Frédérick D'Aragon1,2, Francois Lamontagne3,4, Deborah Cook5,6, Sonny Dhanani7, Sean Keenan8,9, Michaël Chassé10, Shane English11,12, Karen E A Burns13,14, Anne Julie Frenette15,16, Ian Ball17,18, John Gordon Boyd19,20, Marie-Hélène Masse3, Ruth Breau6, Aemal Akhtar6, Andreas Kramer21, Bram Rochwerg5,6, François Lauzier22,23, Demetrios James Kutsogiannis24, Quazi Ibrahim6, Lori Hand6, Qi Zhou6, Maureen O Meade5,6. 1. Department of Anesthesiology, Université de Sherbrooke, 2001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada. Frederick.DAragon@USherbrooke.ca. 2. Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC, Canada. Frederick.DAragon@USherbrooke.ca. 3. Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC, Canada. 4. Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada. 5. Department of Medicine, McMaster University, Hamilton, ON, Canada. 6. Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada. 7. Division of Critical Care, Department of Pediatrics, Children's Hospital of Eastern, Ontario University of Ottawa, Ottawa, ON, Canada. 8. Department of Critical Care, University of British Columbia, Vancouver, BC, Canada. 9. BC Transplant, Vancouver, BC, Canada. 10. Department of Medicine (Critical Care), Université de Montreal, Montreal, QC, Canada. 11. Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 12. Ottawa Hospital Research Institute, Ottawa, ON, Canada. 13. Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. 14. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 15. Pharmacy faculty, Université de Montreal, Montreal, QC, Canada. 16. Hôpital Sacre-Coeur de Montreal, Montreal, QC, Canada. 17. Department of Medicine, Western University, London, ON, Canada. 18. Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. 19. Department of Medicine (Neurology), Queen's University, Kingston, ON, Canada. 20. Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada. 21. Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada. 22. Population Health and Optimal Health Practice Research Unit, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada. 23. Departments of Medicine, Université Laval, Quebec City, QC, Canada. 24. Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.
Abstract
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.
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.
Authors: Ian M Ball; Laura Hornby; Bram Rochwerg; Matthew J Weiss; Clay Gillrie; Michaël Chassé; Frederick D'Aragon; Maureen O Meade; Karim Soliman; Aadil Ali; Samantha Arora; John Basmaji; J Gordon Boyd; Bernard Cantin; Prosanto Chaudhury; Marcelo Cypel; Darren Freed; Anne Julie Frenette; Pam Hruska; Constantine J Karvellas; Sean Keenan; Andreas Kramer; Demetrios James Kutsogiannis; Dale Lien; Patrick Luke; Meagan Mahoney; Jeffrey M Singh; Lindsay C Wilson; Alissa Wright; Jeffrey Zaltzman; Sam D Shemie Journal: CMAJ Date: 2020-04-06 Impact factor: 8.262
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Authors: Nicholas Murphy; Charles Weijer; Jennifer Chandler; Frédérick D'Aragon; Andrew Healey; Matthew J Weiss; Marat Slessarev Journal: Can J Anaesth Date: 2022-07-13 Impact factor: 6.713
Authors: Daniel Oehler; Charlotte Böttger; Moritz Benjamin Immohr; Raphael Romano Bruno; Jafer Haschemi; Daniel Scheiber; Patrick Horn; Hug Aubin; Igor Tudorache; Ralf Westenfeld; Payam Akhyari; Malte Kelm; Artur Lichtenberg; Udo Boeken Journal: Life (Basel) Date: 2022-07-14
Authors: Frederick D'Aragon; Olivier Lachance; Vincent Lafleur; Ivan Ortega-Deballon; Marie-Helene Masse; Gabrielle Trepanier; Daphnee Lamarche; Marie-Claude Battista Journal: Open Access Emerg Med Date: 2022-08-05