Management of the neurologically deceased organ donor: A Canadian clinical practice guideline

Ball, Ian; Hornby, Laura; Rochwerg, Bram; Weiss, Matthew J.; Gillrie, Clay; Chassé, Michaël; D’Aragon, Frédérick; Meade, Maureen O.; Soliman, Karim; Ali, Aadil; Arora, Samantha; Basmaji, John; Boyd, J. Gordon; Cantin, Bernard; Chaudhury, Prosanto; Cypel, Marcelo; Freed, Darren H.; Frenette, Anne Julie; Hruska, Pam; Karvellas, Constantine J.; Keenan, Sean; Kramer, Andreas H.; Kutsogiannis, Demetrios J; Lien, Dale; Luke, Patrick; Mahoney, Meagan; Singh, Jeffrey M.; Wilson, Lindsay; Wright, Alissa; Zaltzman, Jeffrey S.; Shemie, Sam D.

doi:10.1503/cmaj.190631

Cited by 34 publications

(41 citation statements)

References 43 publications

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“…Potential limitations are the low or very low certainty in the evidence identified for many of the questions, and indirect evidence that did not change after the systematic review update. However, management recommendations are consistent with similar documents recently published [ 11 , 131 , 132 ].…”

Section: General Considerations and Future Directionssupporting

confidence: 86%

Brazilian guidelines for the management of brain-dead potential organ donors. The task force of the AMIB, ABTO, BRICNet, and the General Coordination of the National Transplant System

Westphal

Robinson

Cavalcanti

et al. 2020

Ann. Intensive Care

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Objective To contribute to updating the recommendations for brain-dead potential organ donor management. Method A group of 27 experts, including intensivists, transplant coordinators, transplant surgeons, and epidemiologists, joined a task force formed by the General Coordination Office of the National Transplant System/Brazilian Ministry of Health (CGSNT-MS), the Brazilian Association of Intensive Care Medicine (AMIB), the Brazilian Association of Organ Transplantation (ABTO), and the Brazilian Research in Intensive Care Network (BRICNet). The questions were developed within the scope of the 2011 Brazilian Guidelines for Management of Adult Potential Multiple-Organ Deceased Donors. The topics were divided into mechanical ventilation, hemodynamic support, endocrine-metabolic management, infection, body temperature, blood transfusion, and use of checklists. The outcomes considered for decision-making were cardiac arrest, number of organs recovered or transplanted per donor, and graft function/survival. Rapid systematic reviews were conducted, and the quality of evidence of the recommendations was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Two expert panels were held in November 2016 and February 2017 to classify the recommendations. A systematic review update was performed in June 2020, and the recommendations were reviewed through a Delphi process with the panelists between June and July 2020. Results A total of 19 recommendations were drawn from the expert panel. Of these, 7 were classified as strong (lung-protective ventilation strategy, vasopressors and combining arginine vasopressin to control blood pressure, antidiuretic hormones to control polyuria, serum potassium and magnesium control, and antibiotic use), 11 as weak (alveolar recruitment maneuvers, low-dose dopamine, low-dose corticosteroids, thyroid hormones, glycemic and serum sodium control, nutritional support, body temperature control or hypothermia, red blood cell transfusion, and goal-directed protocols), and 1 was considered a good clinical practice (volemic expansion). Conclusion Despite the agreement among panel members on most recommendations, the grade of recommendation was mostly weak. The observed lack of robust evidence on the topic highlights the importance of the present guideline to improve the management of brain-dead potential organ donors.

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Section: General Considerations and Future Directionssupporting

confidence: 86%

Brazilian guidelines for the management of brain-dead potential organ donors. The task force of the AMIB, ABTO, BRICNet, and the General Coordination of the National Transplant System

Westphal

Robinson

Cavalcanti

et al. 2020

Ann. Intensive Care

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“…However, management recommendations are consistent with similar documents recently published. ( 11 , 128 , 129 )…”

Section: Discussionmentioning

confidence: 99%

Brazilian guidelines for the management of brain-dead potential organ donors. The task force of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Transplantes de Órgãos, Brazilian Research in Critical Care Network, and the General Coordination of the National Transplant System

et al. 2021

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“…This may be particularly beneficial for domains unfamiliar to many residents, but where best-practice standards exist, such as organ donation and WLST. 23,24 Didactic sessions may also help residents familiarize themselves with the prognostic literature that informs goals of care discussions. While available data support that EOL training can improve trainee self-confidence, comfort, preparedness, and knowledge, the best approach to teaching each skill requires further study.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Skills and Professionalism for Critical Care Residents in Training: The ESPRIT Survey

Arora

Shaikh

Karachi

et al. 2020

J Intensive Care Med

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End-of-life (EOL) care is a key aspect of critical care medicine (CCM) training. The goal of this study was to survey CCM residents and program directors (PDs) across Canada to describe current EOL care education. Using a literature review, we created a self-administered survey encompassing 10 CCM national objectives of training to address: (1) curricular content and evaluation methods, (2) residents’ preparedness to meet these objectives, and (3) opportunities for educational improvement. We performed pilot testing and clinical sensibility testing, then distributed it to all residents and PDs across the 13 Canadian CCM programs. Our response rate was 84.3% overall (77 [81.1%] for residents and 13 [100%] for PDs). Residents rated direct observation, informal advice, and self-reflection as both the top 3 most utilized and perceived most effective teaching modalities. Residents most commonly reported comfort with skills related to pain and symptom management (n = 67, 94.3%; score > 3 on 5-point Likert scale), and least commonly reported comfort with donation after cardiac death skills (n = 26-38; 44.8%-65.5%). Base specialty and time in CCM training were independently associated with comfort ratings for some, but not all, EOL skills. With respect to family meetings, residents infrequently received feedback; however, most PDs believed feedback on 6 to 10 meetings is required for competence. When PD perceptions of teaching effectiveness were compared with resident comfort ratings, differences were most apparent for skills related to pain and symptom management, cultural awareness, and ethical principles. By the end of their first subspecialty training year, PDs expect residents to be competent at most, but not all, EOL skills. In summary, trainees and programs rely on clinical activities to develop competency in EOL care, resulting in some educational gaps. Transitioning to competency-based medical education presents an opportunity to address some of these gaps, while other gaps will require more specific curricular intervention.

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Management of the neurologically deceased organ donor: A Canadian clinical practice guideline

Cited by 34 publications

References 43 publications

Brazilian guidelines for the management of brain-dead potential organ donors. The task force of the AMIB, ABTO, BRICNet, and the General Coordination of the National Transplant System

Brazilian guidelines for the management of brain-dead potential organ donors. The task force of the AMIB, ABTO, BRICNet, and the General Coordination of the National Transplant System

End-of-Life Skills and Professionalism for Critical Care Residents in Training: The ESPRIT Survey

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