Grant: Knowledge Synthesis Grant

Organ transplantation is for many patients with terminal heart, lung, liver and kidney disease the only hope for survival. In 2011, 4660 patients were on the waiting list for transplantation in Canada and 285 died waiting for an organ. For the purpose of organ donation, organs can be obtained from living donors, harvested after cardiac death (DCD) or after neurological death diagnosis (NDD). Organs harvested after NDD represent the principal source of organ transplanted in Canada and in 2011, 466 patients with NDD procured a total of 1518 organs for transplantation. The only source for hearts, pancreas and intestine transplantation come from NDD organ donors. As such, it is of uttermost importance to accurately identify potential patients in a state of neurological death and to proceed in a humane, accurate, timely and cost-effective manner to NDD. Neurological death, also called brain death, is the condition a patient has an irreversible loss of consciousness and of the functions of the brain required to stay alive such as breathing. Physicians rely on a very extensive physical examination and tests at the bedside to diagnose this condition. Situations however happen where the physician can't diagnose brain death at the bedside because of certain medications or facial trauma, for example. He then has to use additional tests called "ancillary tests" to help diagnose this condition. We will conduct a knowledge synthesis of the available literature about the use of ancillary tests for diagnosis of brain death. This work will provide clinicians with an up to date and reliable appraisal of all the current literature to help them make the best decisions regarding the use of these tests for diagnosis of brain death. It will help policy-makers implement evidence based clinical guidelines about the use of these tests and it will provide solid foundation for researchers in areas where data is inconclusive to further study the determination of brain death using these tests