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      International guideline development for the determination of death

      research-article
      , , , , , , , , , and The International Guidelines for Determination of Death phase 1 participants, in collaboration with the World Health Organization
      Intensive Care Medicine
      Springer Berlin Heidelberg
      Death, Brain death, Circulatory death, Cardiac death, Organ donation, Brain injury, Cardiopulmonary resuscitation, Autoresuscitation

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          Abstract

          Introduction and Methods

          This report summarizes the results of the first phase in the development of international guidelines for death determination, focusing on the biology of death and the dying process, developed by an invitational forum of international content experts and representatives of a number of professional societies.

          Results and Conclusions

          Precise terminology was developed in order to improve clarity in death discussion and debate. Critical events in the physiological sequences leading to cessation of neurological and/or circulatory function were constructed. It was agreed that death determination is primarily clinical and recommendations for preconditions, confounding factors, minimum clinical standards and additional testing were made. A single operational definition of human death was developed: ‘the permanent loss of capacity for consciousness and all brainstem functions, as a consequence of permanent cessation of circulation or catastrophic brain injury’. In order to complete the project, in the next phase, a broader group of international stakeholders will develop clinical practice guidelines, based on comprehensive reviews and grading of the existing evidence.

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          Most cited references14

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          Is Open Access

          The state of the international organ trade: a provisional picture based on integration of available information

          Organ transplantation is widely practised worldwide. The expansion of organ transplantation has led to a critical shortage of organs and the development of the organ trade. Many patients travel to areas where organs are obtainable through commercial transactions. Although the international organ trade is regarded as an important health policy issue, its current state remains obscure because of scarce data and the lack of efforts to synthesize available data. This paper is an attempt to integrate information about the current international organ trade and create a tentative global picture based on a systematic review of 309 media reports, journal articles and other documents. The international organ trade is described in terms of its forms, the organ-exporting countries, the organ-importing countries and its outcomes and consequences.
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            ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation.

            The American Society of Transplant Surgeons (ASTS) champions efforts to increase organ donation. Controlled donation after cardiac death (DCD) offers the family and the patient with a hopeless prognosis the option to donate when brain death criteria will not be met. Although DCD is increasing, this endeavor is still in the midst of development. DCD protocols, recovery techniques and organ acceptance criteria vary among organ procurement organizations and transplant centers. Growing enthusiasm for DCD has been tempered by the decreased yield of transplantable organs and less favorable posttransplant outcomes compared with donation after brain death. Logistics and ethics relevant to DCD engender discussion and debate among lay and medical communities. Regulatory oversight of the mandate to increase DCD and a recent lawsuit involving professional behavior during an attempted DCD have fueled scrutiny of this activity. Within this setting, the ASTS Council sought best-practice guidelines for controlled DCD organ donation and transplantation. The proposed guidelines are evidence based when possible. They cover many aspects of DCD kidney, liver and pancreas transplantation, including donor characteristics, consent, withdrawal of ventilatory support, operative technique, ischemia times, machine perfusion, recipient considerations and biliary issues. DCD organ transplantation involves unique challenges that these recommendations seek to address.
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              Severe brain injury to neurological determination of death: Canadian forum recommendations.

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                Author and article information

                Contributors
                sam.shemie@mcgill.ca
                Journal
                Intensive Care Med
                Intensive Care Med
                Intensive Care Medicine
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0342-4642
                1432-1238
                25 March 2014
                25 March 2014
                2014
                : 40
                : 788-797
                Affiliations
                Canadian Blood Services and Division of Critical Care, Montreal Children’s Hospital, McGill University Health Centre, 2300 Tupper Street room C-806, Montreal, QC H3H 1P3 Canada
                Article
                3242
                10.1007/s00134-014-3242-7
                4028548
                24664151
                4a76837f-5ffd-4ef1-8ce8-a0b42a018412
                © The Author(s) 2014

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                : 7 January 2014
                : 5 February 2014
                Categories
                Conference Reports and Expert Panel
                Custom metadata
                © Springer-Verlag Berlin Heidelberg and ESICM 2014

                Emergency medicine & Trauma
                death,brain death,circulatory death,cardiac death,organ donation,brain injury,cardiopulmonary resuscitation,autoresuscitation

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