Death Prediction and Physiology after Removal of Therapy (DePPaRT) Study

The dying process is a natural part of life, and while difficult and sad, can also present opportunities for new beginnings through organ and tissue donation. When possible, the opportunity to donate organs after death should be integrated into good end of life care.  A growing number of organ donations in Canada are resulting from “donation after circulatory death” (DCD) a type of donation that can occur in situations where a person has no hope of recovery and life support therapy will be removed, but they do not meet stringent testing criteria for brain death. Physicians and the public are generally supportive of DCD, but ethical and logistical concerns continue to hinder its uptake. Some of these concerns include:

 

  • the inability to predict which donors will die within a time frame that enables them to proceed to donation,

  • the lack of consensus on the definition of circulatory death and how to diagnose it, and

  • disagreement about how long to wait, after circulation stops, before organ procurement can begin.

 

Each time delay increases the amount of time that organs remain without oxygen and risks the potential for organ damage. Currently the wait time to declare death and proceed to organ procurement is 5 minutes. However, some critics of DCD cite the possibility of autoresuscitation, or spontaneous resumption of circulation without intervention, as a reason to delay the time to organ procurement after arrest of circulation. Our team’s reviews of scientific literature have shown that current evidence is not sufficient to draw final conclusions on these controversies.

 

The Determination of Death Practices in Intensive Care Units (DDePICt) research program led by Dr. Sonny Dhanani from the Children's Hospital of Eastern Ontario and the University of Ottawa aims to provide much needed information about the physiology of death after withdrawal of life sustaining therapy in the ICU, helping to inform DCD practice in Canada and worldwide. The DDePICt research program is part of the Canadian Critical Care Trials Group and the Canadian National Transplant Research Program, as part of the Project to increase solid organ and hematopoietic cell donation (Project 2).  Core members of the DDePICt research program include: Sonny Dhanani, Sam Shemie, Laura Hornby, Amanda van Beinum and Nathan Scales.  

 

In 2014, the DDePICt team received funding as part of the Canadian National Transplant Research Program to carry out the observational study: “Death Prediction and Physiology after Removal of Therapy (DePPaRT)”. The DePPaRT study, which is currently underway, will recruit 500 patients at 13 sites across Canada, and several sites internationally including in the Czech Republic and the United Kingdom. The DePPaRT study will document the physiology of the dying process and, under the leadership of Dr. Jason Shahin from McGill University, will also aim to develop a tool that will allow doctors to predict how long it will take patients to die after the removal of life sustaining therapy. A qualitative component of the study let by Prof. Jennifer Chandler from the University of Ottawa will investigate the decision-making surrounding consent for organ donation and how family members felt when their loved ones became organ donors or were unable to proceed to donation. Results from both the quantitative and qualitative aspects of this study will inform DCD policy and practice and could lead to improvements in the uptake of the practice, both nationally and internationally. The DePPaRT study aims to address the shortage of available organs in Canada by first addressing directly our shortage of empirical knowledge about donation processes.

 

The team published the results of the original pilot study in Critical Care Medicine in 2014 (see reference below). The pilot study recruited 41 out of a goal of 45 patients, had a consent rate of 87%, and recorded 73% protocol compliance. The landmark pilot study was able to show feasibility of examining the natural history of the dying process following withdrawal of life sustaining therapies in Canadian ICUs by recording and analyzing the vital signs of dying patients.

 

For more information on the DePPaRT study or the DDePICt research program, please visit www.ddepict.com or contact Amanda van Beinum at avanbeinum (at) cheo.on.ca 

 

 

Pilot Study Publication: 

Dhanani S, Hornby L, Ward R, et al.: Vital Signs After Cardiac Arrest Following Withdrawal of Life-Sustaining Therapy: A Multicenter Prospective Observational Study. Crit Care Med 2014; 42:2358–2369 

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