Deceased organ donation potential in Canada: a review of consecutive deaths in Alberta

Kramer, Andreas H.; Hornby, Karen; Doig, Christopher J.; Armstrong, Denise E.; Grantham, Laura; Kashuba, Sherri; Couillard, Philippe; Kutsogiannis, Demetrios J

doi:10.1007/s12630-019-01437-1

Cited by 8 publications

(11 citation statements)

References 29 publications

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“…Unfortunately, donation opportunities are missed; historically, in a single center in Canada (1990–1997) ( 1 ), approximately 16% of potential pediatric organ donors were not approached. More contemporary data of combined adult and pediatric populations in Canada demonstrate similar missed approach rates with a multisite study in Alberta, Canada estimating a missed approach rate of 20% ( 2 ), and a survey of four Canadian organ donation organizations (ODOs) estimating missed approach rates between 38.4% and 1.6% ( 3 ). Such missed opportunities, if still present in pediatric populations, may account for the disparity between pediatric donors and children on transplantation waitlists.…”

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confidence: 64%

Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021–2022*

Lee,

Martin,

Mahoney

et al. 2023

Pediatric Critical Care Medicine

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Objectives: To understand contemporary pediatric organ donation programs in Canadian PICUs, including: policies and practices, data collection and reporting, and system and process barriers. Design: A cross-sectional survey carried out 2021–2022. Setting: Canadian PICUs affiliated with a donor physician network. Subjects: Pediatric intensivists identified as the donation program lead, or most knowledgeable about donation for their institution. Measurements and Main Results: A 19-item survey was developed through collaboration with stakeholders from the organ donation and transplantation community within Canada. Domains and items were generated and reduced iteratively during an in-person workshop. Pretesting and pilot testing were completed to ensure readability, flow, clinical sensibility, and construct validity. Fifteen of 16 (94%) invited Canadian PICUs from seven provinces completed the survey representing 88% (15/18) of all noncardiac Canadian PICUs. Surveys were completed between June 2021 and September 2022. All units support donation after death by neurologic criteria (DNC); 14 of 15 indicated donation policies were in place and 1 of 15 indicated no policy but the ability to facilitate donation. Thirteen of 15 units (87%) support donation after death by circulatory criteria (DCC) with policies in place, with 11 of 13 of these indicating routine support of donation opportunities. The majority (13/15) of units identified a donation champion. Of the 16 identified champions across these centers, 13 were physicians and were registered nurses or nurse practitioners. Eight of 13 units (62%) with donation champions had positions supported financially, of which 5 units came from the Organ Donation Organization and the other 3 came from the provincial health authority. Finally, only 3 of 15 PICU donation programs have a pediatric donation committee with family involvement. Variability exists in identification (including determination of death practices), referral, and approach for donation between units. Conclusions: Although all Canadian PICUs support donation after DNC donation, and most support donation after DCC, variability exists in the identification, referral, and approach of potential donors. There is a notable lack of family involvement in pediatric donation programs. There are many opportunities for standardization of PICU donation programs which may result in improved rates of pediatric organ donation in Canada.

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confidence: 64%

Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021–2022*

Lee,

Martin,

Mahoney

et al. 2023

Pediatric Critical Care Medicine

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“…11 The Alberta death audit found that 18% of brain death cases were not referred. 12 Timely referrals entail calling the ODO when EOL conversations are planned and/or conducted to ensure sufficient time for the donation process. Untimely referral compromises the donation process by not allowing time for donor assessment, mobilizing resources, and a well-planned approach.…”

Section: Resultsmentioning

confidence: 99%

Preventable harm in the Canadian organ donation and transplantation system: a descriptive study of missed organ donor identification and referral

Zavalkoff

O’Donnell

Lalani

et al. 2023

Can J Anesth/J Can Anesth

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Purpose Deceased organ donation is predicated on timely identification and referral (IDR) of potential organ donors. Many Canadian provinces have legislated mandatory referral of potential deceased donors. Untimely or missed IDRs are safety events where best or expected practice has not occurred causing preventable harm to patients and denying families the opportunity of donation at end of life (EOL) as well as denying transplant waitlist patients access to lifesaving organs. Methods We requested donor definitions and data to calculate IDR, consent, and approach rates from all Canadian organ donation organizations (ODOs) for 2016–2018. We then estimated the number of missed IDR patients who were eligible for approach ( safety events ) and the associated preventable harm to patients at EOL and on transplant waitlists. Results Annually, there were 63–76 missed IDR patients eligible for approach (3.6–4.5 per million population [PMP]) from four ODOs—three with mandatory referral legislation. Applying each ODO’s approach and consent rates for the corresponding year, there were 37–41 missed donors (2.4 donor PMP) annually. Assuming three transplants per donor, the theoretical number of missed transplants would be 111–123 (6.4–7.3 transplants PMP) annually. Conclusions Data from four Canadian ODOs show that missed IDR safety events resulted in important preventable harm measured by a lost opportunity for donation of 2.4 donors PMP annually and 354 potentially missed transplants between 2016 and 2018. Given that 223 patients died on Canada’s waitlist in 2018, national donor audits and quality improvement initiatives to optimize IDR are essential to reduce preventable harm to these vulnerable populations.

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“…We also do not have data regarding missed donation opportunities and consent rates for DCD during the study period, although a related study assessing donation potential in western Canada was recently published. 53…”

Section: Discussionmentioning

confidence: 99%

Donation after circulatory determination of death in western Canada: a multicentre study of donor characteristics and critical care practices

Kramer

Holliday

Keenan

et al. 2020

Can J Anesth/J Can Anesth

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Purpose Donation after circulatory determination of death (DCD) has been performed in Canada since 2006. Numerous aspects of donor management remain controversial. Methods We performed a multicentre cohort study involving potential DCD donors in western Canada (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017), as well as recipients of their organs, to describe donor characteristics and critical care practices, and their relation to one-year recipient and graft survival. Results There were 257 patients in four provinces that underwent withdrawal of life-sustaining therapies (WLST) in anticipation of possible DCD. The proportion of patients that died within two hours of WLST ranged from 67% to

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Deceased organ donation potential in Canada: a review of consecutive deaths in Alberta

Cited by 8 publications

References 29 publications

Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021–2022*

Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021–2022*

Preventable harm in the Canadian organ donation and transplantation system: a descriptive study of missed organ donor identification and referral

Donation after circulatory determination of death in western Canada: a multicentre study of donor characteristics and critical care practices

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