmaji J, Brahmania M, Healey A, Shemie S, Skaro A, Wilson L, Weijer C. Protocol for a qualitative pilot study to explore ethical issues and stakeholder trust in the use of normothermic regional perfusion in organ donation in Canada. BMJ Open 2022; 12:e067515. [PMID: 36175093 PMCID: PMC9528605 DOI: 10.1136/bmjopen-2022-067515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The process of controlled organ donation after circulatory determination of death (cDCDD) results in ischaemic injury to organs and leads to poorer outcomes in organ recipients. Although not yet used in Canada, normothermic regional perfusion (NRP) is a perfusion technology used postmortem with cDCDD donors to selectively restore perfusion of oxygenated blood to target organs in situ, reversing ischaemic injury and improving organ viability and post-transplant outcomes. However, NRP poses significant ethical challenges. To preserve trust in deceased donation, these ethical challenges must be addressed to the satisfaction of Canadian stakeholders before NRP's implementation. This study will identify ethical issues pertaining to NRP and explore perspectives of NRP among key stakeholders. By developing an explanatory framework delineating how stakeholder perceptions of NRP's ethical implications impact trust in Canada's donation and transplantation systems, this study will inform the development of responsible policy on NRP's use in Canada. METHODS AND ANALYSIS This study includes two workstreams. Workstream 1 is a scoping review of medical and bioethical literature to identify ethical issues stemming from NRP. We will apply a common search string across Medline, PubMed (other than Medline) and Embase to identify relevant articles. We will identify grey literature through Google searches, websites of organ donation organisations and consultation with our research network. No date limits will be applied. All peer-reviewed publications, commentaries, editorials or documents that engage with ethical issues in NRP (or conceptual and empirical issues as they relate to these ethical issues) will be included. News articles, conference abstracts and publications not in English will be excluded. Workstream 2 consists of interviews with healthcare providers, institutional stakeholders, organ recipients and deceased donors' family members (n=24-36), as well as focus groups with healthcare providers involved in deceased donation and transplantation (n=20-32). Constructivist grounded theory methodology will guide data collection and analysis in workstream 2. ETHICS AND DISSEMINATION This study was approved by Western University's research ethics committee (Western REM; ID: 120001). All participants will be asked to provide written informed consent to participate. Findings will be shared with Canadian organ donation and transplantation organisations, presented at national conferences and published in medical journals.
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Affiliation(s)
- Nicholas Murphy
- Philosophy and Medicine, Western University, London, Ontario, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation and Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Mary Ott
- Department of Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Marat Slessarev
- Department of Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
- Regional Medical Lead, Trillium Gift of Life Network, Toronto, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
| | - John Basmaji
- London Health Sciences Centre, London, Ontario, Canada
- Departments of Medicine and Epidemiology & Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Mayur Brahmania
- London Health Sciences Centre, London, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Andrew Healey
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Trillium Gift of Life Network, Toronto, Ontario, Canada
| | - Sam Shemie
- Division of Critical Care Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Anton Skaro
- London Health Sciences Centre, London, Ontario, Canada
- Department of Surgery, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | | | - Charles Weijer
- Departments of Medicine, Epidemiology & Biostatistics, and Philosophy, Western University, London, Ontario, Canada
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Trottier A, Maitre G, Hébert A, Weiss MJ. Potential Heart, Liver, and Kidney Donation after Circulatory Determination of Death in a Neonatal Intensive Care Unit. Neonatology 2021; 118:546-552. [PMID: 34352783 DOI: 10.1159/000517660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pediatric organ donation after circulatory determination of death (DCD) has increased in recent years; however, there are few data reporting the number of neonatal potential DCD organ donors and no Canadian-specific reports. OBJECTIVE The main objective of this study was to estimate the number of patients who may have become actual DCD organ donors from a single, tertiary neonatal intensive care unit (NICU) over 5 years. METHODS We reviewed all medical charts of newborns ≥2.5 kg, who died in our center's NICU from January 2013 to December 2017. We determined how many could have become actual organ donors after brain death (DBD) or DCD based on 3 sets of organ-specific eligibility criteria defined as conservative, standard, and liberal. RESULTS Of the 39 deceased patients, none met the criteria for DBD. Twenty-nine (75%) died after the withdrawal of life-sustaining therapies. According to the conservative criteria, 1 patient would have been eligible for kidneys and liver donation. Three patients met standard criteria for kidneys and 1 for liver. Eight patients would have been eligible donors for kidneys, 7 for liver, and 2 for heart according to liberal criteria. Only 2 patients were evaluated for DCD, and no organ donation was performed. CONCLUSIONS While uncommon, we identified potential DCD organ donors in the NICU population for kidney, heart, and liver transplants. The substantial variability in the number of potential donors depending on the selected eligibility criteria emphasizes the need for a standardized definition adapted to local capacities.
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Affiliation(s)
- Alexandra Trottier
- Department of Pediatrics, University Laval, Medicine faculty, Québec, Québec, Canada.,Department of Pediatrics, Emergency Unit, CHU Ste-Justine, University of Montréal, Montréal, Québec, Canada
| | - Guillaume Maitre
- Pediatric Intensive Care Unit, McGill University Health Center, Montreal Children's Hospital, Montréal, Québec, Canada.,Division of Pediatrics, Department "Woman-Mother-Child", Pediatric Intensive Care Unit, Biology and Medicine faculty, Lausanne University Hospital, Lausanne, Switzerland
| | - Audrey Hébert
- Department of Pediatrics, Neonatal Intensive Care Unit, CHU de Québec, Centre Mère-Enfant Soleil, University Laval, Medicine faculty, Québec, Québec, Canada
| | - Matthew J Weiss
- Division of Pediatric Intensive Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, University Laval, Medicine faculty, Québec, Québec, Canada.,Transplant Québec, Montréal, Québec, Canada.,Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, Ontario, Canada
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