Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study
Purpose Canadian donor management practices have not been reported. Our aim was to inform clinicians and other stakeholders about the range of current practices. Methods This prospective observational cohort study enrolled consecutive, newly consented organ donors from August 1 2015 to July 31 2018...
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| Veröffentlicht in: | Canadian journal of anesthesia 2020-08, Vol.67 (8), p.992-1004 |
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| creator | D’Aragon, Frédérick Lamontagne, Francois Cook, Deborah Dhanani, Sonny Keenan, Sean Chassé, Michaël English, Shane Burns, Karen E. A. Frenette, Anne Julie Ball, Ian Boyd, John Gordon Masse, Marie-Hélène Breau, Ruth Akhtar, Aemal Kramer, Andreas Rochwerg, Bram Lauzier, François Kutsogiannis, Demetrios James Ibrahim, Quazi Hand, Lori Zhou, Qi Meade, Maureen O. |
| description | Purpose
Canadian donor management practices have not been reported. Our aim was to inform clinicians and other stakeholders about the range of current practices.
Methods
This prospective observational cohort study enrolled consecutive, newly consented organ donors from August 1 2015 to July 31 2018 at 27 academic and five community adult intensive care units in British Columbia, Alberta, Ontario, and Quebec. Research staff prospectively recorded donor management data. Provincial organ donation organizations verified the organs donated. We formally compared practices across provinces.
Results
Over a median collection period of eight months, 622 potential donors were classified at baseline as having neurologic determination of death (NDD donors;
n
= 403) or circulatory death (DCD donors;
n
= 219). Among NDD donors, 85.6% underwent apnea testing (rarely with carbon dioxide insufflation), 33.2% underwent ancillary testing, and subsequent therapeutic hypothermia (34–35°C) was rare. Neurologic determination of death donors were more hemodynamically unstable with most having received vasopressin and norepinephrine infusions, with a large majority having received high-dose corticosteroids and intravenous thyroxine. Among DCD donors, 61.6% received corticosteroids, and 8.9% received thyroxine. Most donors did not receive lung-protective ventilation strategies. Invasive procedures after donation consent included bronchoscopy (71.7%), cardiac catheterization (NDD donors only; 21.3%), and blood transfusions (19.3%). Physicians ordered intravenous antemortem heparin for 94.8% of DCD donors. The cohort donated 1,629 organs resulting in 1,532 transplants. Case selection, death determinations, and hormone, nutrition and heparin practices all varied across provinces.
Conclusion
These study findings highlight areas for knowledge translation and further clinical research. Interprovincial discrepancies will likely pose unique challenges to national randomized trials.
Trial registration
: www.clinicaltrials.gov (NCT03114436); registered 10 April, 2017. |
| doi_str_mv | 10.1007/s12630-020-01692-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2400519522</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2421630846</sourcerecordid><originalsourceid>FETCH-LOGICAL-c403t-455cd09868eb820f7035d25bc68c715252638684b838f5813184aa9cc2f693c3</originalsourceid><addsrcrecordid>eNp9kT1PwzAQhi0EgvLxBxiQJRaWwPkcOw4bKuVDQrBUiM1yHAeC2rjYydB_j0sLSAwMlqV7n3vtu5eQYwbnDKC4iAwlhwwwHSZLzIotMmJ5KTNVFmKbjEBxzCSDlz2yH-M7ACgp1C7Z48iVUChG5OXZhNZU7aztl7TtaO2sM9HVtPadD9Sa4FblselMbS6pocEtfOipb2j_5jb17Prp8Wo6oda_rbTYD_XykOw0Zhbd0eY-INObyXR8lz083d6Prx4ymwPvs1wIW0OppHKVQmgK4KJGUVmpbMEEijRiEvNKcdUIxThTuTGltdjIklt-QM7WtovgPwYXez1vo3WzmemcH6LGHECwUiAm9PQP-u6H0KXPaZSAHAuO5b9UjiwtXOUyUbimbPAxBtfoRWjnJiw1A70KR6_D0Skc_RWOLlLTycZ6qOau_mn5TiMBfA3EJHWvLvy-_Y_tJ_SOla4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2421630846</pqid></control><display><type>article</type><title>Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study</title><source>MEDLINE</source><source>SpringerLink_现刊</source><creator>D’Aragon, Frédérick ; Lamontagne, Francois ; Cook, Deborah ; Dhanani, Sonny ; Keenan, Sean ; Chassé, Michaël ; English, Shane ; Burns, Karen E. A. ; Frenette, Anne Julie ; Ball, Ian ; Boyd, John Gordon ; Masse, Marie-Hélène ; Breau, Ruth ; Akhtar, Aemal ; Kramer, Andreas ; Rochwerg, Bram ; Lauzier, François ; Kutsogiannis, Demetrios James ; Ibrahim, Quazi ; Hand, Lori ; Zhou, Qi ; Meade, Maureen O.</creator><creatorcontrib>D’Aragon, Frédérick ; Lamontagne, Francois ; Cook, Deborah ; Dhanani, Sonny ; Keenan, Sean ; Chassé, Michaël ; English, Shane ; Burns, Karen E. A. ; Frenette, Anne Julie ; Ball, Ian ; Boyd, John Gordon ; Masse, Marie-Hélène ; Breau, Ruth ; Akhtar, Aemal ; Kramer, Andreas ; Rochwerg, Bram ; Lauzier, François ; Kutsogiannis, Demetrios James ; Ibrahim, Quazi ; Hand, Lori ; Zhou, Qi ; Meade, Maureen O. ; Canadian Critical Care Trials Group and the Canadian Donation and Transplant Research Program ; the Canadian Critical Care Trials Group and the Canadian Donation and Transplant Research Program</creatorcontrib><description>Purpose
Canadian donor management practices have not been reported. Our aim was to inform clinicians and other stakeholders about the range of current practices.
Methods
This prospective observational cohort study enrolled consecutive, newly consented organ donors from August 1 2015 to July 31 2018 at 27 academic and five community adult intensive care units in British Columbia, Alberta, Ontario, and Quebec. Research staff prospectively recorded donor management data. Provincial organ donation organizations verified the organs donated. We formally compared practices across provinces.
Results
Over a median collection period of eight months, 622 potential donors were classified at baseline as having neurologic determination of death (NDD donors;
n
= 403) or circulatory death (DCD donors;
n
= 219). Among NDD donors, 85.6% underwent apnea testing (rarely with carbon dioxide insufflation), 33.2% underwent ancillary testing, and subsequent therapeutic hypothermia (34–35°C) was rare. Neurologic determination of death donors were more hemodynamically unstable with most having received vasopressin and norepinephrine infusions, with a large majority having received high-dose corticosteroids and intravenous thyroxine. Among DCD donors, 61.6% received corticosteroids, and 8.9% received thyroxine. Most donors did not receive lung-protective ventilation strategies. Invasive procedures after donation consent included bronchoscopy (71.7%), cardiac catheterization (NDD donors only; 21.3%), and blood transfusions (19.3%). Physicians ordered intravenous antemortem heparin for 94.8% of DCD donors. The cohort donated 1,629 organs resulting in 1,532 transplants. Case selection, death determinations, and hormone, nutrition and heparin practices all varied across provinces.
Conclusion
These study findings highlight areas for knowledge translation and further clinical research. Interprovincial discrepancies will likely pose unique challenges to national randomized trials.
Trial registration
: www.clinicaltrials.gov (NCT03114436); registered 10 April, 2017.</description><identifier>ISSN: 0832-610X</identifier><identifier>EISSN: 1496-8975</identifier><identifier>DOI: 10.1007/s12630-020-01692-7</identifier><identifier>PMID: 32385825</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Anesthesiology ; Blood & organ donations ; British Columbia ; Cardiology ; Cohort analysis ; Critical care ; Critical Care Medicine ; Drug dosages ; Hospitals ; Humans ; Hypothermia ; Intensive ; Intensive care ; Medicine ; Medicine & Public Health ; NCT ; NCT03114436 ; Ontario ; Pain Medicine ; Pediatrics ; Pneumology/Respiratory System ; Prospective Studies ; Provinces ; Reports of Original Investigations ; Steroids ; Tissue and Organ Procurement ; Tissue Donors ; Transplants & implants ; Ventilators</subject><ispartof>Canadian journal of anesthesia, 2020-08, Vol.67 (8), p.992-1004</ispartof><rights>Canadian Anesthesiologists' Society 2020. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>Canadian Anesthesiologists' Society 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c403t-455cd09868eb820f7035d25bc68c715252638684b838f5813184aa9cc2f693c3</citedby><cites>FETCH-LOGICAL-c403t-455cd09868eb820f7035d25bc68c715252638684b838f5813184aa9cc2f693c3</cites><orcidid>0000-0003-1323-0449</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12630-020-01692-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12630-020-01692-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32385825$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>D’Aragon, Frédérick</creatorcontrib><creatorcontrib>Lamontagne, Francois</creatorcontrib><creatorcontrib>Cook, Deborah</creatorcontrib><creatorcontrib>Dhanani, Sonny</creatorcontrib><creatorcontrib>Keenan, Sean</creatorcontrib><creatorcontrib>Chassé, Michaël</creatorcontrib><creatorcontrib>English, Shane</creatorcontrib><creatorcontrib>Burns, Karen E. A.</creatorcontrib><creatorcontrib>Frenette, Anne Julie</creatorcontrib><creatorcontrib>Ball, Ian</creatorcontrib><creatorcontrib>Boyd, John Gordon</creatorcontrib><creatorcontrib>Masse, Marie-Hélène</creatorcontrib><creatorcontrib>Breau, Ruth</creatorcontrib><creatorcontrib>Akhtar, Aemal</creatorcontrib><creatorcontrib>Kramer, Andreas</creatorcontrib><creatorcontrib>Rochwerg, Bram</creatorcontrib><creatorcontrib>Lauzier, François</creatorcontrib><creatorcontrib>Kutsogiannis, Demetrios James</creatorcontrib><creatorcontrib>Ibrahim, Quazi</creatorcontrib><creatorcontrib>Hand, Lori</creatorcontrib><creatorcontrib>Zhou, Qi</creatorcontrib><creatorcontrib>Meade, Maureen O.</creatorcontrib><creatorcontrib>Canadian Critical Care Trials Group and the Canadian Donation and Transplant Research Program</creatorcontrib><creatorcontrib>the Canadian Critical Care Trials Group and the Canadian Donation and Transplant Research Program</creatorcontrib><title>Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study</title><title>Canadian journal of anesthesia</title><addtitle>Can J Anesth/J Can Anesth</addtitle><addtitle>Can J Anaesth</addtitle><description>Purpose
Canadian donor management practices have not been reported. Our aim was to inform clinicians and other stakeholders about the range of current practices.
Methods
This prospective observational cohort study enrolled consecutive, newly consented organ donors from August 1 2015 to July 31 2018 at 27 academic and five community adult intensive care units in British Columbia, Alberta, Ontario, and Quebec. Research staff prospectively recorded donor management data. Provincial organ donation organizations verified the organs donated. We formally compared practices across provinces.
Results
Over a median collection period of eight months, 622 potential donors were classified at baseline as having neurologic determination of death (NDD donors;
n
= 403) or circulatory death (DCD donors;
n
= 219). Among NDD donors, 85.6% underwent apnea testing (rarely with carbon dioxide insufflation), 33.2% underwent ancillary testing, and subsequent therapeutic hypothermia (34–35°C) was rare. Neurologic determination of death donors were more hemodynamically unstable with most having received vasopressin and norepinephrine infusions, with a large majority having received high-dose corticosteroids and intravenous thyroxine. Among DCD donors, 61.6% received corticosteroids, and 8.9% received thyroxine. Most donors did not receive lung-protective ventilation strategies. Invasive procedures after donation consent included bronchoscopy (71.7%), cardiac catheterization (NDD donors only; 21.3%), and blood transfusions (19.3%). Physicians ordered intravenous antemortem heparin for 94.8% of DCD donors. The cohort donated 1,629 organs resulting in 1,532 transplants. Case selection, death determinations, and hormone, nutrition and heparin practices all varied across provinces.
Conclusion
These study findings highlight areas for knowledge translation and further clinical research. Interprovincial discrepancies will likely pose unique challenges to national randomized trials.
Trial registration
: www.clinicaltrials.gov (NCT03114436); registered 10 April, 2017.</description><subject>Adult</subject><subject>Anesthesiology</subject><subject>Blood & organ donations</subject><subject>British Columbia</subject><subject>Cardiology</subject><subject>Cohort analysis</subject><subject>Critical care</subject><subject>Critical Care Medicine</subject><subject>Drug dosages</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypothermia</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>NCT</subject><subject>NCT03114436</subject><subject>Ontario</subject><subject>Pain Medicine</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Prospective Studies</subject><subject>Provinces</subject><subject>Reports of Original Investigations</subject><subject>Steroids</subject><subject>Tissue and Organ Procurement</subject><subject>Tissue Donors</subject><subject>Transplants & implants</subject><subject>Ventilators</subject><issn>0832-610X</issn><issn>1496-8975</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kT1PwzAQhi0EgvLxBxiQJRaWwPkcOw4bKuVDQrBUiM1yHAeC2rjYydB_j0sLSAwMlqV7n3vtu5eQYwbnDKC4iAwlhwwwHSZLzIotMmJ5KTNVFmKbjEBxzCSDlz2yH-M7ACgp1C7Z48iVUChG5OXZhNZU7aztl7TtaO2sM9HVtPadD9Sa4FblselMbS6pocEtfOipb2j_5jb17Prp8Wo6oda_rbTYD_XykOw0Zhbd0eY-INObyXR8lz083d6Prx4ymwPvs1wIW0OppHKVQmgK4KJGUVmpbMEEijRiEvNKcdUIxThTuTGltdjIklt-QM7WtovgPwYXez1vo3WzmemcH6LGHECwUiAm9PQP-u6H0KXPaZSAHAuO5b9UjiwtXOUyUbimbPAxBtfoRWjnJiw1A70KR6_D0Skc_RWOLlLTycZ6qOau_mn5TiMBfA3EJHWvLvy-_Y_tJ_SOla4</recordid><startdate>20200801</startdate><enddate>20200801</enddate><creator>D’Aragon, Frédérick</creator><creator>Lamontagne, Francois</creator><creator>Cook, Deborah</creator><creator>Dhanani, Sonny</creator><creator>Keenan, Sean</creator><creator>Chassé, Michaël</creator><creator>English, Shane</creator><creator>Burns, Karen E. A.</creator><creator>Frenette, Anne Julie</creator><creator>Ball, Ian</creator><creator>Boyd, John Gordon</creator><creator>Masse, Marie-Hélène</creator><creator>Breau, Ruth</creator><creator>Akhtar, Aemal</creator><creator>Kramer, Andreas</creator><creator>Rochwerg, Bram</creator><creator>Lauzier, François</creator><creator>Kutsogiannis, Demetrios James</creator><creator>Ibrahim, Quazi</creator><creator>Hand, Lori</creator><creator>Zhou, Qi</creator><creator>Meade, Maureen O.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1323-0449</orcidid></search><sort><creationdate>20200801</creationdate><title>Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study</title><author>D’Aragon, Frédérick ; Lamontagne, Francois ; Cook, Deborah ; Dhanani, Sonny ; Keenan, Sean ; Chassé, Michaël ; English, Shane ; Burns, Karen E. A. ; Frenette, Anne Julie ; Ball, Ian ; Boyd, John Gordon ; Masse, Marie-Hélène ; Breau, Ruth ; Akhtar, Aemal ; Kramer, Andreas ; Rochwerg, Bram ; Lauzier, François ; Kutsogiannis, Demetrios James ; Ibrahim, Quazi ; Hand, Lori ; Zhou, Qi ; Meade, Maureen O.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c403t-455cd09868eb820f7035d25bc68c715252638684b838f5813184aa9cc2f693c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Anesthesiology</topic><topic>Blood & organ donations</topic><topic>British Columbia</topic><topic>Cardiology</topic><topic>Cohort analysis</topic><topic>Critical care</topic><topic>Critical Care Medicine</topic><topic>Drug dosages</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypothermia</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>NCT</topic><topic>NCT03114436</topic><topic>Ontario</topic><topic>Pain Medicine</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Prospective Studies</topic><topic>Provinces</topic><topic>Reports of Original Investigations</topic><topic>Steroids</topic><topic>Tissue and Organ Procurement</topic><topic>Tissue Donors</topic><topic>Transplants & implants</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>D’Aragon, Frédérick</creatorcontrib><creatorcontrib>Lamontagne, Francois</creatorcontrib><creatorcontrib>Cook, Deborah</creatorcontrib><creatorcontrib>Dhanani, Sonny</creatorcontrib><creatorcontrib>Keenan, Sean</creatorcontrib><creatorcontrib>Chassé, Michaël</creatorcontrib><creatorcontrib>English, Shane</creatorcontrib><creatorcontrib>Burns, Karen E. A.</creatorcontrib><creatorcontrib>Frenette, Anne Julie</creatorcontrib><creatorcontrib>Ball, Ian</creatorcontrib><creatorcontrib>Boyd, John Gordon</creatorcontrib><creatorcontrib>Masse, Marie-Hélène</creatorcontrib><creatorcontrib>Breau, Ruth</creatorcontrib><creatorcontrib>Akhtar, Aemal</creatorcontrib><creatorcontrib>Kramer, Andreas</creatorcontrib><creatorcontrib>Rochwerg, Bram</creatorcontrib><creatorcontrib>Lauzier, François</creatorcontrib><creatorcontrib>Kutsogiannis, Demetrios James</creatorcontrib><creatorcontrib>Ibrahim, Quazi</creatorcontrib><creatorcontrib>Hand, Lori</creatorcontrib><creatorcontrib>Zhou, Qi</creatorcontrib><creatorcontrib>Meade, Maureen O.</creatorcontrib><creatorcontrib>Canadian Critical Care Trials Group and the Canadian Donation and Transplant Research Program</creatorcontrib><creatorcontrib>the Canadian Critical Care Trials Group and the Canadian Donation and Transplant Research Program</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Canadian Business & Current Affairs Database</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Canadian journal of anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>D’Aragon, Frédérick</au><au>Lamontagne, Francois</au><au>Cook, Deborah</au><au>Dhanani, Sonny</au><au>Keenan, Sean</au><au>Chassé, Michaël</au><au>English, Shane</au><au>Burns, Karen E. A.</au><au>Frenette, Anne Julie</au><au>Ball, Ian</au><au>Boyd, John Gordon</au><au>Masse, Marie-Hélène</au><au>Breau, Ruth</au><au>Akhtar, Aemal</au><au>Kramer, Andreas</au><au>Rochwerg, Bram</au><au>Lauzier, François</au><au>Kutsogiannis, Demetrios James</au><au>Ibrahim, Quazi</au><au>Hand, Lori</au><au>Zhou, Qi</au><au>Meade, Maureen O.</au><aucorp>Canadian Critical Care Trials Group and the Canadian Donation and Transplant Research Program</aucorp><aucorp>the Canadian Critical Care Trials Group and the Canadian Donation and Transplant Research Program</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study</atitle><jtitle>Canadian journal of anesthesia</jtitle><stitle>Can J Anesth/J Can Anesth</stitle><addtitle>Can J Anaesth</addtitle><date>2020-08-01</date><risdate>2020</risdate><volume>67</volume><issue>8</issue><spage>992</spage><epage>1004</epage><pages>992-1004</pages><issn>0832-610X</issn><eissn>1496-8975</eissn><abstract>Purpose
Canadian donor management practices have not been reported. Our aim was to inform clinicians and other stakeholders about the range of current practices.
Methods
This prospective observational cohort study enrolled consecutive, newly consented organ donors from August 1 2015 to July 31 2018 at 27 academic and five community adult intensive care units in British Columbia, Alberta, Ontario, and Quebec. Research staff prospectively recorded donor management data. Provincial organ donation organizations verified the organs donated. We formally compared practices across provinces.
Results
Over a median collection period of eight months, 622 potential donors were classified at baseline as having neurologic determination of death (NDD donors;
n
= 403) or circulatory death (DCD donors;
n
= 219). Among NDD donors, 85.6% underwent apnea testing (rarely with carbon dioxide insufflation), 33.2% underwent ancillary testing, and subsequent therapeutic hypothermia (34–35°C) was rare. Neurologic determination of death donors were more hemodynamically unstable with most having received vasopressin and norepinephrine infusions, with a large majority having received high-dose corticosteroids and intravenous thyroxine. Among DCD donors, 61.6% received corticosteroids, and 8.9% received thyroxine. Most donors did not receive lung-protective ventilation strategies. Invasive procedures after donation consent included bronchoscopy (71.7%), cardiac catheterization (NDD donors only; 21.3%), and blood transfusions (19.3%). Physicians ordered intravenous antemortem heparin for 94.8% of DCD donors. The cohort donated 1,629 organs resulting in 1,532 transplants. Case selection, death determinations, and hormone, nutrition and heparin practices all varied across provinces.
Conclusion
These study findings highlight areas for knowledge translation and further clinical research. Interprovincial discrepancies will likely pose unique challenges to national randomized trials.
Trial registration
: www.clinicaltrials.gov (NCT03114436); registered 10 April, 2017.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>32385825</pmid><doi>10.1007/s12630-020-01692-7</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0003-1323-0449</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0832-610X |
| ispartof | Canadian journal of anesthesia, 2020-08, Vol.67 (8), p.992-1004 |
| issn | 0832-610X 1496-8975 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2400519522 |
| source | MEDLINE; SpringerLink_现刊 |
| subjects | Adult Anesthesiology Blood & organ donations British Columbia Cardiology Cohort analysis Critical care Critical Care Medicine Drug dosages Hospitals Humans Hypothermia Intensive Intensive care Medicine Medicine & Public Health NCT NCT03114436 Ontario Pain Medicine Pediatrics Pneumology/Respiratory System Prospective Studies Provinces Reports of Original Investigations Steroids Tissue and Organ Procurement Tissue Donors Transplants & implants Ventilators |
| title | Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T14%3A53%3A45IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Variability%20in%20deceased%20donor%20care%20in%20Canada:%20a%20report%20of%20the%20Canada-DONATE%20cohort%20study&rft.jtitle=Canadian%20journal%20of%20anesthesia&rft.au=D%E2%80%99Aragon,%20Fr%C3%A9d%C3%A9rick&rft.aucorp=Canadian%20Critical%20Care%20Trials%20Group%20and%20the%20Canadian%20Donation%20and%20Transplant%20Research%20Program&rft.date=2020-08-01&rft.volume=67&rft.issue=8&rft.spage=992&rft.epage=1004&rft.pages=992-1004&rft.issn=0832-610X&rft.eissn=1496-8975&rft_id=info:doi/10.1007/s12630-020-01692-7&rft_dat=%3Cproquest_cross%3E2421630846%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2421630846&rft_id=info:pmid/32385825&rfr_iscdi=true |