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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [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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Murphy N, Weijer C, Smith M, Chandler J, Chamberlain E, Gofton T, Slessarev M. Controlled Donation After Circulatory Determination of Death: A Scoping Review of Ethical Issues, Key Concepts, and Arguments. J Law Med Ethics 2021; 49:418-440. [PMID: 34665091 DOI: 10.1017/jme.2021.63] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Controlled donation after circulatory determination of death (cDCDD) is an important strategy for increasing the pool of eligible organ donors.
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Honarmand K, Ball I, Weiss M, Slessarev M, Sibbald R, Sarti A, Meade M, D'Aragon F, Chasse M, Basmaji J, Parsons Leigh J. Cardiac donation after circulatory determination of death: protocol for a mixed-methods study of healthcare provider and public perceptions in Canada. BMJ Open 2020; 10:e033932. [PMID: 32690728 PMCID: PMC7375636 DOI: 10.1136/bmjopen-2019-033932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Cardiac transplantation remains the best treatment for patients with end-stage heart disease that is refractory to medical or device therapies, however, a major challenge for heart transplantation is the persistent discrepancy between the number of patients on waiting lists and the number of available hearts. While other countries (eg, UK, Australia and Belgium) have explored and implemented alternative models of transplantation, such as cardiac donation after circulatory determination of death (DCDD) to alleviate transplantation wait times, ethical concerns have hindered implementation in some countries. This study aims to explore the attitudes and opinions of healthcare providers and the public about cardiac DCDD in order to identify and describe opportunities and challenges in ensuring that proposed cardiac DCDD procedures in Canada are consistent with Canadian values and ethical norms. METHODS AND ANALYSIS This study will include two parts that will be conducted concurrently. Part 1 is a qualitative study consisting of semi-structured interviews with Canadian healthcare providers who routinely care for organ donors and/or transplant recipients to describe their perceptions about cardiac DCDD. Part 2 is a convergent parallel mixed-methods design consisting of a series of focus groups and follow-up surveys with members of the Canadian general public to describe their perceptions about cardiac DCDD. ETHICS AND DISSEMINATION This study has been approved by the Research Ethics Board at Western University. The findings will be presented at regional and national conferences and reported in peer-reviewed publications.
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Affiliation(s)
- Kimia Honarmand
- Department of Medicine, Western University, London, Ontario, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Matthew Weiss
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval Faculté de Médecine, Québec, Québec, Canada
- Transplant Québec, Montreal, Québec, Canada
| | - Marat Slessarev
- Department of Medicine, Western University, London, Ontario, Canada
| | - Robert Sibbald
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Aimee Sarti
- Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Maureen Meade
- Department of Medicine, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Universite de Sherbrooke Faculte de Medecine et des Sciences de la Sante, Sherbrooke, Québec, Canada
- Centre de Recherche du CHUS, Sherbrooke, Québec, Canada
| | - Michael Chasse
- University of Montreal Research Center, Innovation Hub and Department of Medicine (Critical Care), University of Montreal, Montreal, Québec, Canada
| | - John Basmaji
- Department of Medicine, Western University, London, Ontario, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, New Brunswick, Canada
- Department of Epidemiology and Biostatistics, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Honarmand K, Parsons Leigh J, Basmaji J, Martin CM, Sibbald R, Nagpal D, Lau V, Priestap F, De S, Healey A, Dhanani S, Weiss MJ, Shemie S, Ball IM. Attitudes of healthcare providers towards cardiac donation after circulatory determination of death: a Canadian nation-wide survey. Can J Anaesth 2020; 67:301-312. [PMID: 31898778 DOI: 10.1007/s12630-019-01559-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The number of patients on cardiac transplant waitlists exceeds the number of available donor organs. Cardiac donation is currently limited to those declared dead by neurologic criteria in all but three countries. Cardiac donation after circulatory determination of death (cardiac DCDD) can be conducted using direct procurement and perfusion (DPP) or normothermic regional perfusion (NRP). Implementation of cardiac DCDD in many countries has been slowed by ethical debates within the donation and transplantation community. We conducted a national survey to determine the perceptions of healthcare providers regarding cardiac DCDD. METHODS We conducted an electronic survey of 398 healthcare providers who are involved in the management of heart donors and/or heart transplant recipients in Canada (226 nurses, 82 critical care physicians, 31 donation specialists, and 59 transplant specialists). Our primary outcomes were their attitudes towards and concerns regarding cardiac DCDD protocols and their implementation in Canada. We distributed the survey electronically through several Canadian donation and transplantation organizations. RESULTS We identified that 361 of 391 respondents (92.3%; 95% confidence interval [CI], 89.6 to 95.1) believed that DPP is acceptable, and 329 of 377 respondents (87.3%; 95% CI, 83.9 to 90.7) supported its implementation in Canada. We found that 301 of 384 respondents (78.4%; 95% CI, 74.2 to 82.6) believed that NRP is acceptable and 266 of 377 respondents (70.6%; 95% CI, 66.0 to 75.2) supported its implementation in Canada. CONCLUSION This is the first survey describing the attitudes of healthcare providers towards cardiac DCDD. We identified widespread support for cardiac DCDD and its implementation in Canada among Canadian healthcare providers within the organ donation and transplantation community in Canada.
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Affiliation(s)
- Kimia Honarmand
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada.
| | - Jeanna Parsons Leigh
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - John Basmaji
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Claudio M Martin
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Robert Sibbald
- Department of Family Medicine, Western University, London, ON, Canada
| | - Dave Nagpal
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Vince Lau
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Fran Priestap
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Sabe De
- Division of Cardiology, Western University, London, ON, Canada
| | - Andrew Healey
- Trillium Gift of Life Network, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sonny Dhanani
- Department of Pediatrics, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Division of Pediatric Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Matthew J Weiss
- Division of Pediatric Intensive Care, Centre-Mère Enfant Soleil du CHU de Québec, Québec City, QC, Canada
- Department of Pediatrics, Faculté de Médecine, Université Laval, Québec City, QC, Canada
- Population Health and Optimal Health Practices Research Unit, Traumatology-Emergency-Critical Care Medicine, Université Laval, CHU de Québec - Université Laval Research Center, Québec City, QC, Canada
| | - Sam Shemie
- Deceased Organ Donation, Canadian Blood Services and Division of Critical Care Medicine, Montreal Children's Hospital and McGill University Health Centre & Research Institute, Montreal, QC, Canada
| | - Ian M Ball
- Department of Medicine, Western University, London Health Sciences Centre, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
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Ball IM, Martin C, Sibbald R. Potassium chloride for medical assistance in dying followed by organ donation. Can J Anaesth 2020; 67:905-6. [DOI: 10.1007/s12630-020-01603-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/15/2020] [Accepted: 01/26/2020] [Indexed: 10/25/2022] Open
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