Abstract
Purpose
Variability has been reported in the practices to determine death by neurological criteria for adults and children. The objective of this study was to determine if this variability exists in the Canadian context.
Methods
A cross-sectional survey of the Canadian intensive care units (ICUs) involved in the care of potential organ donors, and Canadian organ procurement organizations (OPOs) was undertaken. We contacted the medical directors of these units and asked them to provide their guidelines for the neurological determination of death (NDD). A framework, which identifies key diagnostic criteria for NDD, was used to assess the content of all study documents.
Results
With a response rate of 68%, we found that key diagnostic criteria for NDD were incorporated inconsistently in the guidelines from Canadian ICUs and OPOs. Areas of concern include omissions in: the testing of brainstem reflexes; components of the apnea test; indications for the use of supplementary testing; wait intervals prior to performing the first NDD examination; the definition of NDD; and potential confounding factors. In addition, inconsistencies were found pertaining to wait intervals required between examinations and the legal timing of death.
Conclusion
These findings reinforce the need to standardize the practice of the neurological determination of death in Canadian centres, which has the potential to reduce practice variation. Clear medical standards for NDD augment the quality, rigour and credibility of this determination.
Résumé
Objectif
Une variabilité a été rapportée dans les pratiques de détermination de la mort par des critères neurologiques chez les adultes et les enfants. Notre objectif était de vérifier si cette variabilité existe dans le contexte canadien.
Méthode
Une enquête transversale a été entreprise auprès ďunités de soins intensifs (USI) canadiennes, impliquées dans les soins à de potentiels donneurs ďorganes, et de services canadiens ďapprovisionnement en organes (SAO). Nous avons demandé aux directeurs de ces unités de fournir leurs directives pour le diagnostic du décès neurologique (DDN). Un cadre de travail, qui désigne les critères diagnostiques clés du DDN, a été utilisé pour évaluer le contenu de tous les documents de ľétude.
Résultats
Nous avons appris, avec 68 % de répondants, que les critères diagnostiques pour le DDN étaient incorporés de façon irrégulière dans les directives des USI et des SAO canadiens. Les aspects préoccupants relevés étaient des omissions dans les tests de réflexes du tronc cérébral, des composantes du test ďapnée, des indications de ľusage de tests supplémentaires, les délais avant le premier examen du DDN, la définition du DDN et des facteurs de confusion possibles. De plus, il y avait des incohérences relatives aux délais requis entre les examens et la détermination légale de ľheure de la mort.
Conclusion
Ces résultats renforcent la nécessité de normaliser la pratique de détermination neurologique de la mort dans les centres canadiens, ce qui pourrait réduire la variation de la pratique. Des normes médicales claires pour le DDN augmentent la qualité, la rigueur et la crédibilité de la constatation de la mort.
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Hornby, K., Shemie, S.D., Teitelbaum, J. et al. Variability in hospital-based brain death guidelines in Canada. Can J Anesth 53, 613–619 (2006). https://doi.org/10.1007/BF03021854
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DOI: https://doi.org/10.1007/BF03021854