How to improve organ donation rates

In Canada, the primary postmortem source of transplantable organs is patients whose deaths have been determined on the basis of brain death criteria (heart-beating donors). Greg Knoll and John Mahoney1 suggest that patients who die after cardiac arrest (non-heart-beating donors [NHBDs]) should also be considered as a source of transplantable organs.

Fundamental changes to organ donation in Canada would seem most appropriate if all other conventional approaches related to brain death donation had already been optimally explored. For example, the Collège des médecins du Québec reviewed all deaths in Quebec for the year 20002 and found that, of all patients who appeared brain dead on the basis of the chart review, 23% had not been identified as potential organ donors at the time. Furthermore, for patients with a diagnosis of brain death, 24% of the families were not approached for consent to donation.

Acknowledging variability in the recognition, diagnosis and documentation of brain death, the Canadian Council for Donation and Transplantation (CCDT), which provides advice to various levels of government, sponsored a national forum on the subject in April 2003.3 The forum's multidisciplinary participants developed standards to address the optimal management of severely brain injured patients who may experience brain death, including the option of organ donation as a part of standard end-of-life care.

In its position paper,4 the Canadian Critical Care Society (CCCS) has called for a moratorium on NHBD protocols without prior national discussions. The CCDT is preparing to initiate such a national discussion, with input and recommendations from representatives of the relevant health care professions and society as a whole. Planning for this initiative is scheduled for 2004.

Sam D. Shemie Division of Critical Care Montreal Children's Hospital Montréal, Que. Chair, Canadian Forum on Severe Brain Injury to Neurological Determination of Death Christopher Doig Department of Critical Care Medicine Foothills Hospital Multisystem Intensive Care Unit Calgary Health Region Calgary, Alta. Chair, Donation Committee Canadian Council for Donation and Transplantation Graeme Rocker Professor of Medicine Dalhousie University Halifax, NS President, Canadian Critical Care Society Philip Belitsky Director, Transplantation Services Queen Elizabeth II Health Sciences Centre Halifax, NS Chair, Canadian Council for Donation and Transplantation