P.169: Canada-DONATE: Preliminary results from a mutlicentre prospective observational study.

Abstract

On behalf of the Canadian Critical Care Trials Group and. the Canadian Donation and Transplant Research Program. Background: Canadian donor management practices have not been reported. Our aim was to inform clinicians and other stakeholders about the range of current practices. Methods: We consecutively enrolled all consented adult deceased organ donors [donation after neurological determination of death (DND) and donation after circulatory determination of death (DCD)] in 32 participating hospitals across Canada, utilizing a waiver of research consent,. Research staff prospectively recorded detailed data from various hospital sources included death determination procedures, cardiopulmonary monitoring technologies, general prophylactic interventions, organ donation specific therapies and clinical complications, defined a priori, from one day prior to donation consent up to the time of organ recovery. Organ Donation Organizations provided reasons of organ decline, date, time and location of transplant procedure, and recipient age and sex. We formally compared practices across multiple provinces. Results: From August 2015 to August 2018, we screened 641 potential donors and enrolled 622, classified at baseline as having a neurological death (NDD donors; 403) or imminent circulatory death (DCD donors; 219). Mean age was 51.5 ± 16.6 and 40.0% were female. The most prevalent diagnoses leading to organ donation were anoxic brain injury (34.4%), brain hemorrhage (30.1%), brain trauma (23.6%), and stroke (6.6%). The mean time from donation consent to organ retrieval was similarly 1.6 days (±0.7SD) among NDD and DCD donors who ultimately donated organs. NDD donors, were more hemodynamically unstable: most received vasopressin and norepinephrine infusions, and a large majority received high-dose corticosteroids and intravenous thyroxine. Among DCD donors, 61.6% received corticosteroids, and 8.9% received thyroxine. Most donors (NDD and DCD) did not receive lung-protective tidal volumes or end expiratory pressures. Nutrition was generally continued for DCD donors, and discontinued for NDD donors. Case selection, death determinations, hormone, nutrition and heparin therapies all varied significantly across provinces. Conclusions: Study findings highlight areas for knowledge translation. Interprovincial discrepancies will pose unique challenges to national randomized trials.