Organ donation after death determination by circulatory criteria: family members' experiences with withdrawal of life-sustaining measures in Canadian intensive care units

doi:10.1007/s12630-025-02978-4

. 2025 Jun;72(6):975-985.

doi: 10.1007/s12630-025-02978-4. Epub 2025 Jun 26.

Organ donation after death determination by circulatory criteria: family members' experiences with withdrawal of life-sustaining measures in Canadian intensive care units

Aimee J Sarti^{1

2}, Stephanie Sutherland^{3

4}, Maureen Meade⁵, Matthew J Weiss⁶, Sonny Dhanani⁷, Ken M Lotherington⁸, Angele Landriault⁹, Brandi Vanderspank-Wright^{4

10}, Sabira Valiani¹¹, Sean Keenan^{12

13

14}, Andreas H Kramer¹⁵, Stephen Beed¹⁶, Joanne Brennan⁴, Pierre Cardinal³, Michaël Chassé¹⁷, Peter Nickerson¹⁸, Sam D Shemie^{8

19}; Canadian Critical Care Trials Group (CCCTG)

Affiliations

¹ Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada. asarti@toh.ca.
² Ottawa Hospital Research Institute, Ottawa, ON, Canada. asarti@toh.ca.
³ Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada.
⁴ Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ Department of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada.
⁶ Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec City, QC, Canada.
⁷ Division of Critical Care, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
⁸ Canadian Blood Services, Ottawa, ON, Canada.
⁹ Learning and Practice Improvement (LPI) Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada.
¹⁰ School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
¹¹ Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
¹² BC Transplant, Vancouver, BC, Canada.
¹³ Division of Critical Care Medicine, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.
¹⁴ Transplant Manitoba, Winnipeg, MB, Canada.
¹⁵ University of Calgary, Calgary, AB, Canada.
¹⁶ Department of Critical Care, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
¹⁷ Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
¹⁸ Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹⁹ Division of Pediatric Critical Care, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.

PMID: 40571891
DOI: 10.1007/s12630-025-02978-4

Organ donation after death determination by circulatory criteria: family members' experiences with withdrawal of life-sustaining measures in Canadian intensive care units

Aimee J Sarti et al. Can J Anaesth. 2025 Jun.

. 2025 Jun;72(6):975-985.

doi: 10.1007/s12630-025-02978-4. Epub 2025 Jun 26.

Authors

Affiliations

¹ Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada. asarti@toh.ca.
² Ottawa Hospital Research Institute, Ottawa, ON, Canada. asarti@toh.ca.
³ Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada.
⁴ Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ Department of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada.
⁶ Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec City, QC, Canada.
⁷ Division of Critical Care, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
⁸ Canadian Blood Services, Ottawa, ON, Canada.
⁹ Learning and Practice Improvement (LPI) Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada.
¹⁰ School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
¹¹ Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
¹² BC Transplant, Vancouver, BC, Canada.
¹³ Division of Critical Care Medicine, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.
¹⁴ Transplant Manitoba, Winnipeg, MB, Canada.
¹⁵ University of Calgary, Calgary, AB, Canada.
¹⁶ Department of Critical Care, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
¹⁷ Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
¹⁸ Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹⁹ Division of Pediatric Critical Care, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.

PMID: 40571891
DOI: 10.1007/s12630-025-02978-4

Abstract
in English, French

Purpose: Donation after death determination by circulatory criteria (DCC) is an option currently available for imminently dying patients who do not meet neurologic criteria for death. When organ donation is not successful following withdrawal of life-sustaining measures (WLSM), family members may experience additional feelings of loss and bereavement. In this study, we sought to explore the lived experiences of family members who consented to donation after DCC, including families whose loved ones proceeded to donation and those for whom donation was not possible.

Methods: We conducted a qualitative study using semi-structured interviews with family members whose loved ones agreed to donation after DCC and underwent WLSM in Canadian intensive care units. We recruited participants from all Canadian provinces with an organ donation organization (n = 10) and analyzed themes using a modified grounded theory approach.

Results: Interviews with 79 family members of 78 potential donors with DCC revealed nine main themes as important in the context of WLSM in DCC: 1) early and repetitive communication, 2) predicting time of death (after WLSM), 3) invitation to witness WLSM, 4) family agency in donation after DCC (e.g., wishing they had been able to take some action and/or exert more control), 5) environment, 6) support, 7) honouring donor/meaning making, 8) guilt, and 9) triple loss (i.e., death, unsuccessful donation, and loss for recipients).

Conclusion: In this qualitative study, we identified a range of experiences among family members in the context of WLSM in DCC. Among those, we found family involvement in the WLSM and the DCC process to be very important. Family member perspectives on organ donation are essential to guide practices that can support consistent, high-quality family-centred care in this context.

RéSUMé: OBJECTIF: Le don après détermination du décès selon des critères circulatoires (DCC) est une option actuellement disponible pour les patientes et patients dont le décès est imminent qui ne répondent pas aux critères neurologiques de décès. Lorsque le don d’organes échoue à la suite de l’interruption des traitements de maintien des fonctions vitales (TMFV), les membres de la famille peuvent éprouver des sentiments de perte et de deuil supplémentaires. Dans cette étude, nous avons cherché à explorer les expériences vécues par les membres de la famille qui ont consenti au don après DCC, y compris de familles dont les proches ont procédé au don et celles pour qui le don n’était pas possible. MéTHODE: Nous avons mené une étude qualitative à l’aide d’entretiens semi-structurés avec les membres de la famille dont les proches ont accepté de faire un don après DCC et chez qui les TMFV avaient été interrompus dans des unités de soins intensifs canadiennes. Nous avons recruté des participants et participantes de toutes les provinces canadiennes disposant d’un organisme de don d’organes (n = 10) et analysé les thèmes en utilisant une approche de théorie ancrée modifiée. RéSULTATS: Les entretiens menés avec 79 membres de la famille de 78 donneuses et donneurs potentiels atteints de DCC ont révélé neuf thèmes principaux importants dans le contexte de l’interruption des TMFV : 1) la communication précoce et répétitive, 2) la prédiction de l’heure du décès (après le DCC), 3) l’invitation à être témoin de l’interruption des TMFV, 4) le pouvoir d’agir de la famille dans le don après un DCC (p. ex., le souhait d’avoir été en mesure d’agir et/ou d’exercer plus de contrôle), 5) l’environnement, 6) le soutien, 7) l’hommage à la personne faisant le don/la création de sens, 8) la culpabilité et 9) la triple perte (soit la mort, le don infructueux et la perte pour les receveurs et receveuses). CONCLUSION: Dans cette étude qualitative, nous avons identifié un éventail d’expériences parmi les membres de la famille dans le contexte de l’interruption des TMFV suite à un DCC. Parmi ces expériences, nous avons constaté que la participation des familles à l’interruption des TMFV et au processus de DDC était très importante. Les perspectives des membres de la famille sur le don d’organes sont essentielles pour orienter des pratiques qui puissent soutenir des soins uniformes et de haute qualité centrés sur la famille dans ce contexte.

Keywords: bereaved family members; donation after circulatory death; intensive care; organ donation; qualitative study.

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References

1. Domínguez-Gil B, Ascher N, Capron AM, et al. Expanding controlled donation after the circulatory determination of death: statement from an international collaborative. Intensive Care Med 2021; 47: 265–81. https://doi.org/10.1007/s00134-020-06341-7 - DOI - PubMed - PMC
1. Kramer AH, Holliday K, Keenan S, et al. Donation after circulatory determination of death in western Canada: a multicentre study of donor characteristics and critical care practices. Can J Anesth 2020; 67: 521–31. https://doi.org/10.1007/s12630-020-01594-8 - DOI - PubMed
1. Shemie SD, Baker AJ, Knoll G, et al. National recommendations for donation after cardiocirculatory death in Canada. CMAJ 2006; 175: S1–24. https://doi.org/10.1503/cmaj.060895 - DOI - PubMed - PMC
1. Shemie SD, Hornby L, Baker A, et al. International guideline development for the determination of death. Intensive Care Med 2014; 40: 788–97. https://doi.org/10.1007/s00134-014-3242-7 - DOI - PubMed - PMC
1. Shemie, SD, Wilson LC, Hornby L, et al. A brain-based definition of death and criteria for its determination after arrest of circulation or neurological function in Canada: a 2023 clinical practice guideline. Can J Anesth 2023; 70: 483–557. https://doi.org/10.1007/s12630-023-02431-4 - DOI - PubMed

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[1] Domínguez-Gil B, Ascher N, Capron AM, et al. Expanding controlled donation after the circulatory determination of death: statement from an international collaborative. Intensive Care Med 2021; 47: 265–81. https://doi.org/10.1007/s00134-020-06341-7 - DOI - PubMed - PMC

[2] Domínguez-Gil B, Ascher N, Capron AM, et al. Expanding controlled donation after the circulatory determination of death: statement from an international collaborative. Intensive Care Med 2021; 47: 265–81. https://doi.org/10.1007/s00134-020-06341-7 - DOI - PubMed - PMC

[3] Kramer AH, Holliday K, Keenan S, et al. Donation after circulatory determination of death in western Canada: a multicentre study of donor characteristics and critical care practices. Can J Anesth 2020; 67: 521–31. https://doi.org/10.1007/s12630-020-01594-8 - DOI - PubMed

[4] Kramer AH, Holliday K, Keenan S, et al. Donation after circulatory determination of death in western Canada: a multicentre study of donor characteristics and critical care practices. Can J Anesth 2020; 67: 521–31. https://doi.org/10.1007/s12630-020-01594-8 - DOI - PubMed

[5] Shemie SD, Baker AJ, Knoll G, et al. National recommendations for donation after cardiocirculatory death in Canada. CMAJ 2006; 175: S1–24. https://doi.org/10.1503/cmaj.060895 - DOI - PubMed - PMC

[6] Shemie SD, Baker AJ, Knoll G, et al. National recommendations for donation after cardiocirculatory death in Canada. CMAJ 2006; 175: S1–24. https://doi.org/10.1503/cmaj.060895 - DOI - PubMed - PMC

[7] Shemie SD, Hornby L, Baker A, et al. International guideline development for the determination of death. Intensive Care Med 2014; 40: 788–97. https://doi.org/10.1007/s00134-014-3242-7 - DOI - PubMed - PMC

[8] Shemie SD, Hornby L, Baker A, et al. International guideline development for the determination of death. Intensive Care Med 2014; 40: 788–97. https://doi.org/10.1007/s00134-014-3242-7 - DOI - PubMed - PMC

[9] Shemie, SD, Wilson LC, Hornby L, et al. A brain-based definition of death and criteria for its determination after arrest of circulation or neurological function in Canada: a 2023 clinical practice guideline. Can J Anesth 2023; 70: 483–557. https://doi.org/10.1007/s12630-023-02431-4 - DOI - PubMed

[10] Shemie, SD, Wilson LC, Hornby L, et al. A brain-based definition of death and criteria for its determination after arrest of circulation or neurological function in Canada: a 2023 clinical practice guideline. Can J Anesth 2023; 70: 483–557. https://doi.org/10.1007/s12630-023-02431-4 - DOI - PubMed

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Organ donation after death determination by circulatory criteria: family members' experiences with withdrawal of life-sustaining measures in Canadian intensive care units

Affiliations

Organ donation after death determination by circulatory criteria: family members' experiences with withdrawal of life-sustaining measures in Canadian intensive care units

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Abstract
in English, French

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Abstract in English, French

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Abstract
in English, French