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Heart donation and transplantation after circulatory determination of death: expert guidance from a Canadian consensus building process
Controlled donation after circulatory determination of death (DCD), where death is determined after cardiac arrest, has been responsible for the largest quantitative increase in Canadian organ donation and transplants, but not for heart transplants. Innovative international advances in DCD heart tra...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035095/ https://www.ncbi.nlm.nih.gov/pubmed/33543427 http://dx.doi.org/10.1007/s12630-021-01926-2 |
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author | Shemie, Sam D. Torrance, Sylvia Wilson, Lindsay Hornby, Laura MacLean, Janet Mohr, Jim Gillrie, Clay Badiwala, Mitesh V. Baker, Andrew Freed, Darren H. Simpson, Christy Teitelbaum, Jeanne Brodrecht, Diana Healey, Andrew |
author_facet | Shemie, Sam D. Torrance, Sylvia Wilson, Lindsay Hornby, Laura MacLean, Janet Mohr, Jim Gillrie, Clay Badiwala, Mitesh V. Baker, Andrew Freed, Darren H. Simpson, Christy Teitelbaum, Jeanne Brodrecht, Diana Healey, Andrew |
author_sort | Shemie, Sam D. |
collection | PubMed |
description | Controlled donation after circulatory determination of death (DCD), where death is determined after cardiac arrest, has been responsible for the largest quantitative increase in Canadian organ donation and transplants, but not for heart transplants. Innovative international advances in DCD heart transplantation include direct procurement and perfusion (DPP) and normothermic regional perfusion (NRP). After death is determined, DPP involves removal and reanimation of the arrested heart on an ex situ organ perfusion system. Normothermic regional perfusion involves surgically interrupting (ligating the aortic arch vessels) brain blood flow after death determination, followed by restarting the heart and circulation in situ using extracorporeal membrane oxygenation. The objectives of this Canadian consensus building process by a multidisciplinary group of Canadian stakeholders were to review current evidence and international DCD heart experience, comparatively evaluate international protocols with existing Canadian medical, legal, and ethical practices, and to discuss implementation barriers. Review of current evidence and international experience of DCD heart donation (DPP and NRP) determined that DCD heart donation could be used to provide opportunities for more heart transplants in Canada, saving additional lives. Although candid discussion identified a number of potential barriers and challenges for implementing DCD heart donation in Canada, it was determined that DPP implementation is feasible (pending regulatory approval for the use of an ex situ perfusion device in humans) and in alignment with current medical guidelines for DCD. Nevertheless, further work is required to evaluate the consistency of NRP with current Canadian death determination policy and to ensure the absence of brain perfusion during this process. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s12630-021-01926-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-8035095 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-80350952021-04-27 Heart donation and transplantation after circulatory determination of death: expert guidance from a Canadian consensus building process Shemie, Sam D. Torrance, Sylvia Wilson, Lindsay Hornby, Laura MacLean, Janet Mohr, Jim Gillrie, Clay Badiwala, Mitesh V. Baker, Andrew Freed, Darren H. Simpson, Christy Teitelbaum, Jeanne Brodrecht, Diana Healey, Andrew Can J Anaesth Reports of Original Investigations Controlled donation after circulatory determination of death (DCD), where death is determined after cardiac arrest, has been responsible for the largest quantitative increase in Canadian organ donation and transplants, but not for heart transplants. Innovative international advances in DCD heart transplantation include direct procurement and perfusion (DPP) and normothermic regional perfusion (NRP). After death is determined, DPP involves removal and reanimation of the arrested heart on an ex situ organ perfusion system. Normothermic regional perfusion involves surgically interrupting (ligating the aortic arch vessels) brain blood flow after death determination, followed by restarting the heart and circulation in situ using extracorporeal membrane oxygenation. The objectives of this Canadian consensus building process by a multidisciplinary group of Canadian stakeholders were to review current evidence and international DCD heart experience, comparatively evaluate international protocols with existing Canadian medical, legal, and ethical practices, and to discuss implementation barriers. Review of current evidence and international experience of DCD heart donation (DPP and NRP) determined that DCD heart donation could be used to provide opportunities for more heart transplants in Canada, saving additional lives. Although candid discussion identified a number of potential barriers and challenges for implementing DCD heart donation in Canada, it was determined that DPP implementation is feasible (pending regulatory approval for the use of an ex situ perfusion device in humans) and in alignment with current medical guidelines for DCD. Nevertheless, further work is required to evaluate the consistency of NRP with current Canadian death determination policy and to ensure the absence of brain perfusion during this process. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s12630-021-01926-2) contains supplementary material, which is available to authorized users. Springer International Publishing 2021-02-05 2021 /pmc/articles/PMC8035095/ /pubmed/33543427 http://dx.doi.org/10.1007/s12630-021-01926-2 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Reports of Original Investigations Shemie, Sam D. Torrance, Sylvia Wilson, Lindsay Hornby, Laura MacLean, Janet Mohr, Jim Gillrie, Clay Badiwala, Mitesh V. Baker, Andrew Freed, Darren H. Simpson, Christy Teitelbaum, Jeanne Brodrecht, Diana Healey, Andrew Heart donation and transplantation after circulatory determination of death: expert guidance from a Canadian consensus building process |
title | Heart donation and transplantation after circulatory determination of death: expert guidance from a Canadian consensus building process |
title_full | Heart donation and transplantation after circulatory determination of death: expert guidance from a Canadian consensus building process |
title_fullStr | Heart donation and transplantation after circulatory determination of death: expert guidance from a Canadian consensus building process |
title_full_unstemmed | Heart donation and transplantation after circulatory determination of death: expert guidance from a Canadian consensus building process |
title_short | Heart donation and transplantation after circulatory determination of death: expert guidance from a Canadian consensus building process |
title_sort | heart donation and transplantation after circulatory determination of death: expert guidance from a canadian consensus building process |
topic | Reports of Original Investigations |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035095/ https://www.ncbi.nlm.nih.gov/pubmed/33543427 http://dx.doi.org/10.1007/s12630-021-01926-2 |
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