Share this article on:

Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death—Summary Report*

Weiss, Matthew J. MD, FRCPC1,2,3; Hornby, Laura MSc3; Rochwerg, Bram MD, MSc, FRCPC4; van Manen, Michael MD, PhD, FRCPC5; Dhanani, ; Sonny MD, FRCPC6; Sivarajan, V. Ben MD, MSc, FRCPC7; Appleby, Amber RN, MM3; Bennett, Mary MD, FRCPC8; Buchman, Daniel MSW, PhD9; Farrell, Catherine MD, FRCPC10; Goldberg, Aviva MD, MA, FRCPC11; Greenberg, Rebecca RN, PhD12; Singh, Ram MD, FRCPC13; Nakagawa, Thomas A. MD, FAAP, FCCM14; Witteman, William MIS15; Barter, Jill MD, FRCPC16; Beck, Allon MD, FRCPC17; Coughlin, Kevin MD, MSHc, FRCPC18; Conradi, Alf MD, FRCPC19; Cupido, Cynthia MD, MSc, FRCPC20; Dawson, Rosanne LLB21; Dipchand, Anne MD, FRCPC22; Freed, Darren MD, PhD, FRCPC23; Hornby, Karen MSc3; Langlois, Valerie MD, FRCPC24; Mack, Cheryl MD, MA, FRCPC25; Mahoney, Meagan MD, FRCPC26; Manhas, Deepak MD, FRCPC27; Tomlinson, Christopher MD, FRCPC28; Zavalkoff, Samara MD, FRCPC29; Shemie, Sam D. MD, FRCPC3,30,31

doi: 10.1097/PCC.0000000000001320
Special Article

Objectives: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada.

Methods: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners.

Results: We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report.

Conclusions: This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation.

1Division of Pediatric Intensive Care, CHU de Quebec, Centre Mère-Enfant Soleil, Québec, QC, Canada.

2Department of Pediatrics, Université Laval Faculté de Médecine, Québec, QC, Canada.

3Canadian Blood Services Decreased Donation, Ottawa, ON, Canada.

4Department of Medicine & Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.

5Division of Neonatal Intensive Care, University of Alberta & Stollery Children’s Hospitals, Edmonton, AB, Canada.

6Division of Critical Care, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada.

7Division of Paediatric Cardiac Intensive Care Unit, University of Alberta & Stollery Children’s Hospitals, Edmonton, AB, Canada.

8Division of Critical Care, BC Children’s Hospital, Vancouver, BC, Canada.

9Bioethics Program, University Health Network, Toronto, ON, Canada.

10Critical Care Medicine, Département de pédiatrie, CHU Sainte-Justine, Montréal, QC, Canada.

11Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.

12Department of Bioethics, Hospital for Sick Children, Toronto, ON, Canada.

13Division of Paediatric Critical Care Medicine, Western University Children’s Hospital, London, ON, Canada.

14Division of Critical Care, Johns Hopkins All Children’s Hospital, St. Petersburg, FL.

15Information Specialist, Québec, QC, Canada.

16Division of Pediatric Intensive Care, Janeway Childrens Health and Rehabilitation Centre, St. Johns, NL, Canada.

17Division of Pediatric Intensive Care, Victoria General Hospital, Victoria, BC, Canada.

18Division of Neonatal Intensive Care, Children’s Hospital of the London Health Sciences Centre, London, ON, Canada.

19Division of Pediatric Intensive Care, University of Alberta & Stollery Children’s Hospitals, Edmonton, AB, Canada.

20Division of Pediatric Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada.

21Canadian Blood Services Legal Department, Ottawa, ON, Canada.

22Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada.

23Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, AB, Canada.

24Division of Nephrology, Hospital for Sick Children, Toronto, ON, Canada.

25Division of Pediatric Anesthesia, Stollery Children’s Hospital, Edmonton, AB, Canada.

26Division of Pediatric Intensive Care, Alberta Children’s Hospital, Calgary, AB, Canada.

27Division of Neonatal Intensive Care, BC Women’s Hospital + Health Centre, Vancouver, BC, Canada.

28Division of Neonatology, Hospital for Sick Children, Toronto, ON, Canada.

29Division of Critical Care, Montreal Children’s Hospital, McGill University Health Centre and Research Institute, Montréal, QC, Canada.

30Division of Critical Care, Montreal Children’s Hospital, McGill University Health Centre and Research Institute, Montréal, QC, Canada.

31Department of Pediatrics, McGill University, Montréal, QC, Canada.

*See also p. 1068.

This work was endorsed by the Canadian Paediatric Society, the Canadian Critical Care Society, the Canadian Association of Critical Care Nurses, and the Canadian Society of Transplantation.

This work was performed by Dr. Weiss in collaboration with the above authors at the CHU de Quebec, Centre Mère-Enfant Soleil, and the Université Laval, Québec, QC, Canada.

Financially supported by Canadian Blood Services. Funding from other sources reported by authors was for work outside of this particular project.

Dr. Weiss received funding from the Canadian Blood Services; he disclosed that he was recently nominated as medical director of Transplant Québec, a governmental nonprofit organ donation organization; and he disclosed government work. Dr. Hornby received funding from the Canadian Blood Services (paid research consultant and was paid for a portion of the work on this project). Dr. Sivarajan received funding from the Canadian Blood Services (hotel/travel for consensus meeting for guideline development) and from the Ontario Trillium Gift of Life Network (stipend paid for his role as hospital donation physician as part of provincial program). Dr. Appleby received funding from the Canadian Blood Services (employee where part of her paid time was spent supporting this work; sponsored travel and meeting costs associated with the face to face meetings). Dr. Farrell received funding from the Canadian Blood Services (payments made to defray travel expenses for attendance at two plenary meetings to plan the work and prepare the major portion of the article), Centre de soins de santé et de services sociaux des Laurentides (honorarium for lecture at a conference on head trauma organized by the health authority in May 2015), CHU Sainte-Justine Honorarium (lecture given during a Continuing Medical Education conference [Pédiatrie Plus] held outside the hospital, in November 2016), and the Canadian Paediatric Society (member of the Executive and Board of Directors of the Society, and a portion of her travel expenses are paid for attendance at Board meetings); and she disclosed that she is a designated organ donation physician specialist for her institution, and she works closely with Transplant-Québec. Dr. Goldberg received funding from the Canadian Blood Services (funding for travel to meetings for preparation of the article). Dr. Nakagawa received funding from UpToDate, and he disclosed that he is the Assistant Medical Director for Carolina Donor Services in Durham, NC. Dr. Barter received funding from Canadian Blood Services provided support for transportation to a meeting in October 2015 to commence the process of writing these guidelines. Dr. Dawson received funding from Canadian Blood Services (employer), and she disclosed work for hire. Dr. Dipchand’s institution received funding from the National Institutes of Health/National Institute of Allergy and Infectious Diseases. Dr. Hornby received funding the Canadian Blood Services. Dr. Langlois’ institution received funding from Astella Pharma Canada for a grant not related to the submitted work. Dr. Mack received funding for travel from the Canadian Blood Services. Dr. Mahoney received funding from the Canadian Blood Services. Dr. Shemie disclosed that he is a medical advisor for deceased organ donation at Canadian Blood Services, and he disclosed government work. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Matthew J. Weiss, Département de pédiatrie Centre Mère-Enfant Soleil du CHU de Québec 2705 boul Laurier Local R1735 Québec, QC G1V 4G2; and Canadian Blood Services, Deceased Donation, 1800 Alta Vista Drive Ottawa, Ontario, K1G 4J5. E-mail: matthew-john.weiss@mail.chudequebec.ca

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies