• Frédérick D'Aragon, Francois Lamontagne, Deborah Cook, Sonny Dhanani, Sean Keenan, Michaël Chassé, Shane English, BurnsKaren E AKEAInterdepartmental 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, Ian Ball, John Gordon Boyd, Marie-Hélène Masse, Ruth Breau, Aemal Akhtar, Andreas Kramer, Bram Rochwerg, François Lauzier, Demetrios James Kutsogiannis, Quazi Ibrahim, Lori Hand, Qi Zhou, Maureen O Meade, and Canadian Critical Care Trials Group and the Canadian Donation and Transplant Research Program.
• Department of Anesthesiology, Université de Sherbrooke, 2001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada. Frederick.DAragon@USherbrooke.ca.
• Can J Anaesth. 2020 Aug 1; 67 (8): 9921004992-1004.

PurposeCanadian donor management practices have not been reported. Our aim was to inform clinicians and other stakeholders about the range of current practices.MethodsThis 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.ResultsOver 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.ConclusionThese study findings highlight areas for knowledge translation and further clinical research. Interprovincial discrepancies will likely pose unique challenges to national randomized trials.Trial Registrationwww.clinicaltrials.gov (NCT03114436); registered 10 April, 2017.

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