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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

01-10-2018 | Reports of Original Investigations

Hamilton-DONATE: a city-wide pilot observational study of the ICU management of deceased organ donors

Authors: Frederick D’Aragon, MD, Deborah Cook, MD, Sony Dhanani, MD, Christine Ribic, MD, Karen E. A. Burns, MD, Aemal Akhtar, MSc, Lori Hand, BSc, Erika Arseneau, MSc, Cynthia Cupido, MD, Heather Whittigham, MD, Andrew Healey, MD, Anne Julie Frenette, BPharm, MSc, François Lamontagne, MD, Maureen O. Meade, MD, for the Canadian Critical Care Trials Group and the Canadian National Transplant Research Program

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 10/2018

Abstract

Purpose

Improving the medical care of deceased organ donors to increase transplant rates and improve allograft function requires an understanding of the current epidemiology and clinical practices of deceased donation within intensive care units (ICUs). Herein, we report the results of our investigation into the feasibility of a multicentre prospective cohort study addressing the afformentioned issues.

Methods

We conducted a 12-month prospective observational cohort study in six ICUs and one coronary care unit in Hamilton, Canada. We included consecutive children and adults following consent for deceased organ donation (including neurologic determination of death [NDD] or donation after circulatory death [DCD]). Intensive care unit research staff recorded donor management data from hospital records, extending from one day prior to the consent for organ donation up to the time of organ retrieval. The provincial Organ Donation Organization (ODO) supplemented these data and, additionally, provided data on corresponding organ recipients. We identified, evaluated, and measured three potential obstacles to the feasibility of a national cohort study: obtaining authorization to implement the study with a waiver of research consent, accessibility of transplant recipient data, and the time required to complete very detailed case report forms (CRFs), with valuable lessons learned for implementation in future projects.

Results

The local Research Ethics Board and the ODO Privacy Office both authorized the recording of donor and recipient study data with a waiver of research consent. Sixty-seven consecutive consented donors were included (31 NDD and 36 DCD donors); 50 of them provided 144 organs for transplantation to 141 recipients. We identified the age and sex of the recipients as well as the location and date of transplant for all organ recipients in Ontario; however, we obtained no recipient data for six organs transported outside of Ontario. Intensive care unit research staff estimated that future CRF completion will require five to seven hours per patient.

Conclusion

The Hamilton-DONATE pilot study supports the feasibility of a larger cohort study to describe the epidemiology and clinical practices related to deceased donor care in Canada.

Trial registration

wwwclinicaltrials.gov (NCT02902783). Registered 16 September 2016.

Available only for authorised users

Grinyo JM. Why is organ transplantation clinically important? Cold Spring Harbor Perspect Med 2013. DOI: https://doi.org/10.1101/cshperspect.a014985.CrossRef

Canadian Institute for Health Information. Canadian Organ Replacement Register Annual Report: Treatment of End-Stage Organ Failure in Canada, 2004-2013. April 2015. Available from URL: https://secure.cihi.ca/free_products/2015_CORR_AnnualReport_ENweb.pdf (accessed April 2018).

Rosendale JD, Chabalewski FL, McBride MA, et al. Increased transplanted organs from the use of a standardized donor management protocol. Am J Transplant 2002; 2: 761-8.CrossRefPubMed

Wheeldon DR, Potter CD, Oduro A, Wallwork J, Large SR. Transforming the “unacceptable” donor: outcomes from the adoption of a standardized donor management technique. J Heart Lung Transplant 1995; 14: 734-42.PubMed

Kotloff RM, Blosser S, Fulda GJ, et al. Management of the potential organ donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement. Crit Care Med 2015; 43: 1291-325.CrossRefPubMed

Shemie SD, Ross H, Pagliarello J, et al. Organ donor management in Canada: recommendations of the forum on Medical Management to Optimize Donor Organ Potential. CMAJ 2006; 174: S13-32.CrossRefPubMedPubMedCentral

Malinoski DJ, Daly MC, Patel MS, Oley-Graybill C, Foster CE 3rd, Salim A. Achieving donor management goals before deceased donor procurement is associated with more organs transplanted per donor. J Trauma 2011; 71: 990-5; discussion 996.CrossRef

Smith M. Physiologic changes during brain stem death–lessons for management of the organ donor. J Heart Lung Transplant 2004; 23(9 Suppl): S217-22.CrossRefPubMed

Floerchinger B, Oberhuber R, Tullius SG. Effects of brain death on organ quality and transplant outcome. Transplant Rev (Orlando) 2012; 26: 54-9.CrossRef

10.

Dhanani S, Shemie SD. Advancing the science of organ donor management. Crit Care 2014; 18: 612.CrossRefPubMedPubMedCentral

11.

Greer DM, Valenza F, Citerio G. Improving donor management and transplantation success: more research is needed. Intensive Care Med 2015; 41: 537-40.CrossRefPubMed

12.

D’Aragon F, Belley-Cote E, Agarwal A, et al. Effect of corticosteroid administration on neurologically deceased organ donors and transplant recipients: a systematic review and meta-analysis. BMJ Open 2017; 7: e014436.CrossRefPubMedPubMedCentral

13.

von Elm E, Altman DG, Egger M, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007; 335: 806-8.CrossRef

14.

Ferguson ND, Cook DJ, Guyatt GH, et al. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med 2013; 368: 795-805.CrossRefPubMed

15.

Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration 2011. Available from URL: http://handbook-5-1.cochrane.org/ (accessed April 2018).

16.

Canadian Institutes of Health Research; Natural Sciences and Engineering Research Council of Canada; Social Sciences and Humanities Research Council of Canada. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Government of Canada; 2014. Available from URL: http://www.frqs.gouv.qc.ca/documents/10191/186009/TCPS2.+pdf/6a8ab915-431b-428d-aa86-b22ca5c78053 (accessed April 2018).

17.

Tu JV, Willison DJ, Silver FL, et al. Impracticability of informed consent in the Registry of the Canadian Stroke Network. N Engl J Med 2004; 350: 1414-21.CrossRefPubMed

18.

Duan EH, Adhikari NK, D’Aragon F, et al. Management of acute respiratory distress syndrome and refractory hypoxemia. A multicenter observational study. Ann Am Thorac Soc 2017; 14: 1818-26.CrossRefPubMed

19.

Rabbat CG, Cook DJ, Crowther MA, et al. Dalteparin thromboprophylaxis for critically ill medical-surgical patients with renal insufficiency. J Crit Care 2005; 20: 357-63.CrossRefPubMed

20.

Mascia L, Pasero D, Slutsky AS, et al. Effect of a lung protective strategy for organ donors on eligibility and availability of lungs for transplantation: a randomized controlled trial. JAMA 2010; 304: 2620-7.CrossRefPubMed

21.

Koo KK, Sun JC, Zhou Q, et al. Pulmonary artery catheters: evolving rates and reasons for use. Crit Care Med 2011; 39: 1613-8.CrossRefPubMed

22.

Macdonald PS, Aneman A, Bhonagiri D, et al. A systematic review and meta-analysis of clinical trials of thyroid hormone administration to brain dead potential organ donors. Crit Care Med 2012; 40: 1635-44.CrossRefPubMed

23.

Dikdan GS, Mora-Esteves C, Koneru B. Review of randomized clinical trials of donor management and organ preservation in deceased donors: opportunities and issues. Transplantation 2012; 94: 425-41.CrossRefPubMed

Title: Hamilton-DONATE: a city-wide pilot observational study of the ICU management of deceased organ donors
Authors: Frederick D’Aragon, MD
Deborah Cook, MD
Sony Dhanani, MD
Christine Ribic, MD
Karen E. A. Burns, MD
Aemal Akhtar, MSc
Lori Hand, BSc
Erika Arseneau, MSc
Cynthia Cupido, MD
Heather Whittigham, MD
Andrew Healey, MD
Anne Julie Frenette, BPharm, MSc
François Lamontagne, MD
Maureen O. Meade, MD
for the Canadian Critical Care Trials Group and the Canadian National Transplant Research Program
Publication date: 01-10-2018
Publisher: Springer US
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 10/2018
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-018-1179-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Hamilton-DONATE: a city-wide pilot observational study of the ICU management of deceased organ donors

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

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