title: National recommendations for donation after cardiocirculatory death in Canada: Donation after cardiocirculatory death in Canada.
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.
authors.affiliation: Division of Pediatric Critical Care, Montreal Children's Hospital, McGill University Health Centre, Montréal, Canada. sam.shemie@muhc.mcgill.ca
authors.forename: Sam D
authors.initials: SD
authors.lastname: Shemie
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Baker
authors.forename: Greg
authors.initials: G
authors.lastname: Knoll
authors.forename: William
authors.initials: W
authors.lastname: Wall
authors.forename: Graeme
authors.initials: G
authors.lastname: Rocker
authors.forename: Daniel
authors.initials: D
authors.lastname: Howes
authors.forename: Janet
authors.initials: J
authors.lastname: Davidson
authors.forename: Joe
authors.initials: J
authors.lastname: Pagliarello
authors.forename: Jane
authors.initials: J
authors.lastname: Chambers-Evans
authors.forename: Sandra
authors.initials: S
authors.lastname: Cockfield
authors.forename: Catherine
authors.initials: C
authors.lastname: Farrell
authors.forename: Walter
authors.initials: W
authors.lastname: Glannon
authors.forename: William
authors.initials: W
authors.lastname: Gourlay
authors.forename: David
authors.initials: D
authors.lastname: Grant
authors.forename: Stéphan
authors.initials: S
authors.lastname: Langevin
authors.forename: Brian
authors.initials: B
authors.lastname: Wheelock
authors.forename: Kimberly
authors.initials: K
authors.lastname: Young
authors.forename: John
authors.initials: J
authors.lastname: Dossetor
mesh_terms: D002170:Canada; D003643:Death; D003657:Decision Making; D006801:Humans; D009926:Organ Preservation; D016730:Program Development; D013727:Terminal Care; D009626:Terminology as Topic; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000941:ethics* / Q000331:legislation & jurisprudence*; D028761:Withholding Treatment