Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study.

Variabilité des soins prodigués aux donneurs décédés au Canada : un compte rendu de l’étude de cohorte Canada-DONATE.
Adult British Columbia Humans Ontario Prospective Studies Tissue Donors Tissue and Organ Procurement

Journal

Canadian journal of anaesthesia = Journal canadien d'anesthesie
ISSN: 1496-8975
Titre abrégé: Can J Anaesth
Pays: United States
ID NLM: 8701709

Informations de publication

Date de publication:
08 2020
Historique:
received: 31 12 2019
accepted: 06 03 2020
revised: 06 03 2020
pubmed: 10 5 2020
medline: 20 2 2021
entrez: 10 5 2020
Statut: ppublish

Résumé

Canadian donor management practices have not been reported. Our aim was to inform clinicians and other stakeholders about the range of current practices. 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. 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. These study findings highlight areas for knowledge translation and further clinical research. Interprovincial discrepancies will likely pose unique challenges to national randomized trials. www.clinicaltrials.gov (NCT03114436); registered 10 April, 2017. RéSUMé: OBJECTIF: Les pratiques canadiennes de prise en charge des donneurs n’ont pas été rapportées. Notre objectif était d’informer les cliniciens et autres parties intéressées quant à l’éventail des pratiques actuelles. MéTHODE: Cette étude de cohorte observationnelle et prospective a recruté des donneurs d’organes consécutifs ayant récemment consenti au don entre le 1

Autres résumés

Type: Publisher (fre)
RéSUMé: OBJECTIF: Les pratiques canadiennes de prise en charge des donneurs n’ont pas été rapportées. Notre objectif était d’informer les cliniciens et autres parties intéressées quant à l’éventail des pratiques actuelles. MéTHODE: Cette étude de cohorte observationnelle et prospective a recruté des donneurs d’organes consécutifs ayant récemment consenti au don entre le 1

Identifiants

DOI: 10.1007/s12630-020-01692-7 PMID: 32385825
pubmed: 32385825
doi: 10.1007/s12630-020-01692-7
pii: 10.1007/s12630-020-01692-7
doi:

Banques de données

ClinicalTrials.gov
['NCT03114436']

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

992-1004

Subventions

Organisme : CIHR
ID : FRN94829
Pays : Canada

Références

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Auteurs

Frédérick D'Aragon (F)

Department of Anesthesiology, Université de Sherbrooke, 2001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada. Frederick.DAragon@USherbrooke.ca.
Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC, Canada. Frederick.DAragon@USherbrooke.ca.
ORCID: 0000-0003-1323-0449

Francois Lamontagne (F)

Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada.

Deborah Cook (D)

Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada.

Sonny Dhanani (S)

Division of Critical Care, Department of Pediatrics, Children's Hospital of Eastern, Ontario University of Ottawa, Ottawa, ON, Canada.

Sean Keenan (S)

Department of Critical Care, University of British Columbia, Vancouver, BC, Canada.
BC Transplant, Vancouver, BC, Canada.

Michaël Chassé (M)

Department of Medicine (Critical Care), Université de Montreal, Montreal, QC, Canada.

Shane English (S)

Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Ottawa Hospital Research Institute, Ottawa, ON, Canada.

Karen E A Burns (KEA)

Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.

Anne Julie Frenette (AJ)

Pharmacy faculty, Université de Montreal, Montreal, QC, Canada.
Hôpital Sacre-Coeur de Montreal, Montreal, QC, Canada.

Ian Ball (I)

Department of Medicine, Western University, London, ON, Canada.
Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.

John Gordon Boyd (JG)

Department of Medicine (Neurology), Queen's University, Kingston, ON, Canada.
Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.

Marie-Hélène Masse (MH)

Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC, Canada.

Ruth Breau (R)

Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada.

Aemal Akhtar (A)

Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada.

Andreas Kramer (A)

Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.

Bram Rochwerg (B)

Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada.

François Lauzier (F)

Population Health and Optimal Health Practice Research Unit, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada.
Departments of Medicine, Université Laval, Quebec City, QC, Canada.

Demetrios James Kutsogiannis (DJ)

Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.

Quazi Ibrahim (Q)

Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada.

Lori Hand (L)

Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada.

Qi Zhou (Q)

Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada.

Maureen O Meade (MO)

Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Variability in deceased donor care in Canada:...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Colombie-Britannique › Variability in deceased donor care in Canada:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Variability in deceased donor care in Canada:...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Ontario › Variability in deceased donor care in Canada:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Variability in deceased donor care in Canada:...
questionsmedicales.fr › Personnes › Donneurs de tissus › Variability in deceased donor care in Canada:...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Acquisition d'organes et de tissus › Variability in deceased donor care in Canada:...