Cardiac donation after circulatory determination of death: protocol for a mixed-methods study of healthcare provider and public perceptions in Canada

Abstract

IntroductionCardiac transplantation remains the best treatment for patients with end-stage heart disease that is refractory to medical or device therapies, however, a major challenge for heart transplantation is the persistent discrepancy between the number of patients on waiting lists and the number of available hearts. While other countries (eg, UK, Australia and Belgium) have explored and implemented alternative models of transplantation, such as cardiac donation after circulatory determination of death (DCDD) to alleviate transplantation wait times, ethical concerns have hindered implementation in some countries. This study aims to explore the attitudes and opinions of healthcare providers and the public about cardiac DCDD in order to identify and describe opportunities and challenges in ensuring that proposed cardiac DCDD procedures in Canada are consistent with Canadian values and ethical norms.Methods and analysisThis study will include two parts that will be conducted concurrently. Part 1 is a qualitative study consisting of semi-structured interviews with Canadian healthcare providers who routinely care for organ donors and/or transplant recipients to describe their perceptions about cardiac DCDD. Part 2 is a convergent parallel mixed-methods design consisting of a series of focus groups and follow-up surveys with members of the Canadian general public to describe their perceptions about cardiac DCDD.Ethics and disseminationThis study has been approved by the Research Ethics Board at Western University. The findings will be presented at regional and national conferences and reported in peer-reviewed publications.

Potential Heart, Liver, and Kidney Donation after Circulatory Determination of Death in a Neonatal Intensive Care Unit

“…Considering that infant mortality in Canada is the greatest during the first month of life [16] and withdrawal of life-sustaining therapies (WLST) is the most frequent cause of death in Canadian neonatal intensive care units (NICUs), neonatal DCD could increase the number of organ donors both for the neonatal and older populations. This is particularly true if cardiac DCD were to be implemented [17]. There have been studies evaluating newborns' eligibility for DCD, though none in Canada.…”

Implications of the updated Canadian Death Determination Guidelines for organ donation interventions that restore circulation after determination of death by circulatory criteria

“…Second, qualitative studies should continue to determine the acceptability of NRP among stakeholders and explore what form consent to NRP should take. 17 Third, prospective studies with imminently dying patients should document the temporal relationship between cessation of circulation and brain function. Finally, studies assessing surgical safeguards to prevent intracranial blood flow should be undertaken with rigorous neuromonitoring protocols in place.…”

Protocol for a qualitative pilot study to explore ethical issues and stakeholder trust in the use of normothermic regional perfusion in organ donation in Canada

“…12 NRP raises ethical questions which provoke concern among some stakeholders, with three areas of concern dominating discussion. [13][14][15][16] First, postmortem resumption of in situ circulation in NRP contradicts the traditional standard for death determination in cDCDD (ie, permanent cessation of circulation), 17 a standard endorsed in Canada's 2006 cDCDD guidelines. 2 This may entail subsequent violations of the dead donor rule, 18 the injunction that organ recovery cannot cause death.…”

“…The relationship between stakeholder perspectives of NRP and trust in donation and transplantation is currently unknown. While essential research into NRP's perceived acceptability among the public and healthcare providers is ongoing, 13 calls for further investigation into other key stakeholders' perspectives on NRP are growing louder. 21 Objectives This pilot study seeks to inform the development of responsible policy regarding NRP.…”