Grant: Planning Grants - Priority Announcement: Ethics

As a result of persistent shortages in organs for transplantation, donation after cardiac death (DCD) has been given reconsideration and wide endorsement. Yet, in Canada and internationally, DCD practice remains controversial. At the center of most controversial debates lies one question: when is a patient dead? What are the physiologic determinants that define death? Uncertainty remains as to how long to wait to determine death, once the heart stops beating, in order that the organs to be transplanted remain healthy and at the same time ensuring that enough time has passed so that heart will not restart on its own and that the brain has stopped functioning. These questions must be addressed, and transplant medicine must be informed by scientific evidence that is supported by legal and ethical clarity. To achieve this goal, broad international research collaboration is needed to observe and document the physiologic changes that occur during the dying process after the removal of life sustaining therapy. Studying dying patients in critical care presents many practical, technical and ethical challenges. We began with a pilot project to gather enough information to help set a larger, multi-center study across Canada, the US and UK. This meeting will bring together a diverse group of national and international experts to develop an international research network that will ensure the development of a research protocol and funding plan, so that there can be clear evidence to set standards for the determination of death after cardiac arrest. To be successful, the collaboration, input and support of a multi-disciplinary team that includes health care professionals involved in the practical and ethical aspects of organ donation, as well as researchers with expertise in critical care, ethics, methodology, biostatistics, and biomechanical engineering is essential. This collaboration will help identify strategies to translate research results into policy and into practice.