Organ donor management in Canada: recommendations of the forum on Medical Management to Optimize Donor Organ Potential.

Council for Donation and Transplantation (CCDT) sponsored a forum entitled " Medical Management to Optimize Donor Organ Potential, " 23–25 Feb. 2004, to develop guidelines and recommendations for organ donor management in Canada. Discussions were restricted to the interval of care that begins with neurological determination of death (NDD), commonly called " brain death, " and consent to organ donation, and culminates in surgical organ procurement. This period presents a significant opportunity to enhance multi-organ function and improve organ utilization. The forum was the first structured, cooperative assembly of health professionals in the fields of critical care and trans-plantation and can be viewed as a landmark event in Canada. End-of-life care in the intensive care unit (ICU) includes all efforts to actualize the desire and opportunity to donate organs. The evolving collaboration to establish best donor management practices in the ICU and operating room must be accompanied by efforts to ensure optimum organ utilization. In turn, improving the use of organs must be linked with improving transplant graft and patient outcomes. Therapies to protect organs rely on expert clinical management to increase the number of eligible donors and optimize organ function for the purposes of transplantation. Experts involved in this forum focused on 2 key areas: • How to achieve optimum donor organ physiology • How to increase the number of potential donors whose organs are suitable for donation, increase the number of organs transplanted per donor, improve graft function, graft survival and patient survival and identify and explore logistic challenges in the period from NDD to organ procurement. This initiative did not address related challenges, such as the consent process, post-procurement organ perfusion and preservation or surgical retrieval team logistics. The objectives of the forum were • To review and benchmark existing national and international practices, guidelines and policies related to donor organ management, including organ-protective therapies (sources included articles and reports in the basic science and clinical literature; regional, national and international donor management guidelines; and material from related conferences and workshops) • To develop expert consensus recommendations for organ-protective therapies in the ICU and intraoperative management of the organ donor • To develop expert consensus recommendations for the CCDT, Canadian Society of Transplantation, Canadian Critical Care Society, Canadian Association of Transplan-tation and other relevant organizations and groups • To develop a mechanism to involve both critical care and transplant communities in reviewing and updating the expert consensus …