Heart transplantation after declaration of death by cardiorespiratory criteria

Eynon, C Andy; Murphy, Paul; Smith, Martin; Danbury, Chris; Manara, Alex

doi:10.1016/j.healun.2009.09.011

Cited by 8 publications

(8 citation statements)

References 6 publications

(3 reference statements)

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“…Implementation of such programs in other countries, including Canada, has been hindered by practical considerations and ethical debates within the medical community both for and against DCDD heart programs. [11][12][13][14] We conducted a national survey to determine the attitudes and opinions of Canadian healthcare providers towards cardiac DCDD and perceived barriers to its implementation.…”

Section: Résumémentioning

confidence: 99%

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

Honarmand

Leigh

Basmaji

et al. 2020

Can J Anesth/J Can Anesth

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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.

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Section: Résumémentioning

confidence: 99%

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

Honarmand

Leigh

Basmaji

et al. 2020

Can J Anesth/J Can Anesth

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“…It has been argued that if the diagnosis of death by circulatory criteria necessitates the irreversible cessation of cardiac activity, its restoration violates the dead donor rule, which states that organ recovery can only occur after death. [9][10][11] NRP is possibly more controversial than DPP because it involves restoration of circulation within the donor's body after surgically interrupting the cerebral vasculature to ensure that circulatory flow to the brain is not restored. In some jurisdictions, such as Australia, where the definition of death is based on permanent cessation of systemic circulation, its restoration within the donor body would violate such a definition.…”

Section: Cardiac Dcdd Protocolsmentioning

confidence: 99%

“…12 Furthermore, there are concerns about the restoration of cerebral blood flow when thoracoabdominal circulation is restored within the donor body. 10 There is no consensus on the best methods to ensure that surgical techniques are effective in preventing restoration of any cerebral perfusion nor what amount, if any, such flow would violate the dead donor rule.…”

Section: Cardiac Dcdd Protocolsmentioning

confidence: 99%

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

et al. 2020

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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.

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“…The authors suggested that hearts from Maastricht category III donors might be suitable for use in clinical transplantation. This report again prompted ethical debate surrounding the postmortem restoration of mechanical cardiac function using cardiopulmonary bypass in a donor that had been declared dead based on cardiorespiratory criteria ( 189 ). However, the technique of NRP has become an accepted means of facilitating multi-organ DCD retrievals in some countries ( 190 ).…”

Section: Dcd Heart Transplantationmentioning

confidence: 99%

Transplantation of Hearts Donated after Circulatory Death

White

Messer

Large

et al. 2018

Front. Cardiovasc. Med.

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Cardiac transplantation has become limited by a critical shortage of suitable organs from brain-dead donors. Reports describing the successful clinical transplantation of hearts donated after circulatory death (DCD) have recently emerged. Hearts from DCD donors suffer significant ischemic injury prior to organ procurement; therefore, the traditional approach to the transplantation of hearts from brain-dead donors is not applicable to the DCD context. Advances in our understanding of ischemic post-conditioning have facilitated the development of DCD heart resuscitation strategies that can be used to minimize ischemia-reperfusion injury at the time of organ procurement. The availability of a clinically approved ex situ heart perfusion device now allows DCD heart preservation in a normothermic beating state and minimizes exposure to incremental cold ischemia. This technology also facilitates assessments of organ viability to be undertaken prior to transplantation, thereby minimizing the risk of primary graft dysfunction. The application of a tailored approach to DCD heart transplantation that focuses on organ resuscitation at the time of procurement, ex situ preservation, and pre-transplant assessments of organ viability has facilitated the successful clinical application of DCD heart transplantation. The transplantation of hearts from DCD donors is now a clinical reality. Investigating ways to optimize the resuscitation, preservation, evaluation, and long-term outcomes is vital to ensure a broader application of DCD heart transplantation in the future.

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Heart transplantation after declaration of death by cardiorespiratory criteria

Cited by 8 publications

References 6 publications

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

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

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

Transplantation of Hearts Donated after Circulatory Death

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