Organ Donation Organization Architecture: Recommendations From an International Consensus Forum

Abstract

Background. This report contains recommendations from 1 of 7 domains of the International Donation and Transplantation Legislative and Policy Forum (the Forum). The purpose is to provide expert guidance on the structure and function of Organ and Tissue Donation and Transplantation (OTDT) systems. The intended audience is OTDT stakeholders working to establish or improve existing systems. Methods. The Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This domain group included administrative, clinical, and academic experts in OTDT systems and 3 patient, family, and donor partners. We identified topic areas and recommendations through consensus, using the nominal group technique. Selected topics were informed by narrative literature reviews and vetted by the Forum’s scientific committee. We presented these recommendations publicly, with delegate feedback being incorporated into the final report. Results. This report has 33 recommendations grouped into 10 topic areas. Topic areas include the need for public and professional education, processes to assure timely referral of patients who are potential donors, and processes to ensure that standards are properly enforced. Conclusions. The recommendations encompass the multiple roles organ donation organizations play in the donation and transplantation process. We recognize the diversity of local conditions but believe that they could be adapted and applied by organ donation organizations across the world to accomplish their fundamental objectives of assuring that everyone who desires to become an organ donor is given that opportunity in a safe, equitable, and transparent manner.

An Update on Brain Death/Death by Neurologic Criteria since the World Brain Death Project

“…This review summarizes the content of the WBDP (including its 17 supplements) and highlights relevant work published after the WBDP, including the 2023 American Academy of Neurology (AAN)/American Academy of Pediatrics (AAP)/Child Neurology Society (CNS)/Society of Critical Care Medicine (SCCM) BD/DNC guideline and the 2023 Canadian BD/DNC guideline (which was published in a "special" special issue of Canadian Journal of Anesthesia called "Defining and Determining Death in Canada" which included over 25 articles on BD/DNC). 1,4,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Following the organizational structure of the WBDP, it addresses the following topics: (1) worldwide variance in BD/DNC, (2) the science of BD/DNC, (3) the concept of BD/DNC, (4) minimum clinical criteria for BD/DNC determination, (5) beyond minimum clinical BD/DNC determination, (6) pediatric and neonatal BD/DNC determination, (7) BD/DNC determination in patients on ECMO, (8) BD/DNC determination after treatment with TTM, (9) BD/DNC documentation, (10) qualification for and education on BD/DNC determination, (11) somatic support after BD/DNC for organ donation and other special circumstances, (12) religion and BD/DNC: managing requests to forego a BD/DNC evaluation or continue somatic support after BD/DNC, and (13) BD/DNC and the law. Finally, it discusses future areas for BD/DNC research.…”

“…2,[4][5][6][7] Multiple other guidance and consensus statements related to neuroprognostication or organ donation cited the WBDP, including those written by the International Donation and Transplantation Legislative Policy Forum, the International Liaison Committee on Resuscitation, the Neurocritical Care Society, the Deutsche Gesellschaft für Neurointesnivmedizin, and the American Association for the Surgery of Trauma Critical Care Committee. [8][9][10][11][12] Although some citing publications focused on specific background content or recommendations, others more broadly reinforced the WBDP's goal to address controversies related to BD/DNC and improve international consistency. [13][14][15][16][17][18]…”