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Updated: Dec 22, 2025
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study
Frédérick D'Aragon1,2, Francois Lamontagne3,4, Deborah Cook5,6
1Department of Anesthesiology, Université de Sherbrooke, 2001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada. Frederick.DAragon@USherbrooke.ca.
Purpose:
Canadian donor management practices have not been reported. Our aim was to inform clinicians and other stakeholders about the range of current practices.
Methods:
This prospective observational cohort study enrolled consecutive, newly consented organ donors from August 1 2015 to July 31 2018 at 27 academic and five community adult intensive care units in British Columbia, Alberta, Ontario, and Quebec. Research staff prospectively recorded donor management data. Provincial organ donation organizations verified the organs donated. We formally compared practices across provinces.
Results:
Over a median collection period of eight months, 622 potential donors were classified at baseline as having neurologic determination of death (NDD donors; n = 403) or circulatory death (DCD donors; n = 219). Among NDD donors, 85.6% underwent apnea testing (rarely with carbon dioxide insufflation), 33.2% underwent ancillary testing, and subsequent therapeutic hypothermia (34-35°C) was rare. Neurologic determination of death donors were more hemodynamically unstable with most having received vasopressin and norepinephrine infusions, with a large majority having received high-dose corticosteroids and intravenous thyroxine. Among DCD donors, 61.6% received corticosteroids, and 8.9% received thyroxine. Most donors did not receive lung-protective ventilation strategies. Invasive procedures after donation consent included bronchoscopy (71.7%), cardiac catheterization (NDD donors only; 21.3%), and blood transfusions (19.3%). Physicians ordered intravenous antemortem heparin for 94.8% of DCD donors. The cohort donated 1,629 organs resulting in 1,532 transplants. Case selection, death determinations, and hormone, nutrition and heparin practices all varied across provinces.
Conclusion:
These study findings highlight areas for knowledge translation and further clinical research. Interprovincial discrepancies will likely pose unique challenges to national randomized trials.
Trial Registration:
www.clinicaltrials.gov (NCT03114436); registered 10 April, 2017.
Insights
Canadian organ donor management varies significantly by province, impacting potential for national research. Practices like hormone use and ventilation strategies differ, highlighting needs for standardization and further study.
Area of Science:
- Organ donation and transplantation research
- Critical care medicine
- Nephrology and urology
Background:
- Canadian organ donor management practices are not well-documented.
- Understanding current practices is crucial for improving organ donation rates and patient outcomes.
Purpose of the Study:
- To characterize the range of current organ donor management practices across Canadian provinces.
- To identify variations in practices that may impact clinical research and knowledge translation.
Main Methods:
- Prospective observational cohort study of consecutive organ donors from August 2015 to July 2018 in Canadian intensive care units.
- Data collected on donor classification (neurologic determination of death vs. circulatory death), management strategies, and invasive procedures.
- Practices were formally compared across provinces.
Main Results:
- Significant interprovincial variations observed in case selection, death determination, and the use of hormones, nutrition, and heparin.
- Most donors did not receive lung-protective ventilation; invasive procedures post-consent were common.
- Practices such as apnea testing, ancillary testing, and therapeutic hypothermia varied between neurologic determination of death and circulatory death donors.
Conclusions:
- Canadian organ donor management practices exhibit considerable interprovincial heterogeneity.
- Discrepancies in practices present challenges for conducting national randomized controlled trials.
- Findings underscore the need for knowledge translation and further clinical research to standardize care and optimize organ utilization.
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