Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death—Summary Report*

Abstract

Objectives:Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada.Methods:We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners.Results:We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report.Conclusions:This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation.

First pediatric organ donation after circulatory determination of death in Singapore: Facing challenges in the absence of a local practice guideline

“…In 2017, Canada became the first country to publish pediatric‐specific guidelines for the practice of donation after circulatory death 27‐29 . These guidelines have paved the way for greater clarity into the subject of pediatric organ DCD.…”

Development of a multinational registry of pediatric deceased organ donation activity

“…A recent report from the Transplantation Society Ethics Committee emphasized the need for more robust evidence‐based tools in pediatric deceased donation . While some such guidelines have been published since, there remains a dearth of evidence‐based guidance for how to best identify and manage patients who are potential organ donors. As identified in recent literature reviews, this is due to a variety of factors, including the lack of research in this vulnerable population.…”

“…For example, Canadian policy makers hope that recently published guidelines on pDCD will result in increased activity in that type of donation and plan to track if this activity could have a negative impact on rates of pDBD donation. 6 Without standard national and international benchmarks for comparison, it will be difficult to determine the impact this initiative has had on the pediatric donation system. Clearly, separating donation rates among standardized age ranges in the pediatric population is also important, since the causes of death in children vary substantially by age.…”

“…This lack of a standardized definition for pediatric donors limits data acquisition and the ability of researchers and stakeholders to clearly understand pediatric deceased donation performance. For example, Canadian policy makers hope that recently published guidelines on pDCD will result in increased activity in that type of donation and plan to track if this activity could have a negative impact on rates of pDBD donation . Without standard national and international benchmarks for comparison, it will be difficult to determine the impact this initiative has had on the pediatric donation system.…”

Predict cardiac death after withdrawal of life-supporting treatment in the neurocritical patients: a neurological score

“…3,4 Successful DCD requires identification of patients who will die within 60 minutes after withdrawal of life-supporting treatment (WLST). [5][6][7] Available scores used by organ-procurement organizations to estimate the time of death after WLST, such as the University of Wisconsin (UW) criteria, and the United Network for Organ Sharing (UNOS) criteria, are lacking of predictive accuracy because they include little information about the neurological status of the patient before WLST and do not present results in a user friendly fashion. 4,8 However, these associations were only confirmed in a small independent cohort.…”