Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death-Summary Report.
Matthew J Weiss, Laura Hornby, Bram Rochwerg, Michael van Manen, Sonny Dhanani, V Ben Sivarajan, Amber Appleby, Mary Bennett, Daniel Buchman, Catherine Farrell, Aviva Goldberg, Rebecca Greenberg, Ram Singh, Thomas A Nakagawa, William Witteman, Jill Barter, Allon Beck, Kevin Coughlin, Alf Conradi, Cynthia Cupido, Rosanne Dawson, Anne Dipchand, Darren Freed, Karen Hornby, Valerie Langlois, Cheryl Mack, Meagan Mahoney, Deepak Manhas, Christopher Tomlinson, Samara Zavalkoff, Sam D Shemie
Author Information
Matthew J Weiss: 1Division of Pediatric Intensive Care, CHU de Quebec, Centre Mère-Enfant Soleil, Québec, QC, Canada.2Department of Pediatrics, Université Laval Faculté de Médecine, Québec, QC, Canada.3Canadian Blood Services Decreased Donation, Ottawa, ON, Canada.4Department of Medicine & Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.5Division of Neonatal Intensive Care, University of Alberta & Stollery Children's Hospitals, Edmonton, AB, Canada.6Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.7Division of Paediatric Cardiac Intensive Care Unit, University of Alberta & Stollery Children's Hospitals, Edmonton, AB, Canada.8Division of Critical Care, BC Children's Hospital, Vancouver, BC, Canada.9Bioethics Program, University Health Network, Toronto, ON, Canada.10Critical Care Medicine, Département de pédiatrie, CHU Sainte-Justine, Montréal, QC, Canada.11Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.12Department of Bioethics, Hospital for Sick Children, Toronto, ON, Canada.13Division of Paediatric Critical Care Medicine, Western University Children's Hospital, London, ON, Canada.14Division of Critical Care, Johns Hopkins All Children's Hospital, St. Petersburg, FL.15Information Specialist, Québec, QC, Canada.16Division of Pediatric Intensive Care, Janeway Childrens Health and Rehabilitation Centre, St. Johns, NL, Canada.17Division of Pediatric Intensive Care, Victoria General Hospital, Victoria, BC, Canada.18Division of Neonatal Intensive Care, Children's Hospital of the London Health Sciences Centre, London, ON, Canada.19Division of Pediatric Intensive Care, University of Alberta & Stollery Children's Hospitals, Edmonton, AB, Canada.20Division of Pediatric Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada.21Canadian Blood Services Legal Department, Ottawa, ON, Canada.22Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada.23Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, AB, Canada.24Division of Nephrology, Hospital for Sick Children, Toronto, ON, Canada.25Division of Pediatric Anesthesia, Stollery Children's Hospital, Edmonton, AB, Canada.26Division of Pediatric Intensive Care, Alberta Children's Hospital, Calgary, AB, Canada.27Division of Neonatal Intensive Care, BC Women's Hospital + Health Centre, Vancouver, BC, Canada.28Division of Neonatology, Hospital for Sick Children, Toronto, ON, Canada.29Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre and Research Institute, Montréal, QC, Canada.30Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre and Research Institute, Montréal, QC, Canada.31Department of Pediatrics, McGill University, Montréal, QC, Canada.
OBJECTIVES: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. METHODS: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners. RESULTS: We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report. CONCLUSIONS: This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation.
