Attitudes of healthcare providers towards cardiac donation after circulatory determination of death: a Canadian nation-wide survey

Abstract

The number of patients on cardiac transplant waitlists exceeds the number of available donor organs. Cardiac donation is currently limited to those declared dead by neurologic criteria in all but three countries. Cardiac donation after circulatory determination of death (cardiac DCDD) can be conducted using direct procurement and perfusion (DPP) or normothermic regional perfusion (NRP). Implementation of cardiac DCDD in many countries has been slowed by ethical debates within the donation and transplantation community. We conducted a national survey to determine the perceptions of healthcare providers regarding cardiac DCDD. Methods We conducted an electronic survey of 398 healthcare providers who are involved in the management of heart donors and/or heart transplant recipients in Canada (226 nurses, 82 critical care physicians, 31 donation specialists, and 59 transplant specialists). Our primary outcomes were their attitudes towards and concerns regarding cardiac DCDD protocols This article is accompanied by an editorial. Please see Can J Anesth 2020; 67: this issue.

Le don cardiaque après un décès cardiocirculatoire : le cœur du sujet

“…Normothermic regional perfusion (NRP), a protocol involving the in situ restoration of cardiac function after DCDD followed by transplantation, was reported as acceptable or strongly acceptable by 74% of respondents. 6 Overall, strong acceptability of cardiac DCDD was observed. When healthcare providers were asked to speculate how cardiac DCDD would be perceived by the public, only 61% and 37% believed that DPP or NRP would be acceptable.…”

“…In this issue of the Journal, two surveys conducted by the same investigators explored the opinions of healthcare providers and of the Canadian public regarding cardiac DCDD to better understand how cardiac DCDD is perceived across Canada. 6,7 Among healthcare providers, 92% of respondents agreed or strongly agreed that the direct procurement and perfusion (DPP) approach, which involves the ex situ perfusion of the heart followed by transplantation, was acceptable. Normothermic regional perfusion (NRP), a protocol involving the in situ restoration of cardiac function after DCDD followed by transplantation, was reported as acceptable or strongly acceptable by 74% of respondents.…”

“…7 The level of agreement decreased to approximately 60% when respondents were asked if they would agree to donate their heart using either approach. 6,7 This observation is difficult to reconcile but may reflect the challenge an individual may face when asked to imagine themselves as a future organ donor. Most public respondents considered that cardiac DCDD posed the same ''level of concern'' as cardiac donation after neurologic declaration of death (NDD), although the specific domains of concerns were not considered.…”

“…Dans ce numéro du Journal, deux sondages réalisés par les mêmes chercheurs se sont intéressés aux opinions des fournisseurs de soins de santé et du grand public canadien concernant le DDC cardiaque afin de mieux en comprendre la perception au pays. 6,7 Parmi les fournisseurs de soins de santé, 92 % des répondants étaient d'accord ou tout à fait d'accord que l'approche de perfusion après prélèvement direct (PPD), qui implique la perfusion ex situ du coeur suivi de la transplantation, était acceptable. La circulation régionale normothermique (CRN), un protocole impliquant la restauration in situ de la fonction cardiaque après le DDC suivi de la transplantation, était perçu comme acceptable ou très acceptable par 74 % des répondants.…”

“…La circulation régionale normothermique (CRN), un protocole impliquant la restauration in situ de la fonction cardiaque après le DDC suivi de la transplantation, était perçu comme acceptable ou très acceptable par 74 % des répondants. 6 Globalement, une forte acceptabilité du DDC cardiaque a été observée. Lorsque les chercheurs ont demandé aux fournisseurs des soins de santé de deviner comment le DDC cardiaque serait perçu par le grand public, seuls 61 % et 37 % pensaient que les méthodes d'PPD ou de CRN seraient acceptables.…”