How to improve organ donation rates
===================================

* Sam D. Shemie
* Christopher Doig
* Graeme Rocker
* Philip Belitsky

*   © 2004 Canadian Medical Association or its licensors

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

## References

1.  1. Knoll GA, Mahoney JE. Non-heart-beating organ donation in Canada: Time to proceed? [editorial]. CMAJ 2003;169(4):302-3. 
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjkvNC8zMDIiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTcwLzMvMzE4LjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. Morin JE, Baran D, Dandavino R, Marleau D, Naud A, Cloutier R. *Potential organ donors in Québec hospitals year 2000. Transplantation Committee report*. Montréal: Collège des médecins du Québec; 2003. Available: [www.cmq.org/uploadedfiles/transplantationEng.pdf](http://www.cmq.org/uploadedfiles/transplantationEng.pdf) (accessed 2004 Jan 5). 
    
    

3.  3. Shemie SD, Doig C, Belitsky P. Advancing toward a modern death: the path from severe brain injury to neurological determination of death [editorial]. CMAJ 2003;168(8):993-5.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjgvOC85OTMiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTcwLzMvMzE4LjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

4.  4. *CCCS position paper on organ and tissue donation: executive summary*. Toronto: Canadian Critical Care Society; 2001. Available: [www.lhsc.on.ca/critcare/ccc/cccs/ODpospaper.pdf](http://www.lhsc.on.ca/critcare/ccc/cccs/ODpospaper.pdf) (accessed 2004 Jan 5).