DDePICt Research Program

Informing the practice of donation after circulatory determination of death in Canada

The Death Prediction and Physiology after Removal of Therapy study aims to provide information about the physiology of death after withdrawal of life sustaining therapy in the ICU...

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DePPaRT Study Completed!

1/20/2021

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After more than 5 years of hard work, we are thrilled to announce that the DePPaRT study is now complete! Our core team (with invaluable help from site coordinators and waveform adjudicators) has worked hard to review and finalize data, and we have completed the main study analysis. Along the way we have continued to publish papers, engage new colleagues, and build collaborations all over the world. 

Although the DePPaRT data collection and main study analysis have been finalized, there remains much to do. Some ongoing exciting projects include:
  • analysis of secondary study outcomes, including a paper on waveform variability led by Nathan Scales and a prediction of time to death study led by Jason Shahin
  • analysis of Qualitative Study outcomes, led by Jennifer Chandler
  • secondary analysis of DePPaRT data focused on processes of withdrawal of life sustaining therapies, funded as part of a CDTRP Astellas Research Innovation Grant
  • analysis of international data

In addition to this scientific work, our team is actively engaging with stakeholders and policy-makers as part of a knowledge translation strategy to ensure that our results are appropriately disseminated. A notable part of this initiative includes integration with Canadian Blood Services' initiative to harmonize criteria for death determination. Check back soon for updates and links to other knowledge translation activities!
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Fall 2018 Updates from the DePPaRT Study

10/1/2018

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As we move into the busy fall season, we thought this would be a good opportunity to give you another quick update on the progress of the DePPaRT study and our larger research program. Here are the recent highlights:
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  • Final study enrolment is 654 (378 CAD, 233 CZR, 43 NLD) patients from 20 sites; Consent rate 94% (45 refusals/690 asked).
  • Data queries and cleaning have been completed for over 80% of patients. A huge THANK YOU to all the research coordinators who have been working so hard to help us with this process.
  • Adjudication of the collected vital sign waveforms has begun and we expect this process to be completed by December. As a result, there will be a number of new collaborators joining the DePPaRT team.
  • For the Qualitative Study, 48 families agreed to be re-contacted. Of these, 28 (58%) consented to be interviewed and those interviews have been completed. 12 (25%) families were lost to follow up, and 8 (17%) declined to participate. The study team has begun the process of qualitative analysis and plans to present a preliminary summary of initial thematic findings at the CST Canadian Transplant Summit in October.
  • Enrolment for the Neuro pilot sub-study (inclusion of EEG and TCD monitoring on 20 DePPaRT patients) at the London Health Sciences Centre and Victoria Hospital is complete, with data analysis underway.
  • Along with co-investigators Dr. Maureen Meade and Dr. Jeffrey Zaltzman, we have received funding from the CNTRP Astellas Research Innovation Grant Competition to complete the study, “Exploration of the impact of donor hemodynamics during donation after circulatory determination of death on patient and graft outcomes in kidney recipients”, the protocol from which is currently undergoing REB review.
  • Abstracts related to DePPaRT that were submitted by Amanda van Beinum, PhD(c) and Dr Nathan Scales have been accepted for presentation at the CST Canadian Transplant Summit in October and Canadian Critical Care Forum in November, respectively.
  • A manuscript entitled, “Engaging Family Partners in Deceased Organ Donation Research - A reflection on one team's experience,” is under review by the Canadian Journal of Anesthesia. We are extremely proud of this paper which was co-created by Amanda van Beinum, PhD(c) and Heather Talbot (DePPaRT Patient Family Partner).
  • Our fantastic planning meeting held last November 6&7 as a pre-meeting workshop of the CNTRP Annual Meeting at Mont Tremblant resulted in:
    • New partnerships with families and patients: Don Brinklow, a heart transplant recipient and his wife and Patti attended our meeting and have agreed to join Heather Talbot as patient, family partners! Thanks so much to Heather, Don and Patti for agreeing to work with us to help guide the direction of our new projects!
    • Continued national and international research collaborations that have lead to multiple grant submissions, including a PSI submission, lead by Dr. Teneille Gofton and Dr. Marat Slessarev, to fund a full study of 100 patients to provide the first large empiric neuro dataset to inform DCD practices in Canada and worldwide and a CIHR submission, co-lead by Dr. Andrew Seely, to create and implement a “Donation Advisor” tool.
    • New collaborations including work with Claudio Sole, PhD(c), and Dr. Andrea Lodi, Polytechnique Montréal, to use machine learning analysis of vital sign waveforms to predict hemodynamic trajectories during WLST

Given all the exciting developments for current and future work, we plan to organize a meeting of our Steering Committee in late October or early November. 
As we finish data analysis and begin the process of publishing and presenting DePPaRT results, and begin to embark on all the new research projects borne from DePPaRT, we want to reaffirm our sincere appreciation and gratitude for all our co-investigators, collaborators, coordinators, and partners in your continued support and dedication to this work. 

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Happy New Year from the DePPaRT Team!

1/2/2018

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We said goodbye to 2017 on a good note (Canadian recruitment finished!) and are looking forward to 2018 as we begin analysis and presentation of our results. The study team is sending out best wishes for 2018 and a huge thank you to all of the participating families and research sites that continue to make this study possible. We could not have done it without you!

Recent Study Updates:

  • Current total recruitment: 641 patients (374 in Canada, 267 internationally)
  • Canadian recruitment closed for all sites except Kingston on December 1st, 2017
  • Three sites in Prague, Czech Republic also closed for recruitment on December 1, 2017 with a final total of 233 patients enrolled. Amazing!
  • International recruitment continues at Maastricht University Medical Centre, Netherlands, and is scheduled to begin soon at Nottingham University Hospital in the United Kingdom
  • Consent rate remains at 94%
  • Qualitative study team has interviewed 22 families of patients eligible for DCD
  • Successful DePPaRT International Planning Meeting held Nov 6 & 7 in Tremblant, QC - lots of great ideas shared for how to move forward with our analysis and where DePPaRT will lead in the future
A recent study update report is available on the updates page. Check back for updates about upcoming presentations and publications of study results. 
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First DePPaRT International Planning Meeting a Success!

11/13/2017

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Last week, clinicians, researchers, patients, and family members from Canada and Europe gathered in Mont Tremblant for the first DePPaRT International Planning Meeting to discuss some preliminary results from the DePPaRT data as well as to set goals for the next steps of this exciting research. It was so exciting and energizing to finally get the chance to have a face to face meeting with collaborators that we've been working with electronically for years. Thank you to everyone who came out and contributed to thinking about how to use the data we have, how to move forward with new ideas, and especially a big thanks to our patient and family partners for helping to remind us of why we continue to do this important research!
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Group shot of the DePPaRT International Meeting Participants
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Homestretch for Canadian DePPaRT Enrollment

9/25/2017

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As we move into the busy fall season, we thought this would be a good opportunity to provide a quick update on the progress of the DePPaRT study. Enrolment continues to move along as anticipated, and our plan is to close study enrolment on December 1, 2017 for the majority of our Canadian sites, with only a few late joining and international sites continuing to enrol into 2018. Here's a quick list of updates:

  • As of September 25th, the total study enrolment is at 591 (344 Canadian) patients from 20 active sites and our overall consent rate remains steady at 94%. With only two months left, we are hoping to end strong and may be even hit 400 patients for our Canadian enrolment.
  • In June, our site in the Netherlands became active and the team at the Maastricht University Medical Center has already enrolled 16 patients. They join Calgary Foothills as the two highest enrolling centers for the period of May-Sept 2017. Congratulations to both teams!
  • Recruitment for the qualitative study of family experiences with DCD and research at the end of life continues to go very well. So far 43 Ontario families have consented to re-contact and 13 interviews have been completed.
  • The Neurological pilot sub-study (inclusion of EEG and TCD monitoring on 20 DePPaRT patients) at the London Health Sciences Centre and Victoria Hospital is almost complete with the 19th patient enrolled last week.
  • Finally, we are busy finalizing the details for our planning meeting to strengthen our international collaborative of DePPaRT site investigators from the Czech Republic, the UK and the Netherlands. The outcomes of this meeting, which will be held on November 6&7 as a pre-meeting workshop of the CNTRP Annual Meeting at Mont Tremblant, will set the stage for the next chapter of our research.
As we move into the homestretch of DePPaRT we want to reaffirm our sincere appreciation of your continued dedication to this work!
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Spring Updates from the DePPaRT Team

5/2/2017

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Spring brings more of the same for the DePPaRT team, which is great news for us! Study enrolment continues to move along well in Canada and internationally, and if the current rates of recruitment continue we plan on closing the majority of sites to enrolment by the end of the year. Additional updates:
  • As of May 1st, the total study enrolment is at 476 patients from 19 active sites with an overall consent rate of 94%!
  • Kingston General Hospital & The Ottawa Hospital (General Campus) were the highest enrolling sites for the period of Feb-May 2017.
  • Recruitment for the qualitative study of family experiences with DCD and research at the end of life is going very well. So far 33 families have consented to re-contact and 8 interviews have been completed.
  • The Neuro pilot substudy (inclusion of EEG and trans-cranial doppler (TCD) monitoring on 20 DePPaRT patients) at the London Health Sciences Centre and Victoria Hospital is also going very well with 13 patients enrolled so far; 4 with EEG only, 3 with TCD only and 6 with EEG and TCD. Congrats to everyone at both sites!
  • Our planning meeting to strengthen our international collaborative of DePPaRT site investigators from the Czech Republic, the UK and the Netherlands will be held on November 6&7 as a pre-meeting workshop of the CNTRP Annual Meeting at Mont Tremblant, QC. More details to follow soon!
We are extremely pleased with how well the study is progressing and are very appreciative of the continued dedication from patient families, study sites, and all of our collaborators!
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Year-end updates & happy holidays from the DePPaRT team

12/21/2016

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The DePPaRT study remains on track and we are happy to be concluding 2016 with a whole list of achievements:
  • Enrollment now at 352/500 patients (that's 70% complete!)
  • Consent rate still at 94%
  • One site in Kingston, 2 new sites in Calgary, and 1 site in Edmonton have started screening and enrolling, bringing our total number of Canadian ICUs to 15! 
  • Canadian enrollment (181) has now surpassed enrollment in Prague, CZ (171) for the first time
  • One site in Maastricht, NL and one in Nottingham, UK are working hard to get started up by spring 2017 - we are very excited to expand to more international centers!
  • The study team published a paper about the ethical process of our pilot study in the Journal of Medical Ethics - you can read a blog post summarizing the article here, or check out the full paper
  • The core team attended and presented at the Canadian National Transplant Research Program annual meeting in Quebec City in October, and the Canadian Critical Care Forum in Toronto in November - all presentations were very well recieved
  • While in QC we also attended the CNTRP Patient Partnership workshop with our fantastic patient partner, whose story was recently featured in an article in the Ottawa Citizen 

In other news, we are very pleased to welcome Mélanie Hogue, former NICU nurse, to our core team to help with coordinating the study. 

On behalf of the core team, we are wishing all our coordinators, collaborators, investigators, and patient families a safe and happy holidays. 

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DePPaRT Study Updates - July 2016 

7/27/2016

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The DePPaRT study is now just 15 patient enrolments away from our 250 patient halfway point!! Total enrolment is now at 235 patients. 

Other updates this month include:
  • Coordinators Marlene Santos and Orla Smith at St. Michael’s hospital have done a great job with enrolment this month with 3 patients enrolled – they are tied with our site in Prague for the highest number of enrolments this month (the first for a Canadian site!)
  • Coordinators Nicole Marinoff and Jane Wang overcame issues with their waveform capture software to enrol their first 2 patients at Sunnybrook!
  • Coordinator Lori Hand at Hamilton has officially passed the 20 patient mark!
  • Coordinator Josie Campisi at the Montreal General has enrolled her first patient since starting with the study
  • The study team at our London site has been asking families to add EEG and trans-cranial doppler measurements during withdrawal of life sustaining therapies – so far they have added EEGs to 5 patients, 3 of which have also had dopplers
  • The DePPaRT central team is busy writing a proposal for a 2016 CIHR meeting grant to bring together our international collaborators

A more detailed breakdown of our enrolment numbers is available on our study progress page.

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DePPaRT-Neuro: Abstract Presented at Canadian Neurological Sciences Congress in Quebec City

7/12/2016

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As an add-on to the DePPaRT study, researchers at the London Health Sciences Centre in London, Ontario have provided families the option to consent not just to existing clinical monitoring, but also to add an EEG machine to monitor what happens to the brain during the process of withdrawal of life sustaining therapies and after death. So far, several patient families have consented, and the local team has been able to collect continuous EEG, blood pressure with arterial wave forms, EKG activity and oxygen saturations. 

​Recently, the London team presented an abstract of their progress to date at the Canadian Neurological Sciences Congress in Quebec City (read the abstract here). Researcher Loretta Norton says the poster generated a lot of interest amongst neurologists at the congress, and she is looking forward to getting additional feedback from a broader audience, including from any interested DePPaRT investigators.

Congratulations Loretta and the London team on a great poster presentation and for leading this important neurological aspect of DePPaRT!
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June Study Updates

6/24/2016

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The DePPaRT team has been busy!!
​There are quite a few updates this month so I’ve listed them here in point form:
  • Study enrolment is now at 216 patients! More detail now available on our DePPaRT Study Progress page. 
  • 13 families of DCD-eligible patients have agreed to future contact for the Qualitative Interview Sub-Study
  • After just over a year of enrolling, our consent rate is still 94%. That said, we are moving forward with a plan to test out a waived consent model at some of our sites where withdrawal of life sustaining therapies most often occur after hours and is resulting in missed consent opportunities
  • Sunnybrook Hospital is now open as an active site, bringing our total number of open sites to 16!
  • Coordinator Lisa Julien has enrolled her first two patients at the QEII site in Halifax. Thanks Lisa!
  • Kingston General Hospital has agreed to join as a study site; we are pleased to welcome coordinator Miranda Hunt and Drs. Boyd and Maslove to our study team
  • We have recently began conversations with collaborators in Maastricht, Netherlands (leaders in DCD practice) and are hoping to have them join as a study site this year
  • Our collaborators in Nottingham, UK are beginning the process of study startup at their centre

We're looking forward to a busy but rewarding summer!
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    Amanda van Beinum
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