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. 2023 Apr;70(4):483-557.
doi: 10.1007/s12630-023-02431-4. Epub 2023 May 2.

A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada: a 2023 clinical practice guideline

Sam D Shemie  1   2   3   4 , Lindsay C Wilson  5 , Laura Hornby  5 , John Basmaji  6 , Andrew J Baker  7   8 , Cécile M Bensimon  9 , Jennifer A Chandler  10 , Michaël Chassé  11 , Rosanne Dawson  5 , Sonny Dhanani  10   12 , Owen T Mooney  13   14   15 , Aimee J Sarti  10   16   17 , Christy Simpson  5   18 , Jeanne Teitelbaum  19   20 , Sylvia Torrance  21 , J Gordon Boyd  22   23 , Joanne Brennan  16 , Heather Brewster  24 , Robert Carignan  25 , Kirk J Dawe  26   27 , Christopher J Doig  28   29 , Kennedy Elliott-Pohl  30 , Teneille E Gofton  6 , Michael Hartwick  10   31 , Andrew Healey  31   32   33 , Kimia Honarmand  6   34 , Karen Hornby  35 , George Isac  36 , Aly Kanji  19   20 , Joann Kawchuk  37 , Jennifer A Klowak  12 , Andreas H Kramer  28   38 , Julie Kromm  28   29 , Allana E LeBlanc  36   39   40 , Katarina Lee-Ameduri  13   15 , Laurie A Lee  28   41 , Murdoch Leeies  13   14   42 , Ariane Lewis  43 , Alex Manara  44 , Shauna Matheson  45 , Nicole K A McKinnon  8   46   47 , Nicholas Murphy  6 , Joel Neves Briard  11 , Thaddeus M Pope  10   48   49   50   51 , Mypinder S Sekhon  36   52 , Jai Jai S Shanker  13 , Gurmeet Singh  53   54 , Jeffrey Singh  8   31   55 , Marat Slessarev  6   31 , Karim Soliman  23   31   56 , Stephanie Sutherland  16 , Matthew J Weiss  57   58   59 , Randi Zlotnik Shaul  8   46 , Lionel S Zuckier  10   16 , David J Zorko  8   46 , Bram Rochwerg  32   42   60
Affiliations

A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada: a 2023 clinical practice guideline

Sam D Shemie et al. Can J Anaesth. 2023 Apr.

Abstract
in English, French

This 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients regardless of organ donation potential. This Guideline is endorsed by the Canadian Critical Care Society, the Canadian Medical Association, the Canadian Association of Critical Care Nurses, Canadian Anesthesiologists' Society, the Canadian Neurological Sciences Federation (representing the Canadian Neurological Society, Canadian Neurosurgical Society, Canadian Society of Clinical Neurophysiologists, Canadian Association of Child Neurology, Canadian Society of Neuroradiology, and Canadian Stroke Consortium), Canadian Blood Services, the Canadian Donation and Transplantation Research Program, the Canadian Association of Emergency Physicians, the Nurse Practitioners Association of Canada, and the Canadian Cardiovascular Critical Care Society.

RéSUMé: Ces Lignes directrices de pratique clinique 2023 Lignes directrices de pratique clinique dicale du décès basée sur l’arrêt permanent de la fonction cérébrale qui s’applique à toute personne, ainsi que des recommandations pour la détermination du décès par des critères circulatoires pour des donneurs d’organes potentiels et des recommandations pour la détermination du décès par des critères neurologiques pour tous les patients sous ventilation mécanique, indépendamment de leur potentiel de donneur d’organes. Les présentes Lignes directrices sont approuvées par la Société canadienne de soins intensifs, l’Association médicale canadienne, l’Association canadienne des infirmiers/infirmières en soins intensifs, la Société canadienne des anesthésiologistes, la Fédération des sciences neurologiques du Canada (représentant la Société canadienne de neurologie, la Société canadienne de neurochirurgie, la Société canadienne de neurophysiologie clinique, l’Association canadienne de neurologie pédiatrique, la Société canadienne de neuroradiologie et le Consortium neurovasculaire canadien), la Société canadienne du sang, le Programme de recherche en don et transplantation du Canada, l’Association canadienne des médecins d’urgence, l’Association des infirmières et infirmiers praticiens du Canada, et la Société canadienne de soins intensifs cardiovasculaires (CANCARE) et la Société canadienne de pédiatrie.

Keywords: brain death; circulatory death; death; deceased organ donation; definition of death; neurologic death.

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Conflict of interest statement

All panel members were required to complete a disclosure form declaring any potential direct or indirect competing interests prior to their involvement in the project. Disclosure forms were collected again at project completion, prior to publication. Declarations were reviewed by members of the steering committee. Several panel members have professional roles in organ donation administration, affiliations with governmental not-for-profit entities, or have received funding for scientific research. In addition, three panel members (M. Chassé, T. Gofton, M. Slessarev) were the lead investigators on studies that were used to generate our recommendations but had not yet been peer reviewed at the time of submission. No panel member was judged to have a relevant competing interest. This Guideline has been endorsed by the Canadian Critical Care Society, the Canadian Medical Association, the Canadian Association of Critical Care Nurses, Canadian Anesthesiologists’ Society, the Canadian Neurological Sciences Federation (representing the Canadian Neurological Society, Canadian Neurosurgical Society, Canadian Society of Clinical Neurophysiologists, Canadian Association of Child Neurology, Canadian Society of Neuroradiology, and Canadian Stroke Consortium), Canadian Blood Services, the Canadian Donation and Transplantation Research Program, the Canadian Association of Emergency Physicians, the Nurse Practitioners Association of Canada, and the Canadian Cardiovascular Critical Care Society.

Figures

Fig. 1
Fig. 1
Death determination process overview Aperçu du processus de détermination du décès
Fig. 2
Fig. 2
Death determination by circulatory criteria for potential organ donors checklist Liste de contrôle pour la détermination du décès selon des critères circulatoires pour les donneurs d’organes potentiels
Fig. 2
Fig. 2
Death determination by circulatory criteria for potential organ donors checklist Liste de contrôle pour la détermination du décès selon des critères circulatoires pour les donneurs d’organes potentiels
Fig. 3
Fig. 3
Death determination by neurologic criteria checklist Liste de contrôle pour la détermination du décès selon des critères neurologiques
Fig. 3
Fig. 3
Death determination by neurologic criteria checklist Liste de contrôle pour la détermination du décès selon des critères neurologiques
See this image and copyright information in PMC

Comment in

References

    1. Chen Y, Yang K, Marušic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med. 2017;166:128–132. doi: 10.7326/m16-1565. - DOI - PubMed
    1. Delbecq AL, Van de Ven AH, Gustafson DH. Group Techniques for Program Planning: A Guide to Nominal Group and Delphi Processes. Glenview: Scott Foresman; 1975.
    1. Sarti AJ, Sutherland S, Meade M, et al. Death determination by neurologic criteria—what do families understand? Can J Anesth 2023; 10.1007/s12630-023-02416-3. - PMC - PubMed
    1. Sarti AJ, Honarmand K, Sutherland S, et al. When is a person dead? The Canadian public’s understanding of death and death determination: a nationwide survey. Can J Anesth 2023; 10.1007/s12630-023-02409-2. - PMC - PubMed
    1. Simpson C, Lee-Ameduri K, Hartwick M, et al. Navigating disagreement and conflict in the context of a brain-based definition of death. Can J Anesth 2023; 10.1007/s12630-023-02417-2. - PMC - PubMed

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