Variation in donation after circulatory death hospital policies in a single donor service area

Wall, Anji; Shabbir, Rehma; Chebrolu, Sneha; Vines, Erin; Trahan, Chad; Niles, Patricia; Testa, Giuliano

doi:10.1016/j.amjsurg.2022.03.043

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…[3][4][5][6] While there are well-defined neurologic criteria for death determination, inconsistency in DCD protocols suggests that there is no consensus on the criteria for death determination by circulatory criteria. 7,8 Current Canadian protocols for DCD recommend five minutes of observation of pulselessness based on an invasive arterial blood pressure (ABP) tracing, although practices vary from two to ten minutes. [9][10][11] Without spontaneous resumption or resuscitation attempting to restart circulation, at the end of the observation period, loss of circulation is considered permanent and organ recovery ensues.…”

Section: Re ´Sumementioning

confidence: 99%

Brain-based arterial pulse pressure threshold for death determination: a systematic review

Ganesan

Hornby

Weiss

et al. 2023

Can J Anesth/J Can Anesth

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Purpose There is lack of consensus regarding the minimum arterial pulse pressure required for confirming permanent cessation of circulation for death determination by circulatory criteria in organ donors. We assessed direct and indirect evidence supporting whether one should use an arterial pulse pressure of 0 mm Hg vs more than 0 (5, 10, 20, 40) mm Hg to confirm permanent cessation of circulation. Source We conducted this systematic review as part of a larger project to develop a clinical practice guideline for death determination by circulatory or neurologic criteria. We systematically searched Ovid MEDLINE, Ovid Embase, Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, and Web of Science for articles published from inception until August 2021. We included all types of peer-reviewed original research publications related to arterial pulse pressure as monitored by an indwelling arterial pressure transducer around circulatory arrest or determination of death with either direct context-specific (organ donation) or indirect (outside of organ donation context) data. Principal findings A total of 3,289 abstracts were identified and screened for eligibility. Fourteen studies were included; three from personal libraries. Five studies were of sufficient quality for inclusion in the evidence profile for the clinical practice guideline. One study measured cessation of cortical scalp electroencephalogram (EEG) activity after withdrawal of life-sustaining measures and showed that EEG activity fell below 2 μV when the pulse pressure reached 8 mm Hg. This indirect evidence suggests there is a possibility of persistent cerebral activity at arterial pulse pressures > 5 mm Hg. Conclusion Indirect evidence suggests that clinicians may incorrectly diagnose death by circulatory criteria if they apply any arterial pulse pressure threshold of greater than 5 mm Hg. Moreover, there is insufficient evidence to determine that any pulse pressure threshold greater than 0 and less than 5 can safely determine circulatory death. Study registration PROSPERO (CRD42021275763); first submitted 28 August 2021. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-023-02425-2.

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Section: Re ´Sumementioning

confidence: 99%

Brain-based arterial pulse pressure threshold for death determination: a systematic review

Ganesan

Hornby

Weiss

et al. 2023

Can J Anesth/J Can Anesth

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“…[7] In the United States, there is also considerable variability in the policies dictating cDCD. [8] Consequently, donor surgeons implementing A-NRP in cDCD have to be adaptable. The Mayo team performed femoral or abdominal vessel cannulation, depending on regional, hospital, and/or family preferences.…”

mentioning

confidence: 99%

“…In a few countries, no antemortem interventions are allowed, and the process to establish A-NRP occurs postmortem in the abdomen and chest 7 . In the United States, there is also considerable variability in the policies dictating cDCD 8 . Consequently, donor surgeons implementing A-NRP in cDCD have to be adaptable.…”

mentioning

confidence: 99%

Practical considerations for implementation of abdominal normothermic regional perfusion

Fondevila

Estébanez

Hessheimer

2023

Liver Transplantation

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Knowledge gaps in heart and lung donation after the circulatory determination of death: Report of a workshop of the National Heart, Lung, and Blood Institute

Bernat,

Khush,

Shemie

et al. 2024

The Journal of Heart and Lung Transplantation

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Variation in donation after circulatory death hospital policies in a single donor service area

Cited by 6 publications

References 19 publications

Brain-based arterial pulse pressure threshold for death determination: a systematic review

Brain-based arterial pulse pressure threshold for death determination: a systematic review

Practical considerations for implementation of abdominal normothermic regional perfusion

Knowledge gaps in heart and lung donation after the circulatory determination of death: Report of a workshop of the National Heart, Lung, and Blood Institute

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