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Supplement

Donation after cardiocirculatory death in Canada

Sam D. Shemie, Andrew J. Baker, Greg Knoll, William Wall, Graeme Rocker, Daniel Howes, Janet Davidson, Joe Pagliarello, Jane Chambers-Evans, Sandra Cockfield, Catherine Farrell, Walter Glannon, William Gourlay, David Grant, Stéphan Langevin, Brian Wheelock, Kimberly Young and John Dossetor
CMAJ October 10, 2006 175 (8) S1; DOI: https://doi.org/10.1503/cmaj.060895
Sam D. Shemie
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Andrew J. Baker
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Greg Knoll
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William Wall
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Graeme Rocker
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Daniel Howes
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Janet Davidson
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Joe Pagliarello
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Jane Chambers-Evans
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Sandra Cockfield
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Catherine Farrell
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Walter Glannon
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William Gourlay
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David Grant
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Stéphan Langevin
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Brian Wheelock
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Kimberly Young
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John Dossetor
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Abstract

These recommendations are the result of a national, multidisciplinary, year-long process to discuss whether and how to proceed with organ donation after cardiocirculatory death (DCD) in Canada. A national forum was held in February 2005 to discuss and develop recommendations on the principles, procedures and practice related to DCD, including ethical and legal considerations. At the forum's conclusion, a strong majority of participants supported proceeding with DCD programs in Canada. The forum also recognized the need to formulate and emphasize core values to guide the development of programs and protocols based on the medical, ethical and legal framework established at this meeting.

Although end-of-life care should routinely include the opportunity to donate organs and tissues, the duty of care toward dying patients and their families remains the dominant priority of health care teams. The complexity and profound implications of death are recognized and should be respected, along with differing personal, ethnocultural and religious perspectives on death and donation. Decisions around withdrawal of life-sustaining therapies, management of the dying process and the determination of death by cardiocirculatory criteria should be separate from and independent of donation and transplant processes.

The recommendations in this report are intended to guide individual programs, regional health authorities and jurisdictions in the development of DCD protocols. Programs will develop based on local leadership and advance planning that includes education and engagement of stakeholders, mechanisms to assure safety and quality and public information. We recommend that programs begin with controlled DCD within the intensive care unit where (after a consensual decision to withdraw life-sustaining therapy) death is anticipated, but has not yet occurred, and unhurried consent discussions can be held. Uncontrolled donation (where death has occurred after unanticipated cardiac arrest) should only be considered after a controlled DCD program is well established. Although we recommend that programs commence with kidney donation, regional transplant expertise may guide the inclusion of other organs. The impact of DCD, including pre-and post-mortem interventions, on donor family experiences, organ availability, graft function and recipient survival should be carefully documented and studied.

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In this issue

Canadian Medical Association Journal: 175 (8)
CMAJ
Vol. 175, Issue 8
10 Oct 2006
  • Table of Contents
  • Index by author
  • Canadian Adverse Reaction Newsletter (p 1013 - 1020)

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Donation after cardiocirculatory death in Canada
Sam D. Shemie, Andrew J. Baker, Greg Knoll, William Wall, Graeme Rocker, Daniel Howes, Janet Davidson, Joe Pagliarello, Jane Chambers-Evans, Sandra Cockfield, Catherine Farrell, Walter Glannon, William Gourlay, David Grant, Stéphan Langevin, Brian Wheelock, Kimberly Young, John Dossetor
CMAJ Oct 2006, 175 (8) S1; DOI: 10.1503/cmaj.060895

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Donation after cardiocirculatory death in Canada
Sam D. Shemie, Andrew J. Baker, Greg Knoll, William Wall, Graeme Rocker, Daniel Howes, Janet Davidson, Joe Pagliarello, Jane Chambers-Evans, Sandra Cockfield, Catherine Farrell, Walter Glannon, William Gourlay, David Grant, Stéphan Langevin, Brian Wheelock, Kimberly Young, John Dossetor
CMAJ Oct 2006, 175 (8) S1; DOI: 10.1503/cmaj.060895
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  • Article
    • Abstract
    • Background and objectives
    • Process
    • Recommendations related to DCD
    • Core values and ethics
    • Overarching considerations
    • 1. Terminology and patient conditions
    • 2. Death and the minimum criteria to proceed with organ donation
    • 3. Process and procedures for withdrawal of life-sustaining therapy (WLST) in controlled DCD
    • 4. The option of donation in controlled DCD
    • 5. Interventions relative to phases of care: controlled and uncontrolled DCD
    • 6. Post-mortem care and interventions: uncontrolled DCD
    • 7. Limits of organ viability: controlled and uncontrolled DCD
    • 8. Preservation techniques: controlled and uncontrolled DCD
    • 9. DCD programs — Overarching recommendations for jurisdictions
    • Conclusion
    • Appendix 1
    • Appendix 2
    • Appendix 3
    • Appendix 4
    • Appendix 5
    • Footnotes
    • REFERENCES
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