Duty of care to dying patient is first priority

Canada is a world leader in establishing ethical and medical practices on the determination of death and donation

March 26, 2014 (Canada)– Recent coverage on death and organ donation on CBC’s the fifth estate may have left viewers with the impression that Canadian medical practitioners have an unclear understanding of death and are misleading families about the risk of donation procedures occurring before a patient has actually died. This is simply not true.

The first Canadian case of organ donation after cardiac death took place in Ottawa in 2006, when Emile and Beth Therien made the difficult decision to remove their daughter, Sarah Beth, from life-support and honour her wish to be an organ donor. Emile and Beth were recently interviewed and CBC has posted that interview online. 

Since 2006, more than 360 Canadians donated organs after cardiac death, and more than 1,000 transplants occurred because this donation option is available to Canadian families. However, it’s still not enough to meet the needs of all patients. There are over 4,000 Canadians who need an organ transplant, and more than 250 of those patients die every year waiting.

When a loved one passes, there are many decisions a family must make from notifying others to arranging a funeral. Organ donation is an important part of that process for many families, giving their loved one the chance to leave behind a meaningful legacy that helps save lives.

There are two types of deceased organ donation: after brain death and after cardiac death. In rare cases where donation is possible, strict guidelines protect dying patients and make it impossible for deceased patients to experience pain or suffering during the donation process. The guidelines, which have been in place in Canada for many years, include full disclosure and informed consent, procedures around the withdrawal of life-sustaining treatments, standards for determining death, the separation of duties of the ICU team from the transplant team and the prevention of any donation procedures starting before a patient has passed away.

In medicine, death is defined as the complete and permanent cessation of brain function (brain death) or heart beat (cardiac death). In cardiac death, there is Canadian consensus based on clinical evidence that death is confirmed after two physicians, who are separate from the transplant team, observe the absence of a pulse, breathing and blood pressure for a period of five minutes. Canada also has consistent standards for brain death where two physicians, who are not on the transplant team, must follow detailed checklists to eliminate any reversible conditions and confounding factors to confirm someone is brain dead.

Canada is a world leader in establishing ethical and medical practices for the determination of death for organ donation. Canadian Blood Services and Canada, in collaboration with the World Health Organization (WHO), organized and hosted the development of International Guidelines for the Determination of Death in May 2012. International experts in critical care, neurology, neurosurgery, emergency medicine and many other specialists participated and developed world-respected guidelines that will be released later this spring. The international guidelines are consistent with current practices in Canada, reaffirming Canada’s leadership in ethical and medical conduct and procedure around death in relation to organ donation.

All Canadians have a voice in organ donation. According to a recent poll, nine of 10 Canadians support organ donation, but only half of the population has decided to donate when they die. We encourage all Canadians to use your voice to discuss organ donation with your family and, most importantly, to share your wishes and register your intentions to become an organ donor.

To find a program in your province, visit www.organsandtissues.ca.

• Dr. Sonny Dhanani, Chief Medical Officer – Donation, Trillium Gift of Life Network, Ontario
• Dr. Greg Grant, Provincial Executive Director, BC Transplant
• Dr. Sam Shemie, Medical Director Organ Donation, Canadian Blood Services

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