PURPOSE: Variability has been reported in the practices to determine death by neurological criteria for adults and children. The objective of this study was to determine if this variability exists in the Canadian context. METHODS: A cross-sectional survey of the Canadian intensive care units (ICUs) involved in the care of potential organ donors, and Canadian organ procurement organizations (OPOs) was undertaken. We contacted the medical directors of these units and asked them to provide their guidelines for the neurological determination of death (NDD). A framework, which identifies key diagnostic criteria for NDD, was used to assess the content of all study documents. RESULTS: With a response rate of 68%, we found that key diagnostic criteria for NDD were incorporated inconsistently in the guidelines from Canadian ICUs and OPOs. Areas of concern include omissions in: the testing of brainstem reflexes; components of the apnea test; indications for the use of supplementary testing; wait intervals prior to performing the first NDD examination; the definition of NDD; and potential confounding factors. In addition, inconsistencies were found pertaining to wait intervals required between examinations and the legal timing of death. CONCLUSION: These findings reinforce the need to standardize the practice of the neurological determination of death in Canadian centres, which has the potential to reduce practice variation. Clear medical standards for NDD augment the quality, rigour and credibility of this determination.
PURPOSE: Variability has been reported in the practices to determine death by neurological criteria for adults and children. The objective of this study was to determine if this variability exists in the Canadian context. METHODS: A cross-sectional survey of the Canadian intensive care units (ICUs) involved in the care of potential organ donors, and Canadian organ procurement organizations (OPOs) was undertaken. We contacted the medical directors of these units and asked them to provide their guidelines for the neurological determination of death (NDD). A framework, which identifies key diagnostic criteria for NDD, was used to assess the content of all study documents. RESULTS: With a response rate of 68%, we found that key diagnostic criteria for NDD were incorporated inconsistently in the guidelines from Canadian ICUs and OPOs. Areas of concern include omissions in: the testing of brainstem reflexes; components of the apnea test; indications for the use of supplementary testing; wait intervals prior to performing the first NDD examination; the definition of NDD; and potential confounding factors. In addition, inconsistencies were found pertaining to wait intervals required between examinations and the legal timing of death. CONCLUSION: These findings reinforce the need to standardize the practice of the neurological determination of death in Canadian centres, which has the potential to reduce practice variation. Clear medical standards for NDD augment the quality, rigour and credibility of this determination.
Authors: Giuseppe Citerio; Marcelo Cypel; Geoff J Dobb; Beatriz Dominguez-Gil; Jennifer A Frontera; David M Greer; Alex R Manara; Sam D Shemie; Martin Smith; Franco Valenza; Eelco F M Wijdicks Journal: Intensive Care Med Date: 2016-01-11 Impact factor: 17.440
Authors: Joseph M Darby; Lori A Shutter; Jonathan Elmer; Mohammad Hirzallah; Namir Khandker; Bradley J Molyneaux; A Murat Kaynar; Karen R Nigra; Lawrence R Wechsler Journal: Neurol Clin Pract Date: 2021-02
Authors: Michaël Chassé; Peter Glen; Mary-Anne Doyle; Lauralyn McIntyre; Shane W English; Greg Knoll; Jean-François Lizé; Sam D Shemie; Claudio Martin; Alexis F Turgeon; François Lauzier; Dean A Fergusson Journal: Syst Rev Date: 2013-11-09
Authors: Ernest van Veen; Mathieu van der Jagt; Maryse C Cnossen; Andrew I R Maas; Inez D de Beaufort; David K Menon; Giuseppe Citerio; Nino Stocchetti; Wim J R Rietdijk; Jeroen T J M van Dijck; Erwin J O Kompanje Journal: Crit Care Date: 2018-11-16 Impact factor: 9.097