Neurologic Physiology After Removal of Therapy (NeuPaRT)

There are many Canadians who need an organ transplant and who will never get one. In the past, people could only be organ donors after being declared brain dead.

The dead donor rule serves this purpose by ensuring that death determination precedes organ retrieval. In Canada, death determination occurs in one of two ways. In neurologic determination of death (NDD), death is declared upon completion of a standardized neurologic assessment that confirms permanent loss of brain activity. In donation after circulatory determination of death (DCDD), death is declared 5 minutes after circulatory arrest. By confirming permanent loss of brain activity, the current NDD process protects donors from suffering and maintains stakeholder trust. In contrast, the current DCDD process assumes, but does not explicitly confirm, permanent loss of brain activity when death is declared 5 minutes after circulatory arrest. While this assumption is rooted in a strong physiologic rationale, lack of compelling evidence regarding cessation of brain activity in humans contributes to ongoing mistrust of the DCDD process among healthcare and public stakeholders.

Inclusion criteria

• Age ≥ 18 years
• Plan for the withdrawal of life sustaining measures (WLSM)
• Attending physician anticipates patient will die within 24 hours of the withdrawal of life sustaining measures
• Patient has an indwelling arterial cannula for monitoring blood pressure

Exclusion criteria

• Brain death or plan for Neurologic Determination of Death (NDD)
• Injuries that anatomically preclude the use of neurologic monitoring