Development of Canadian National Guidelines for Pediatric Donation After Circulatory Determined Death (pDCD)

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Abstract

Introduction/Hypothesis

pDCD uptake has been slow in Canada, where most pediatric hospitals do not have active programs and pDCD represents only 8% of pediatric deceased donation. This project generated national, pediatric specific clinical practice guidelines (CPGs) to inform the development of ethical and effective pDCD practice.

Methods

We followed a process of CPG development based on World Health Organization (WHO) and Canadian Medical Association (CMA) methods. These included application of the Appraisal of Guidelines, Research and Evaluation (AGREE II) tool, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Questions requiring recommendations were generated based on: 1) 2006 Canadian DCD guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pDCD leaders, and 3) a scoping review of the pDCD literature (1). Input from these sources drove drafting of actionable questions and Good Practice Statements (GPSs), as defined by the GRADE group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using GRADE, and then formulated into evidence profiles that informed recommendations through the Evidence-to-Decision framework. Recommendations were revised through consensus among the members of 7 topic specific working groups (WGs), and finalized during meetings of WG leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies as well as patient partners.

Results

65 GPS recommendations and 7 GRADEd recommendations covering: 1) Ethics, Consent and Withdrawal of Life Sustaining Therapy (WLST) 2) Eligibility 3) WLST Practices 4) Ante and Post Mortem Interventions 5) Death Determination 6) Neonatal pDCD 7) Cardiac and Innovative pDCD 8) Implementation.

Conclusions

This process showed that rigorous, evidence based CPGs are possible in the domain of pediatric deceased donation. We hope that these CPGs will increase access to pDCD across Canada and serve as a model for international CPG development in deceased donation.

Reference:

1. Weiss MJ, Hornby L, Witteman W, Shemie SD. Pediatric Donation After Circulatory Determination of Death. Pediatr Crit Care Med. 2016 Mar;17(3):e88–108.

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