Quebec adopts new organ donation plan but Canadian MDs not agreed.

Organ Donation after Cardiocirculatory Death is being tested as an end-of-life option, Quebec-Transplant announced. Medical teams at four hospitals are being organized and trained to be in action at an early date. Until now, the transplant option has been available after the brain death of a patient. Families will be able to "honour their loved one's wish to bequeath their organs" after cardiocirculatory arrest.

The new program has not been received positively by all Canadian physicians. Dr. Christopher Doig, Medical Director of the intensive-care unit at Calgary's Foothills Medical Centre, is concerned that it could lead to doctors prematurely stopping life support.

In a comment published in the Canadian Medical Association Journal, he points to a study of 1,600 Canadian ICU healthcare providers who were asked how they would respond in 12 "usual" ICU scenarios. Five potential options, ranging from continuing full treatment to withdrawing all active treatment, were presented to the participating physicians. According to Doig, they did not agree who to consider and when they should become donors.

At a forum for the Canadian Council for Donation and Transplantation, a majority of participants supported proceeding with DCD programs in Canada. The Forum also recognized the need to formulate and emphasize core values to guide the development of programs and protocols based on the medical, ethical and legal framework established at this meeting.

In Quebec, as elsewhere in North America, the numbers of brain deaths has declined while a growing number of patients with a poor and irreversible prognosis are kept alive artificially on a respirator in the intensive care or emergency unit. The condition of these patients is not progressing toward brain death.

The protocol is currently under study by the Quebec-Transplant agency's board of directors.

A pilot project is under way in four hospitals: CHA de l'Enfant-Jesus in Quebec City, the Centre hospitalier, universitaire de Sherbrooke, the Hopital du Sacre-Coeur de Montreal and the McGill University Health Centre.

Customized training sessions were given at each of the hospitals by Dr. John F. Edwards of the Philadelphia Gift of Life Institute. According to Quebec-Transplant, the project has received favourable advice and recommendations from medical and ethical bodies concerned, including the College des medecins du Quebec and the Commission de l'ethique de la science et de la technologie.

Quebec-Transplant is the agency mandated by the ministere de la Sante et des Services sociaux to coordinate organ donation in Quebec.

www.quebec-transplant.qc.ca