In-hospital logistics: what are the key aspects for succeeding in each of the steps of the process of controlled donation after circulatory death?

Murphy, Paul; Boffa, Catherine; Manara, Alex; Ysebaert, Dirk; Jongh, Wim de

doi:10.1111/tri.12708

Cited by 10 publications

(12 citation statements)

References 33 publications

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“…The duration of acceptable warm ischemic time (WIT) should be locally informed and based on organ-specific concerns ( 13 , 46 , 47 ). Current practice in most pDCD centers recommends WIT of 30–90 minutes, depending on the organ to be recovered.…”

Section: Recommendationsmentioning

confidence: 99%

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

Weiss

Hornby

Rochwerg

et al. 2017

Pediatric Critical Care Medicine

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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.

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Section: Recommendationsmentioning

confidence: 99%

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

Weiss

Hornby

Rochwerg

et al. 2017

Pediatric Critical Care Medicine

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“…The duration of this process, translating to the organ warm ischemic time, determines the organs which will remain viable for recovery after circulatory arrest. Organ viability is limited to 30, 60, and 120 minutes of hypotension and hypoxemia for the liver, 21 lung 22 and kidneys, 23 respectively. Recognizing potentially varied perceptions among healthcare staff 24 and the anticipated medical and logistic complexities involved, the multidisciplinary team needs to achieve prior consensus on the individual pediatric organ DCD 25 .…”

Section: Discussionmentioning

confidence: 99%

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

Thong

Chong²,

Koh

et al. 2020

Pediatric Transplantation

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Pediatric organ donation represents only a low proportion of overall organ donation in many parts of world, unable to match the needs for pediatric organ transplantation. Pediatric organ donation after circulatory determination of death (DCD) is increasingly explored in pediatric transplantation, as it increases the availability of organ grafts. A 6‐year‐old Caucasian boy with a history of arteriovenous malformation presented with a catastrophic intracranial bleed, resulting in severe brainstem dysfunction despite maximal medical and surgical measures. He did not fulfill the criteria for brain death, which must be met for pediatric organ donation in Singapore. Due to parental request, his organs were donated after withdrawal of life support and determination of death by circulatory criteria. Pediatric organ DCD poses many challenges in the pediatric population, especially in the absence of a local practice guideline. We present the first case of a pediatric organ DCD that has occurred in Singapore. Further work is needed, particularly in establishing a national policy for pediatric organ DCD and increasing overall awareness and acceptance toward pediatric organ donations.

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“…Donation after circulatory death (DCD) involves donors with permanent absence of respiration and circulation, which have been defined by the Maastricht classification of uncontrolled DCD donors (category I: death out of the hospital setting; category II: unsuccessful resuscitation) and controlled DCD donors (category III: awaiting cardiac arrest; category IV: cardiac arrest in brain death) [ 29 ]. Due to the growing experience with DCD donation in the last decades, the original Maastricht classification was recently reviewed in order to distinguish the several categories of potential donors in different end-of-life situations, and recommendations for the donation process of DCD donors and the surgical techniques for DCD organ retrieval have been extensively described [ 30 , 31 ].…”

Section: The Use Of Donation After Circulatory Death Grafts In Paementioning

confidence: 99%

Donation after Circulatory Death in Paediatric Liver Transplantation: Current Status and Future Perspectives in the Machine Perfusion Era

Angelico

Perera

Manzia

et al. 2018

BioMed Research International

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Efforts have been made by the transplant community to expand the deceased donor pool in paediatric liver transplantation (LT). The growing experience on donation after circulatory death (DCD) for adult LT has encouraged its use also in children, albeit in selective cases, opening new perspectives for paediatric patients. Even though there has recently been a slight increase in the number of DCD livers transplanted in children, with satisfactory graft and patient outcomes, the use of DCD grafts in paediatric recipients is still controversial due to morbid outcomes associated with DCD grafts. In this context, recent advances in the optimization of donor support by extracorporeal membrane oxygenation and in the graft preservation by liver machine perfusion could find application in order to expand the donor pool in paediatric LT. In the present study we review the current literature on DCD liver grafts transplanted in children and on the use of extracorporeal donor support and liver perfusion machines in paediatrics, with the aim of defining the current status and future perspectives of paediatric LT.

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In-hospital logistics: what are the key aspects for succeeding in each of the steps of the process of controlled donation after circulatory death?

Cited by 10 publications

References 33 publications

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

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

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

Donation after Circulatory Death in Paediatric Liver Transplantation: Current Status and Future Perspectives in the Machine Perfusion Era

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