Kimberly Young

Organ donor management in Canada: recommendations of the forum on Medical Management to Optimize Donor Organ Potential

In collaboration with the Canadian Critical Care Society, the Canadian Association of Transplantation and the Canadian Society of Transplantation, the Canadian Council for Donation and Transplantation (CCDT) sponsored a forum entitled „Medical Management to Optimize Donor Organ Potential,” 23–

International guideline development for the determination of death.

Introduction and MethodsThis report summarizes the results of the first phase in the development of international guidelines for death determination, focusing on the biology of death and the dying process, developed by an invitational forum of international content experts and representatives of a number of professional societies.Results and ConclusionsPrecise terminology was developed in order to improve clarity in death discussion and debate. Critical events in the physiological sequences leading to cessation of neurological and/or circulatory function were constructed. It was agreed that death determination is primarily clinical and recommendations for preconditions, confounding factors, minimum clinical standards and additional testing were made. A single operational definition of human death was developed: ‘the permanent loss of capacity for consciousness and all brainstem functions, as a consequence of permanent cessation of circulation or catastrophic brain injury’. In order to complete the project, in the next phase, a broader group of international stakeholders will develop clinical practice guidelines, based on comprehensive reviews and grading of the existing evidence.

The critical pathway for deceased donation: reportable uniformity in the approach to deceased donation

The critical pathway of deceased donation provides a systematic approach to the organ donation process, considering both donation after cardiac death than donation after brain death. The pathway provides a tool for assessing the potential of deceased donation and for the prospective identification and referral of possible deceased donors.

Worldwide variability in deceased organ donation registries

The variability in deceased organ donation registries worldwide has received little attention. We considered all operating registries, where individual wishes about organ donation were recorded in a computerized database. We included registries which recorded an individual’s decision to be a donor (donor registry), and registries which only recorded an individual’s objection (non‐donor registry). We collected information on 15 characteristics including history, design, use and number of registrants for 27 registries (68%). Most registries are nationally operated and government‐owned. Registrations in five nations expire and require renewal. Some registries provide the option to make specific organ selections in the donation decision. Just over half of donor registries provide legally binding authorization to donation. In all national donor registries, except one, the proportion of adults (15+) registered is modest (<40%). These proportions can be even lower when only affirmative decisions are considered. One nation provides priority status on the transplant waiting list as an incentive to affirmative registration, while another nation makes registering a donation decision mandatory to obtain a driver’s license. Registered objections in non‐donor registries are rare (<0.5%). The variation in organ donor registries worldwide necessitates public discourse and quality improvement initiatives, to identify and support leading practices in registry use.

Organ Donation and Transplantation in Canada: Insights from the Canadian Organ Replacement Register

Purpose of reviewTo provide an overview of the transplant component of the Canadian Organ Replacement Register (CORR).FindingsCORR is the national registry of organ failure in Canada. It has existed in some form since 1972 and currently houses data on patients with end-stage renal disease and solid organ transplants (kidney and/or non-kidney). The transplant component of CORR receives data on a voluntary basis from individual transplant centres and organ procurement organizations across the country. Coverage for transplant procedures is comprehensive and complete. Long-term outcomes are tracked based on follow-up reports from participating transplant centres. The longitudinal nature of CORR provides an opportunity to observe the trajectory of a patient’s journey with organ failure over their life span. Research studies conducted using CORR data inform both practitioners and health policy makers alike.ImplicationsThe importance of registry data in monitoring and improving care for Canadian transplant candidates/recipients cannot be over-stated. This paper provides an overview of the transplant data in CORR including its history, data considerations, recent findings, new initiatives, and future directions.ABRÉGÉBut de la revueOffrir un aperçu du volet « transplantation d’organes » du Registre canadien des insuffisances et des transplantations d’organes (RCITO).RésultatsLe RCITO est le Registre canadien des insuffisances d’organes au Canada. Il a commencé à prendre forme en 1972, et contient à l’heure actuelle des données sur des patients atteints de néphropathie terminale et sur des transplantations (rénales ou non rénales) d’organes pleins. Le volet « transplantation d’organes » du RCITO collige des données qui ont été envoyées, sur une base volontaire, par des centres de transplantation et des services d’approvisionnement en organes à travers le pays. Le Registre offre une couverture exhaustive et complète des différentes interventions de transplantation. Les résultats à long terme sont retracés à partir de rapports de rendez-vous de suivi des centres de transplantation participants. L’ampleur longitudinale du RCITO offre la possibilité d’observer le parcours, tout au long de sa vie, du patient atteint d’une insuffisance organique. Les études produites à partir des données du RCITO éclairent à la fois les praticiens et les décideurs du domaine de la santé.ImplicationsOn ne peut surestimer l’importance des données du Registre lorsqu’il s’agit d’effectuer le suivi des candidats canadiens potentiels à une transplantation, ou d’améliorer les soins qui leur sont offerts.Cette revue offre un aperçu des données du RCITO qui se rapportent à la transplantation d’organes, dont : l’historique, les éléments à considérer sur les données, des résultats récents, de nouvelles initiatives et les orientations futures.

Unrelated donor choices for allogeneic hematopoietic cell transplantation in Canada: an evaluation of factors influencing donor selection: DONOR SELECTION AND ONEMATCH

Utilization of unrelated donors and cord blood units (CBUs) for allogeneic hematopoietic cell transplantation continues to increase. Understanding the practices of donor selection by transplant centers is critical for unrelated donor registries and cord blood banks to optimize registry composition and inventory to meet patient need.

Cryopreservation of adult unrelated donor products in hematopoietic cell transplantation: the OneMatch experience and systematic review of the literature

The frequency of cryopreserving blood stem or progenitor products from unrelated donors is not known and the underlying reasons are poorly documented. Greater insight is needed to develop policies on cryopreservation that balance donor safety with patient needs.

Improving organ donation in Canada.

The Canadian Council for Donation and Transplantation (CCDT) agrees with some of the issues raised by Wayne Kondro.[1][1] There is indeed fragmentation in the organization of the organ and tissue donation and transplantation system in Canada, and Canadian donation rates are a concern. We know that