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Wall AE, Adams BL, Brubaker A, Chang CWJ, Croome KP, Frontera J, Gordon E, Hoffman J, Kaplan LJ, Kumar D, Levisky J, Miñambres E, Parent B, Watson C, Zemmar A, Pomfret EA. The American Society of Transplant Surgeons Consensus Statement on Normothermic Regional Perfusion. Transplantation 2024; 108:312-318. [PMID: 38254280 DOI: 10.1097/tp.0000000000004894] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 01/24/2024]
Abstract
On June 3, 2023, the American Society of Transplant Surgeons convened a meeting in San Diego, California to (1) develop a consensus statement with supporting data on the ethical tenets of thoracoabdominal normothermic regional perfusion (NRP) and abdominal NRP; (2) provide guidelines for the standards of practice that should govern thoracoabdominal NRP and abdominal NRP; and (3) develop and implement a central database for the collection of NRP donor and recipient data in the United States. National and international leaders in the fields of neuroscience, transplantation, critical care, NRP, Organ Procurement Organizations, transplant centers, and donor families participated. The conference was designed to focus on the controversial issues of neurological flow and function in donation after circulatory death donors during NRP and propose technical standards necessary to ensure that this procedure is performed safely and effectively. This article discusses major topics and conclusions addressed at the meeting.
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Affiliation(s)
- Anji E Wall
- Division of Abdominal Transplantation, Baylor Simmons Transplant Institute, Dallas, TX
| | | | - Aleah Brubaker
- Department of Surgery, University of California San Diego, San Diego, CA
| | - Cherylee W J Chang
- Neurocritical Care Division, Department of Neurology, Duke University, Durham, NC
| | | | - Jennifer Frontera
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
| | - Elisa Gordon
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jordan Hoffman
- Heart and Lung Transplantation and CTEPH Program, University of Colorado School of Medicine, Anschutz Medical Campus, Denver, CO
| | - Lewis J Kaplan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Surgical Critical Care Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Deepali Kumar
- Transplant Infectious Diseases, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Josh Levisky
- Division of Hepatology, Department of Medicine, Northwestern Medicine, Chicago, IL
| | - Eduardo Miñambres
- Donor Transplant Coordination Unit and Intensive Care Service, Hospital Universitario de Marqués de Valdecilla-IDIVAL, Spain
| | - Brendan Parent
- Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY
| | - Christopher Watson
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | - Elizabeth A Pomfret
- Division of Transplant Surgery and Colorado Center for Transplantation Care, Research and Education (CCTCARE), University of Colorado Anschutz Medical Campus, Denver, CO
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Murphy N, Weijer C, Debicki D, Laforge G, Norton L, Gofton T, Slessarev M. Ethics of non-therapeutic research on imminently dying patients in the intensive care unit. J Med Ethics 2023; 49:311-318. [PMID: 35728941 PMCID: PMC10176359 DOI: 10.1136/medethics-2021-107953] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/23/2022] [Indexed: 05/14/2023]
Abstract
Non-therapeutic research with imminently dying patients in intensive care presents complex ethical issues. The vulnerabilities of the imminently dying, together with societal disquiet around death and dying, contribute to an intuition that such research is beyond the legitimate scope of scientific inquiry. Yet excluding imminently dying patients from research hinders the advancement of medical science to the detriment of future patients. Building on existing ethical guidelines for research, we propose a framework for the ethical design and conduct of research involving the imminently dying. To enable rapid translation to practice, we frame the approach in the form of eight ethical questions that researchers and research ethics committees ought to answer prior to conducting any research with this patient population. (1) Does the study hypothesis require the inclusion of imminently dying patients? (2) Are non-therapeutic risks and burdens minimised consistent with sound scientific design? (3) Are the risks of these procedures no more than minimal risk? (4) Are these non-therapeutic risks justified insofar as they are reasonable in relation to the anticipated benefits of the study? (5) Will valid informed consent be obtained from an authorised surrogate decision maker? (6) How will incidental findings be handled? (7) What additional steps are in place to protect families and significant others of research participants? (8) What additional steps are in place to protect clinical staff and researchers? Several ethical challenges hinder research with imminently dying patients. Nonetheless, provided adequate protections are in place, non-therapeutic research with imminently dying patients is ethically justifiable. Applying our framework to an ongoing study, we demonstrate how our question-driven approach is well suited to guiding investigators and research ethics committees.
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Affiliation(s)
- Nicholas Murphy
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Philosophy, Western University, London, Ontario, Canada
| | - Charles Weijer
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Philosophy, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Derek Debicki
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Geoffrey Laforge
- Brain and Mind Institute, Western University, London, Ontario, Canada
- Department of Psychology, Western University, London, Ontario, Canada
| | - Loretta Norton
- Department of Psychology, King's University College at Western University, London, Ontario, Canada
| | - Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Marat Slessarev
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Brain and Mind Institute, Western University, London, Ontario, 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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Skowronski G, Ramnani A, Walton-Sonda D, Forlini C, O'Leary MJ, O'Reilly L, Sheahan L, Stewart C, Kerridge I. A scoping review of the perceptions of death in the context of organ donation and transplantation. BMC Med Ethics 2021; 22:167. [PMID: 34922506 PMCID: PMC8684159 DOI: 10.1186/s12910-021-00734-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Socio-cultural perceptions surrounding death have profoundly changed since the 1950s with development of modern intensive care and progress in solid organ transplantation. Despite broad support for organ transplantation, many fundamental concepts and practices including brain death, organ donation after circulatory death, and some antemortem interventions to prepare for transplantation continue to be challenged. Attitudes toward the ethical issues surrounding death and organ donation may influence support for and participation in organ donation but differences between and among diverse populations have not been studied. OBJECTIVES In order to clarify attitudes toward brain death, organ donation after circulatory death and antemortem interventions in the context of organ donation, we conducted a scoping review of international English-language quantitative surveys in various populations. STUDY APPRAISAL A search of literature up to October 2020 was performed, using multiple databases. After screening, 45 studies were found to meet pre-specified inclusion criteria. RESULTS 32 studies examined attitudes to brain death, predominantly in healthcare professionals. In most, around 75% of respondents accepted brain death as equivalent to death of the person. Less common perspectives included equating death with irreversible coma and willingness to undertake organ donation even if it caused death. 14 studies examined attitudes to organ donation following circulatory death. Around half of respondents in most studies accepted that death could be confidently diagnosed after only 5 min of cardiorespiratory arrest. The predominant reason was lack of confidence in doctors or diagnostic procedures. Only 6 studies examined attitudes towards antemortem interventions in prospective organ donors. Most respondents supported minimally invasive procedures and only where specific consent was obtained. CONCLUSIONS Our review suggests a considerable proportion of people, including healthcare professionals, have doubts about the medical and ethical validity of modern determinations of death. The prognosis of brain injury was a more common concern in the context of organ donation decision-making than certainty of death.
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Affiliation(s)
- George Skowronski
- Sydney Health Ethics, University of Sydney, Sydney, Australia. .,St George Hospital, Gray Street, Kogarah, NSW, 2217, Australia.
| | | | | | | | | | - Lisa O'Reilly
- South East Sydney Local Health District, Sydney, Australia
| | - Linda Sheahan
- Sydney Health Ethics, University of Sydney, Sydney, Australia
| | | | - Ian Kerridge
- Sydney Health Ethics, University of Sydney, Sydney, Australia.,Haematology Department, Royal North Shore Hospital, St Leonards, Australia
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Basmaji J, Weijer C, Skaro A, Healey A, Shemie SD, Slessarev M. Paving the Road for the Adoption of Normothermic Regional Perfusion in Canada. Crit Care Explor 2021; 3:e0553. [PMID: 34729491 DOI: 10.1097/CCE.0000000000000553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Donation after circulatory determination of death has increased the number of organs available but can result in worse recipient outcomes than organs recovered from donors after neurologic death. Normothermic regional perfusion is a novel tool that can circumvent the shortcomings of donation after circulatory determination of death. However, its implementation may pose a threat to existing laws surrounding death declaration. Here, we propose a research agenda that will allow this technology to be introduced within current Canadian organ donation frameworks.
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Cleveland JD, Kumar SR. Current opinion in pediatric heart transplantation. Curr Opin Organ Transplant 2021; 26:290-295. [PMID: 33938465 DOI: 10.1097/mot.0000000000000870] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Cardiac transplant remains the most effective therapy for children with end-stage heart disease. Outcomes remain better than any alternative therapy for this condition, but its use is limited by donor organ availability. As a result, waitlist times and mortality on the waiting list remain unacceptably high. Novel approaches are necessary to address this problem. RECENT FINDINGS Organ Procurement and Transplant Network/United Network for Organ Sharing readjusted the pediatric heart allocation system in 2016 to prioritize children at highest risk of mortality, encourage judicious listing, and improve appropriate donor organ utilization. Subsequent studies have aligned with these priorities to help risk-stratify patients at the time of listing and identify the importance that should be assigned to donor-specific factors. In addition, many authors are advocating for increased utilization of hearts donated after cardiac death. Pediatric Ventricular Assist Device (VAD) application has also been increasing to help decrease waitlist mortality. Although results have significantly improved, there remain important limitations to widespread use of VADs in the pediatric population. This has prompted novel techniques such as pulmonary artery banding to improve cardiac function and, in some cases, promote recovery. The demand for cardiac replacement continues to increase with an ageing population of patients with congenital heart disease, presenting new challenges and stressors to the system. SUMMARY Pediatric cardiac transplant outcomes are excellent but remain plagued by the limited supply of donor organs. Recent strategies to combat this problem have focused on judicious listing, maximal utilization of available donor organs, and safely extending the lives of patients on the waitlist. New demands on the organ supply chain will continue to stress the system, making these efforts of the highest importance.Clinical Trial Registry Number not applicable.
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Affiliation(s)
- John D Cleveland
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine, University of Southern California
- Heart Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - S Ram Kumar
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine, University of Southern California
- Department of Pediatrics, Keck School of Medicine, University of Southern California
- Heart Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
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Shemie SD, Torrance S, Wilson L, Hornby L, MacLean J, Mohr J, Gillrie C, Badiwala MV, Baker A, Freed DH, Simpson C, Teitelbaum J, Brodrecht D, Healey A. Heart donation and transplantation after circulatory determination of death: expert guidance from a Canadian consensus building process. Can J Anaesth 2021; 68:661-71. [PMID: 33543427 DOI: 10.1007/s12630-021-01926-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022] Open
Abstract
Controlled donation after circulatory determination of death (DCD), where death is determined after cardiac arrest, has been responsible for the largest quantitative increase in Canadian organ donation and transplants, but not for heart transplants. Innovative international advances in DCD heart transplantation include direct procurement and perfusion (DPP) and normothermic regional perfusion (NRP). After death is determined, DPP involves removal and reanimation of the arrested heart on an ex situ organ perfusion system. Normothermic regional perfusion involves surgically interrupting (ligating the aortic arch vessels) brain blood flow after death determination, followed by restarting the heart and circulation in situ using extracorporeal membrane oxygenation. The objectives of this Canadian consensus building process by a multidisciplinary group of Canadian stakeholders were to review current evidence and international DCD heart experience, comparatively evaluate international protocols with existing Canadian medical, legal, and ethical practices, and to discuss implementation barriers. Review of current evidence and international experience of DCD heart donation (DPP and NRP) determined that DCD heart donation could be used to provide opportunities for more heart transplants in Canada, saving additional lives. Although candid discussion identified a number of potential barriers and challenges for implementing DCD heart donation in Canada, it was determined that DPP implementation is feasible (pending regulatory approval for the use of an ex situ perfusion device in humans) and in alignment with current medical guidelines for DCD. Nevertheless, further work is required to evaluate the consistency of NRP with current Canadian death determination policy and to ensure the absence of brain perfusion during this process.
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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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Turgeon AF, Zarychanski R, Francoeur CL, Lauzier F. Cardiac donation after circulatory death: the heart of the matter. Can J Anaesth 2020; 67:281-285. [PMID: 31898772 DOI: 10.1007/s12630-019-01561-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 11/29/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Alexis F Turgeon
- Population Health and Optimal Health Practice Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval Research Centre, Université Laval (Hôpital Enfant-Jésus), Z-206, 1401, 18e rue, Québec City, QC, G1J 1Z4, Canada.
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada.
| | - Ryan Zarychanski
- Sections of Critical Care Medicine, of Haematology and of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Charles L Francoeur
- Population Health and Optimal Health Practice Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval Research Centre, Université Laval (Hôpital Enfant-Jésus), Z-206, 1401, 18e rue, Québec City, QC, G1J 1Z4, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - François Lauzier
- Population Health and Optimal Health Practice Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval Research Centre, Université Laval (Hôpital Enfant-Jésus), Z-206, 1401, 18e rue, Québec City, QC, G1J 1Z4, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada
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Honarmand K, Parsons Leigh J, Martin CM, Sibbald R, Nagpal D, Lau V, Priestap F, De S, Basmaji J, Healey A, Dhanani S, Weiss MJ, Shemie S, Ball IM. Acceptability of cardiac donation after circulatory determination of death: a survey of the Canadian public. Can J Anaesth 2020; 67:292-300. [PMID: 31898773 DOI: 10.1007/s12630-019-01560-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/19/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Cardiac transplantation is a definitive therapy for end-stage heart failure, but demand exceeds supply. Cardiac donation after circulatory determination of death (cardiac DCDD) can be performed using direct procurement and perfusion (DPP), where cardiac activity is restored after heart recovery, or (NRP), where brain blood supply is surgically interrupted, circulation to the thoraco-abdominal organs is restored within the donor's body, followed by heart recovery. While cardiac DCDD would increase the number of heart donors, uptake of programs has been slowed in part because of ethical concerns within the medical community. These debates have been largely devoid of discussion regarding public perceptions. We conducted a national survey of public perceptions regarding cardiac DCDD. METHODS We surveyed 1,001 Canadians about their attitudes towards cardiac DCDD using a rigorously designed and pre-tested survey. RESULTS We found that 843 of 1,001 respondents (84.2%; 95% confidence interval [CI], 81.8 to 86.3) accepted the DPP approach, 642 (64.1%; 95% CI, 61.1 to 67.0) would agree to donate their heart using DPP, and 696 (69.5%; 95% CI, 66.6 to 72.3) would consent to the same for a family member. We found that 779 respondents of 1,001 respondents (77.8%; 95% CI, 75.1 to 80.3) accepted the NRP approach, 587 (58.6%; 95% CI, 55.5 to 61.6) would agree to donate their heart using NRP, and 636 (63.5%; 95% CI, 60.5 to 66.4) would consent to the same for a family member. Most respondents supported the implementation of DPP (738 respondents or 73.7%; 95% CI, 70.9 to 76.3) and NRP (655 respondents or 65.4%; 95% CI, 62.4 to 68.3) in Canada. CONCLUSION The results of this national survey of public attitudes towards cardiac DCDD will inform the implementation of cardiac DCDD programs in a manner that is consistent with public values.
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Affiliation(s)
- Kimia Honarmand
- Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada.
| | - Jeanna Parsons Leigh
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Claudio M Martin
- Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Robert Sibbald
- Department of Family Medicine, Western University, London, ON, Canada
| | - Dave Nagpal
- Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Vince Lau
- Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Fran Priestap
- Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada
| | - Sabe De
- Division of Cardiology, Western University, London, ON, Canada
| | - John Basmaji
- Department of Medicine, London Health Sciences Centre, 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, 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
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Traumatology-Emergency-Critical Care Medicine, Université Laval, 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, London Health Sciences Centre, Western University, 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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