Perceptions of health care providers involved in organ donation or transplantation on cardiac donation after death by circulatory criteria: a qualitative study.

Purpose: Cardiac donation after death determination by circulatory criteria (DCC) can be performed using either 1) direct procurement and perfusion of ex situ organs or 2) normothermic regional perfusion (NRP). Nevertheless, there are concerns regarding the acceptability and ethics of these procedures, particularly NRP in which the blood supply to the brain is surgically interrupted and circulation in the thorax and abdomen is restored prior to heart retrieval. We aimed to understand the perspectives on cardiac donation following DCC of Canadian clinicians who are involved in donation and transplantation.

Methods: We performed a qualitative descriptive study of 75 clinicians to better understand the perspectives of physicians on cardiac DCC. We purposively sampled clinicians who care for organ donors (N = 51) and those who care for transplant recipients (N = 24) in Canada. We performed thematic analysis to generate themes describing participants' perspectives about cardiac DCC and its implementation in Canada.

Results: We found that the broad support and interest to implement cardiac DCC among the cohort of clinicians interviewed was tempered by their anticipation that other clinicians, donor families, and the public would be less supportive. Donor clinicians were particularly concerned about potential erosion in public trust in the organ donation system as a whole. Participants identified opportunities to address anticipated challenges, including strategies for education and communication around cardiac DCC, staged/gradual introduction of cardiac DCC, and the option for stakeholders (clinicians, donor families, potential transplant recipients) to opt out of participation in cardiac DCC.

Conclusions: In this qualitative study of clinicians involved in organ donation or transplantation across Canada, we found broad support for cardiac DCC. Nevertheless, we observed several challenges with the implementation of cardiac DCC, particularly concerns of nonsupport by other stakeholders. Participants also identified opportunities to address anticipated barriers.