PURPOSE Donation after circulatory determination of death (DCD) has been performed in Canada since 2006. Numerous aspects of donor management remain controversial. METHODS We performed a multicentre cohort study involving potential DCD donors in western Canada (2008-2017), as well as recipients of their organs, to describe donor characteristics and critical care practices, and their relation to one-year recipient and graft survival. RESULTS There were 257 patients in four provinces that underwent withdrawal of life-sustaining therapies (WLST) in anticipation of possible DCD. The proportion of patients that died within two hours of WLST ranged from 67% to 88% across provinces (P = 0.06), and was predicted by deeper coma (P = 0.01), loss of pupillary light or corneal reflexes (P = 0.02), and vasopressor use (P = 0.01). There were significant differences between provinces in time intervals from onset of hypotension to death (9-11 min; P = 0.02) and death to vascular cannulation (7-10 min; P < 0.001). There was inconsistency in pre-mortem heparin administration (82-96%; P = 0.03), including timing (before vs after WLST; P < 0.001) and dose (≥ 300 vs < 300 units·kg-1; P < 0.001). Donation after circulatory death provided organs for 321 kidney, 81 liver, and 50 lung transplants. One-year recipient and graft survival did not differ among provinces (range 85-90%, P = 0.45). Predictors of death or graft failure included older recipient age (odds ratio [OR] per year, 1.04; 95% confidence interval [CI],1.01 to 1.07) and male donor sex (OR, 3.35; 95% CI, 1.39 to 8.09), but not time intervals between WLST and cannulation or practices related to heparin use. CONCLUSION There is significant variability in critical care DCD practices in western Canada, but this has not resulted in significant differences in recipient or graft survival. Further research is required to guide optimal management of potential DCD donors.

中文翻译：

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加拿大西部循环死亡后的捐赠：捐赠者特征和重症监护实践的多中心研究。


目的 加拿大自 2006 年起开始进行循环死亡后捐献 (DCD)。捐献者管理的许多方面仍然存在争议。方法 我们进行了一项多中心队列研究，涉及加拿大西部的潜在 DCD 捐献者（2008-2017 年）及其器官接受者，以描述捐献者特征和重症监护实践，以及它们与一年接受者和移植物存活的关系。结果 四个省份的 257 名患者因预期可能发生 DCD 而接受了生命维持治疗 (WLST) 的撤药。 WLST 两小时内死亡的患者比例各省范围从 67% 到 88% 不等 (P = 0.06)，并通过深度昏迷 (P = 0.01)、瞳孔对光或角膜反射丧失 (P = 0.02) 来预测和血管加压药的使用（P = 0.01）。从发生低血压到死亡的时间间隔（9-11分钟；P = 0.02）和死亡到血管插管的时间间隔（7-10分钟；P < 0.001）各省之间存在显着差异。死前肝素给药存在不一致（82-96%；P = 0.03），包括时间（WLST 之前与之后；P < 0.001）和剂量（≥ 300 vs < 300 单位·kg-1；P < 0.001） 。循环死亡后的捐赠为 321 例肾脏、81 例肝脏和 50 例肺移植提供了器官。各省之间的一年受者存活率和移植物存活率没有差异（范围 85-90%，P = 0.45）。死亡或移植失败的预测因素包括受者年龄较大（每年比值比 [OR]，1.04；95% 置信区间 [CI]，1.01 至 1.07）和男性供体性别（OR，3.35；95% CI，1.39 至 8.09） ，但不是 WLST 与插管或与肝素使用相关的实践之间的时间间隔。 结论 加拿大西部的重症监护 DCD 实践存在显着差异，但这并未导致受者或移植物存活率出现显着差异。需要进一步的研究来指导潜在 DCD 捐赠者的最佳管理。