Donation after cardiocirculatory death in Canada

Shemie, Sam D.; Baker, Andrew J.; Knoll, Greg; Wall, William; Rocker, Graeme; Howes, Daniel; Davidson, Janet; Pagliarello, Joe; Chambers‐Evans, Jane; Cockfield, Sandra M.; Farrell, Catherine; Glannon, Walter; Gourlay, William A.; Grant, David; Langevin, Stéphan; Wheelock, Brian; Young, Kimberly; Dossetor, John B.

doi:10.1503/cmaj.060895

Cited by 207 publications

(101 citation statements)

References 41 publications

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“…Donation after cardiocirculatory death is offered in such cases at some Canadian hospitals. 35,36 Our data suggest that this practice has greater potential to increase donation rates in Canada than efforts aimed at improving the recognition of neurologic death. Increased transplantation rates attributable to donation after cardiocirculatory death have been observed in other countries.…”

Section: Main Findingsmentioning

confidence: 82%

Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region

Kramer

Zygun

Doig

et al. 2013

CMAJ

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Section: Main Findingsmentioning

confidence: 82%

Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region

Kramer

Zygun

Doig

et al. 2013

CMAJ

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“…Knowledge of analogous pathologic processes in the human brain would inform not only research on treatment strategies of cardiac arrest and stroke that may complement efforts to reestablish circulation, but also the debate on organ donation after cardiocirculatory death (DCD), where death is declared between 2 and 10 minutes following the cessation of circulatory function 19, 20, 21. Therefore, here we analyzed the sequence of pathophysiologic events in patients during abrupt hypoxia–ischemia after withdrawal of life‐sustaining treatments.…”

mentioning

confidence: 99%

Terminal spreading depolarization and electrical silence in death of human cerebral cortex

Dreier

Major

Foreman

et al. 2018

Annals of Neurology

106

138

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ObjectiveRestoring the circulation is the primary goal in emergency treatment of cerebral ischemia. However, better understanding of how the brain responds to energy depletion could help predict the time available for resuscitation until irreversible damage and advance development of interventions that prolong this span. Experimentally, injury to central neurons begins only with anoxic depolarization. This potentially reversible, spreading wave typically starts 2 to 5 minutes after the onset of severe ischemia, marking the onset of a toxic intraneuronal change that eventually results in irreversible injury.MethodsTo investigate this in the human brain, we performed recordings with either subdural electrode strips (n = 4) or intraparenchymal electrode arrays (n = 5) in patients with devastating brain injury that resulted in activation of a Do Not Resuscitate–Comfort Care order followed by terminal extubation.ResultsWithdrawal of life‐sustaining therapies produced a decline in brain tissue partial pressure of oxygen (ptiO2) and circulatory arrest. Silencing of spontaneous electrical activity developed simultaneously across regional electrode arrays in 8 patients. This silencing, termed “nonspreading depression,” developed during the steep falling phase of ptiO2 (intraparenchymal sensor, n = 6) at 11 (interquartile range [IQR] = 7–14) mmHg. Terminal spreading depolarizations started to propagate between electrodes 3.9 (IQR = 2.6–6.3) minutes after onset of the final drop in perfusion and 13 to 266 seconds after nonspreading depression. In 1 patient, terminal spreading depolarization induced the initial electrocerebral silence in a spreading depression pattern; circulatory arrest developed thereafter.InterpretationThese results provide fundamental insight into the neurobiology of dying and have important implications for survivable cerebral ischemic insults. Ann Neurol 2018;83:295–310

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“…A "no-touch" time of 5 minutes from the time of cessation of antegrade blood flow is standard at our institution. 3 Machine cold perfusion, when used, was with the LifePort Pulsatile Flow Kidney Transporter (Organ Recovery Systems, Chicago, IL), with Kidney Perfusion Solution-1 (KPS-1) solution at 4°C.…”

Section: Methodsmentioning

confidence: 99%

Five-year experience with donation after cardiac death kidney transplantation in a Canadian transplant program: Factors affecting outcomes

Möser

Sharpe

Weernink³

et al. 2012

CUAJ

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Background: Donation after cardiac death (DCD) has led to an increase of up to 40% in the number of kidney transplants in some programs. Unfortunately, the increase in warm ischemic time results in higher rates of delayed graft function (DGF). The purpose of our study was to examine our initial 5-year experience with DCD kidney transplantation and to determine the factors involved in early postoperative function and function at 1 year. Results: DGF was seen in 65% of transplanted kidneys. Mean creatinine clearance (CrCl) at 1 year was 66.7 mL/min. Low pretransplant recipient daily urine output was the most statistically significant predictor of DGF in multivariate analysis (p < 0.001). In comparisons between our early and more recent results, improvements were noted in time from asystole to flush (16.0 vs. 12.0 minutes, p = 0.003), while cold ischemic time increased (464 vs. 725 minutes, p = 0.006). Experience contributed to a significant reduction in hospital length of stay (16 vs. 13 days, p = 0.035) and improved early renal function (CrCl at 3 days 7.8 vs. 11.9 mL/ min, p = 0.027). The use of machine cold perfusion and higher recipient preoperative daily urine output predicted improved early renal function, while increasing donor age predicted poorer function at 1 year. Discussion: Despite early DGF, our results justify the continued transplantation of kidneys from DCD donors.

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Donation after cardiocirculatory death in Canada

Abstract: Abstract*See Appendix 1 for affiliations and a complete list of committees and contributors to this work.

Cited by 207 publications

References 41 publications

Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region

Incidence of neurologic death among patients with brain injury: a cohort study in a Canadian health region

Terminal spreading depolarization and electrical silence in death of human cerebral cortex

Five-year experience with donation after cardiac death kidney transplantation in a Canadian transplant program: Factors affecting outcomes

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