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Murphy NB, Shemie SD, Capron A, Truog RD, Nakagawa T, Healey A, Gofton T, Bernat JL, Fenton K, Khush KK, Schwartz B, Wall SP. Advancing the Scientific Basis for Determining Death in Controlled Organ Donation After Circulatory Determination of Death. Transplantation 2024:00007890-990000000-00733. [PMID: 38637919 DOI: 10.1097/tp.0000000000005002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
In controlled organ donation after circulatory determination of death (cDCDD), accurate and timely death determination is critical, yet knowledge gaps persist. Further research to improve the science of defining and determining death by circulatory criteria is therefore warranted. In a workshop sponsored by the National Heart, Lung, and Blood Institute, experts identified research opportunities pertaining to scientific, conceptual, and ethical understandings of DCDD and associated technologies. This article identifies a research strategy to inform the biomedical definition of death, the criteria for its determination, and circulatory death determination in cDCDD. Highlighting knowledge gaps, we propose that further research is needed to inform the observation period following cessation of circulation in pediatric and neonatal populations, the temporal relationship between the cessation of brain and circulatory function after the withdrawal of life-sustaining measures in all patient populations, and the minimal pulse pressures that sustain brain blood flow, perfusion, activity, and function. Additionally, accurate predictive tools to estimate time to asystole following the withdrawal of treatment and alternative monitoring modalities to establish the cessation of circulatory, brainstem, and brain function are needed. The physiologic and conceptual implications of postmortem interventions that resume circulation in cDCDD donors likewise demand attention to inform organ recovery practices. Finally, because jurisdictionally variable definitions of death and the criteria for its determination may impede collaborative research efforts, further work is required to achieve consensus on the physiologic and conceptual rationale for defining and determining death after circulatory arrest.
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Affiliation(s)
- Nicholas B Murphy
- Departments of Medicine and Philosophy, Western University, London, ON, Canada
| | - Sam D Shemie
- Division of Critical Care Medicine, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
- System Development, Canadian Blood Services, Ottawa, ON, Canada
| | - Alex Capron
- Gould School of Law and Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robert D Truog
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - Thomas Nakagawa
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | - Andrew Healey
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
- Divisions of Emergency and Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - James L Bernat
- Department of Neurology, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Kathleen Fenton
- Advanced Technologies and Surgery Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Bryanna Schwartz
- Heart Development and Structural Diseases Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
- Division of Cardiology, Children's National Hospital, Washington, DC
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
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Shemie SD, Wilson LC, Hornby L, Basmaji J, Baker AJ, Bensimon CM, Chandler JA, Chassé M, Dawson R, Dhanani S, Mooney OT, Sarti AJ, Simpson C, Teitelbaum J, Torrance S, Boyd JG, Brennan J, Brewster H, Carignan R, Dawe KJ, Doig CJ, Elliott-Pohl K, Gofton TE, Hartwick M, Healey A, Honarmand K, Hornby K, Isac G, Kanji A, Kawchuk J, Klowak JA, Kramer AH, Kromm J, LeBlanc AE, Lee-Ameduri K, Lee LA, Leeies M, Lewis A, Manara A, Matheson S, McKinnon NKA, Murphy N, Briard JN, Pope TM, Sekhon MS, Shanker JJS, Singh G, Singh J, Slessarev M, Soliman K, Sutherland S, Weiss MJ, Shaul RZ, Zuckier LS, Zorko DJ, Rochwerg B. A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada: a 2023 clinical practice guideline. Can J Anaesth 2023; 70:483-557. [PMID: 37131020 PMCID: PMC10203028 DOI: 10.1007/s12630-023-02431-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 05/04/2023] Open
Abstract
This 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients regardless of organ donation potential. This Guideline is endorsed by the Canadian Critical Care Society, the Canadian Medical Association, the Canadian Association of Critical Care Nurses, Canadian Anesthesiologists' Society, the Canadian Neurological Sciences Federation (representing the Canadian Neurological Society, Canadian Neurosurgical Society, Canadian Society of Clinical Neurophysiologists, Canadian Association of Child Neurology, Canadian Society of Neuroradiology, and Canadian Stroke Consortium), Canadian Blood Services, the Canadian Donation and Transplantation Research Program, the Canadian Association of Emergency Physicians, the Nurse Practitioners Association of Canada, and the Canadian Cardiovascular Critical Care Society.
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Affiliation(s)
- Sam D Shemie
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
- McGill University, Montreal, QC, Canada.
- MUHC Research Institute, Montreal, QC, Canada.
- Canadian Blood Services, Ottawa, ON, Canada.
| | | | | | | | - Andrew J Baker
- Unity Health Toronto, Toronto, ON, Canada
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Sonny Dhanani
- University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Owen T Mooney
- University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba Gift of Life Program, Winnipeg, MB, Canada
- St. Boniface Hospital, Winnipeg, MB, Canada
| | - Aimee J Sarti
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christy Simpson
- Canadian Blood Services, Ottawa, ON, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Jeanne Teitelbaum
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
- McGill University, Montreal, QC, Canada
| | | | - J Gordon Boyd
- Kingston General Hospital, Kingston, ON, Canada
- Queen's University, Kingston, ON, Canada
| | | | | | | | - Kirk J Dawe
- Eastern Health, St. John's, NL, Canada
- Memorial University of Newfoundland, St. John's, NL, Canada
| | - Christopher J Doig
- University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Edmonton, AB, Canada
| | | | | | - Michael Hartwick
- University of Ottawa, Ottawa, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
| | - Andrew Healey
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
- McMaster University, Hamilton, ON, Canada
- William Osler Health System, Brampton, ON, Canada
| | - Kimia Honarmand
- Western University, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | | | - George Isac
- University of British Columbia, Vancouver, BC, Canada
| | - Aly Kanji
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
- McGill University, Montreal, QC, Canada
| | - Joann Kawchuk
- Saskatchewan Health Authority, Saskatoon, SK, Canada
| | | | - Andreas H Kramer
- University of Calgary, Calgary, AB, Canada
- Southern Alberta Organ & Tissue Donation Program, Calgary, AB, Canada
| | - Julie Kromm
- University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Edmonton, AB, Canada
| | - Allana E LeBlanc
- University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Vancouver, BC, Canada
- Canadian Association of Critical Care Nurses, London, ON, Canada
| | - Katarina Lee-Ameduri
- University of Manitoba, Winnipeg, MB, Canada
- St. Boniface Hospital, Winnipeg, MB, Canada
| | - Laurie A Lee
- University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital, Calgary, AB, Canada
| | - Murdoch Leeies
- University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba Gift of Life Program, Winnipeg, MB, Canada
- Canadian Critical Care Society, Markham, ON, Canada
| | - Ariane Lewis
- NYU Langone Medical Center, New York City, NY, USA
| | | | | | - Nicole K A McKinnon
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
- Peter Gilgan Center for Research and Learning, Toronto, ON, Canada
| | | | | | - Thaddeus M Pope
- University of Ottawa, Ottawa, ON, Canada
- Mitchell Hamline School of Law, Saint Paul, MN, USA
- Queensland University of Technology, Brisbane, Qld, Australia
- Albany Medical College, Albany, NY, USA
- University of Minnesota Center for Bioethics, Minneapolis, MN, USA
| | - Mypinder S Sekhon
- University of British Columbia, Vancouver, BC, Canada
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | - Gurmeet Singh
- Mazankowski Alberta Heart Institute, Edmonton, AB, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Jeffrey Singh
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Marat Slessarev
- Western University, London, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
| | - Karim Soliman
- Queen's University, Kingston, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
- Lakeridge Health, Oshawa, ON, Canada
| | | | - Matthew J Weiss
- Transplant Québec, Montreal, QC, Canada
- CHU de Québec - Université Laval, Quebec City, QC, Canada
- Université Laval, Quebec City, QC, Canada
| | - Randi Zlotnik Shaul
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Lionel S Zuckier
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
| | - David J Zorko
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Bram Rochwerg
- McMaster University, Hamilton, ON, Canada
- Canadian Critical Care Society, Markham, ON, Canada
- Canadian Critical Care Trials Group, Markham, ON, Canada
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