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3. TRANSP

Table 4. R

OUNTRY

RIA

IUM

ARIA

H BLIC

NIA

AND

CE

MANY

CE

GARY

AND

Y

IA

UANIA

MBOURG

TA

WAY

ND

TUGAL

ANIA

AK BLIC

ENIA

N

DEN

ERLANDS

ED DOM

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t 2009 11 03 –

LANT PROG

Records of pro

procuremenhospitals

70

./.

21

14

4

25

160

Approx.140

75

63

40

266

21

7

5 possible

1

28

135

46

12

4

10

177

56

93

Approx. 200

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nt Type: FIN


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GRAMS AN

ocurement hos

nt

neuroswa

1

./

1

1

2

5

5

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./

1

2

12

2

3

1

1

6

5

./

1

4

3

7

6

1

0 aroun


DeNAL

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Con(scie

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ND THEIR O

spitals and IC

surgical ards

nd

11

/.

15

14

2

5

54

50

/.

17

2

26

21

3

1

1

6

58

/.

10

4

3

72

6

11

nd 40



ntific community

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ORGANIZAT

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neurosurgerydedicated ICU

5

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21

14

2

5

54

150

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3

1

37

21

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3

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7

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1

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6

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Approx. 40


Other: (Sp

l 2 only)

Consu

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totanumbe

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92

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./.

77

16

around

337

140

75

126

40

443

21

61 adultchildre

./.

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approx

416

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50

73

10

N/A

56

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around


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l number beds in ICUs

1.471

./.

2366

914

560

und 400

5523

./.

./.

1306

es from 4 ‐20

3586

ND

0 adults, children’s

./.

25

N/A

2854

./.

1200

492

196

5106

t known

./.

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COOR

in eac

that

progr

the c

nurse

that

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local

every

dono

11,4

11,6

11,8

12

12,2

12,4

12,6

12,8

13

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Only 13 o

ch hospital w

declared to

rams running

coordinator i

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are membe

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coordinator

y phase of d

or detection/

4

6

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t 2009 11 03 –

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where organ

have them

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performed.

hospitals and

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donation

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ransplant

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RENOR project

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Training

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nize such co

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RENOR project

5. QUALITY

Deaths c

ly in elderly

ment is futi

rds brain de

ed resources

of life’s choic

On the o

eved goals, e

y time BD cr

tries, that ha

ntating resou

ect has com

ing efficienc

ent is the st

hs with acut

dead. A sim

9 (or ICD‐10)

anoxic path

toring all d

ntiality and i

hmarking me

nd 15% of d

cted in Euro

may fulfill B

uently howev

equate circu

ces leading t

ept. In these

ac death ev

ber of such

ase the num

n the older g

ncreasing ag

ared and eva

DocumenVersion:

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t 2009 11 03 –

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aused by ac

y patients un

le, may hav

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s for acute tr

ce has to be

other hand,

essentially be

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cute cerebra

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PKI: 2009);

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are expecte

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Procaccio et

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CUs, as well

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CD‐9 codes

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gnosed or de

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the primary

, 2010). Mo

t al., 2001; W

sts that thes


Other: (Sp

l 2 only)

Consu

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ibility of adm

ventilation

r clinical ma

the patient’s

f donation an

ICUs is stil

y all potenti

uality progra

orrections co

needed. In p

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ion process.

as the syste

only patien

monitoring is

emorrhagic,

can be use

s. Definition

the corners

Europe (DOP

ths with acut

2006; Wess

eclared. Freq

workload rea

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not tested

12). Detecti

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st of these

Wesslau et al

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Intensive C

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s the standa

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PKI, 2009); ot

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slau et al.,20

quent reason

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cian towards

or documen

ng and dwa

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“silent” brai

.,2006); nev

donors shou

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Public

24

are Unit,

CU when

evolution

f ICU and

est also in

ntation.

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lied, thus

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s the BD

nted and

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in deaths

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some

prope

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prese

2010

(de G

BD cr

patie

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relate

EC Pr

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The c

There

Table 6

G

RENOR project

The dona

ors is the fun

ospitals when

on Plan laid

e Member St

er organizati

transplant co

ence of expe

) can optimi

Groot et al., 2

riteria are m

nt. This sta

flicting of int

ed issues. A c

Finally, im

roject, 2012)

ch European

65.4% (1

ing. In one o

ram started

QAP have s

dinator and

coordination

e are commo

6. Existing qua

COUNTRY

AUSTRIA

BELGIUM

BULGARIA

ESTONIA

FRANCE

GERMANY

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t 2009 11 03 –

ation proces

damental ste

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7) of count

of these the

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standardized

internal guid

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Standprocedrepo

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Y

Y

Y

Y

Y

Y

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– WP5 Deceas

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ave conside

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that often ar

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the most im

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ay for a bette

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e program is

you can see

d procedure

delines for t

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programs for o

ardized dure for rting a ial donor n ICU and ordinator

m

d

YES

YES

YES

YES

YES

YES


DeNAL

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Con(scie

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Commission

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for reportin

the mainten

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Internal guidelines fo

the maintenancethe potentia

donor in the I

YES

YES

YES

YES

YES

YES



ntific community

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ensive Care

donors: prom

ty action for

n (Action Pla

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ng a potenti

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g of the inte

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.

or

of al CU

The coostaff ca

regmonitthe incare

Y

Y

Y


Other: (Sp

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Consu

Units. Ident

moting the ro

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an EC). The

an availabilit

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n donation (

hrough repo

undergo ence

apeutical pro

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needed (Simp

n the donati

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n of outcom

ams for orga

ntary basis.

(table 6), the

al donor be

potential do

ensive care u

y in 15 of cou

ordination arries out gular toring of ntensive e units

YES

YES

YES

NO

NO

NO


ltation P

tification of

ole of coordi

tates, specifi

success obt

ty is mainly

etween the

of the ICU te

(“champions

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pson, BJA, 20

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quality progr

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In Hungary

e most (15) c

etween ICU a

onor in the

units in 12 c

untries.

Common ccriteria for adonors’ sui

YES

YES

YES

YES

YES

YES

al

Public

25

potential

inators in

ed in the

tained by

due to a

ICU staff

eam. The

s”, WHO,

r systems

h, before

ach single

terms of

ysis of all

012).

(ODEQUS

ram goals

n already

the pilot

countries

and local

ICU (16).

countries.

clinical assessing itability

COOR

L

SLOV

UNIT

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diagn

count

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T

CO

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COUNTRY

HUNGARY

LATVIA

LITHUANIA

ITALY

MALTA

POLAND

VAK REPUBLI

SPAIN

SWEDEN

NORWAY

TED KINGDOM

Such indicato

noses and th

tries that ha

the number

tries, as illus

rance Progra

ot collected

Table 7. Regul

OUNTRY

ITALY

HUANIA

LOVAK PUBLIC

LGARIA

NITED NGDOM

DocumenVersion:

Drafting DStatus:

t 2009 11 03 –

Standprocedrepo

potentbetweelocal co

N

Y

Y

Y

Y

Y

C N

Y

Y

Y

M Y

ors as the n

e number of

ave QAPs ru

r of cardiac

strated in th

ammes are p

and consequ

lar records in

Number of deaths in ICU

YES

NO

NO

./.

YES

Coordinatorga

nt Type: FIN


– WP5 Deceas

ardized dure for rting a ial donor n ICU and ordinator

m

d

NO

YES

YES

YES

YES

YES

NO

YES

YES

YES

YES

number of d

f non‐suitab

nning. The n

arrests are

he table belo

performed on

uently availa

procurement

Us

Numbdeathsacute celesions

ICU

YE

NO

NO

./

./


DeNAL

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Con(scie

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Internal guidelines fo

the maintenancethe potentia

donor in the I

YES

YES

YES

YES

YES

YES

NO

YES

YES

YES

YES

deaths in IC

le donors ar

number of d

recorded o

ow. It is how

n a voluntary

able in each I

t hospitals (co

ber of s with erebral inside U

Ncbd

S

O

O

.

.



ntific community

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or

of al CU

The coostaff ca

regmonitthe incare

Y

Y

Y

Y

Y

Y

Y

Y

Y

CUs, the nu

e regularly r

deaths with a

only in appro

wever worthy

y basis but th

ICU.

ountries with Q

Number of confirmed rain death diagnoses

YES

YES

NO

./.

YES


Other: (Sp

l 2 only)

Consu

ordination arries out gular toring of ntensive e units

YES

YES

YES

YES

NO

YES

YES

YES

YES

./.

YES

mber of con

recorded in a

acute cerebr

oximately on

y to underlin

his does not

QAP’s)

Number ocardiac arre

YES

NO

NO

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YES


ltation P

Common ccriteria for adonors’ sui

YES

YES

YES

YES

NO

YES

YES

YES

YES

./.

YES

nfirmed bra

approximate

ral lesions in

ne fifths fro

ne that thes

mean that s

of ests

Numnon‐

do

al

Public

26

clinical assessing itability

ain death

ely half of

nside ICU

om these

e Quality

such data

mber of suitable onors

YES

YES

NO

./.

YES

COOR

CO

LA

HU

PO

S

ES

FR

M

BE

AU

SW

NO

GE

Figur

N

Figure

RENOR project

OUNTRY

ATVIA

UNGARY

OLAND

SPAIN

STONIA

RANCE

MALTA

ELGIUM

USTRIA

WEDEN

ORWAY

RMANY

re 7 illustrate

3

9

Number of deathsICUs

e 7. Regular reco

DocumenVersion:

Drafting DStatus:

t 2009 11 03 –

Number of deaths in ICU

NO

YES

NO

YES

YES

Some centredo

YES

NO

YES

YES

./.

NO

es the record

3

s in Number oacute cer

insi

rds in hospital w

Co

Coordinatorga

nt Type: FIN


– WP5 Deceas

Us

Numbdeathsacute celesions

ICU

NO

./

NO

NO

NO

s Some cedo

NO

NO

YE

YE

./

NO

ding of indica

4

of deaths withrebral lesionside ICU

where organ retr

ountries witho


DeNAL

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Con(scie

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ber of s with erebral inside U

Ncbd

O

.

O

O

O

entres o

O

O

S

S

.

O

ators mentio

5

7

Number of confibrain death disg

rieval is performe

out QAPs



ntific community

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Number of confirmed rain death diagnoses

YES

./.

NO

YES

NO

YES

NO

NO

NO

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YES

NO

oned above f

2

rmednoses

Numb

ed (all countries

Countries w


Other: (Sp

l 2 only)

Consu

Number ocardiac arre

YES

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NO

NO

NO

NO

NO

NO

NO

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NO

NO

for all survey

3

ber of cardiacarrests

s)

with QAPs


ltation P

of ests

Numnon‐

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3

8

Number of non donors

al

Public

27

mber of suitable onors

YES

./.

NO

YES

YES

YES

NO

NO

NO

./.

YES

NO

s.

8

suitable

COOR

6

awar

dona

natio

are b

are o

(18),

celeb

distin

called

Durin

dona

trans

Natio

ment

cente

RENOR project

6. INITIATI

One of t

eness. The

tion in orde

onal public ca

being organiz

organized ye

followed b

bration of th

nguished in

d “week of

ng this week

tion, donor

splanted pati

In most c

onal transpla

tioned the d

ers, etc. as o

1

5

9

13

17

21

co

Figure 8

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t 2009 11 03 –

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the most im

second que

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early. As for

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e European

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18

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mportant fac

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the initiativ

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distributed

donors and r

e organizers

ations, as ill

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16

TVadvertisment

iatives


DeNAL

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Con(scie

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RENESS ON

ctors that in

ocused on t

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ves taken, th

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ay (CZ, SL) o

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16

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DECEASED

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In Sweden

nnection wi

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the figure 9

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Consu

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ese countries

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9. Moreover

transplant

12

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nation rate

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cy, Renal

the data

rea Ricci,

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RENOR project

1. Academy

2008. Ava

2. Action

http://ec.e

3. Barber K,

records. B

4. Bernat JL,

donation.

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or conflict

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7. Council of

8. De Groot Y

tools used

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Reportabl

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project

11. Farsides B

donation

22194435

12. Gardiner D

J Anaesth.

13. Good pra

http://ww

14. Greer DM

in leading

15. Guide of r

DOPKI pro

16. Laureys S,

17. Manara A

Jan;108 Su

18. Matesanz

measures

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death: a m

20. Murphy P

Jan;108 Su

DocumenVersion:

Drafting DStatus:

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Falvey S, Ham

BMJ 2006;332

Capron AM,

Crit Care Med

: Early identifi

t of interest?

; Friele RD; M

nsplant Intern

f Europe. New

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d in the evalua

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mproving the

B. Respecting

and retrieva

.

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. 2012 Jan;108

actice guide

ww.ont.es/pub

, Varelas PN,

US neurologi

recommendat

oject guide of

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AR, Murphy P

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:1124

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Intensive Care

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national2005,1

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wishes and

al. Br J Anae

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8 Suppl 1:i14‐

lines in the

blicaciones/pa

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c institutions.

tion for Quali

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1. Review. Pub

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Transplant Int

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to identify bes

Towards a fr

Review. PubM


DeNAL

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A code of pra

omrc.org.uk/p

P

ats/human_s

. Potential for

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63‐70.

e potential org

e Med 2010 ;

evers JKM. Op

18:1275‐1279

plant. Vol. 1, n

agt M et al. D

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ach to Deceas

and Practices

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28. Review. P

e process o

aginas/publica

dicks EFM. V

Neurology 20

ity Assurance

ations, 2009.

ath? Avoiding

han G. Donat

bMed PMID: 2

E et al. Spani

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B et al. Benc

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Med PMID: 22



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Donor convers

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al. “The Critic

ed Donation”

in Organ Do

nflict: underst

an;108 Supp

national persp

PubMed PMID

f organ do

aciones.aspx (

Variability of b

008; 70:284‐2

Programmes

g diagnostic er

ion after circ

22194426.

ish experience

011(24):333‐3

chmarking in

hospitals. Am

r organ dona

2194432.


Other: (Sp

l 2 only)

Consu

diagnosis and

eports‐guidan

cuments/orga

ion in the UK:

ory determina

ndamental ro

em no guaran

er 2012.

sion rates dep

e Care Med 20

cal Pathway f

”. Transplant I

nation, 2006

tanding the e

l 1:i73‐9. Re

pective on the

: 22194427.

nation. ONT

accessed Janu

brain death de

89,

s in the Decea

rror in brain d

culatory deat

e as a leading

343.

the process o

J Transplant 2

ation in the U


ltation P

REFE

d confirmation

nce.html

ns_impact_en

: audit of inte

ation of death

ole of the inte

ntee for higher

pend on the as

010; 37:665‐6

for Deceased

nternational

‐ 2009) EU c

ethical basis f

eview. PubM

e diagnosis of

T Spain. Ava

uary 2011).

etermination

ased Donation

death. Neurolo

th. Br J Anae

g country: wh

of donation a

2012;12(9):24

UK. Br J Anae

al

Public

34

RENCES

n of death.

EC.

n.pdf

nsive care

h in organ

nsive care

r donation

ssessment

670,

Donation:

2011; 24 :

co‐funded

for organ

ed PMID:

f death. Br

ailable at

guidelines

n Process,

ogy, 2008.

esth. 2012

at kind of

after brain

498‐506

esth. 2012

COOR

2

2

2

2

2

2

2

2

2

3

3

3

3

3

3

3

3

RENOR project

21. Organs fo

Health 20

dh/@en/d

22. Price DP.

Jan;108 Su

23. Procaccio

potential d

24. Procaccio

Potential O

25. Randhawa

population

26. Sherringto

diagnosis

27. Simpson P

6. PubMed

28. Smith M. B

PubMed P

29. Sprung CL

Care Units

30. The Mad

Transplant

31. The Presid

the Pres

http://bio

(accessed

32. Vincent A,

PubMed P

33. Webb AC

hypotherm

34. Wesslau C

an analysi

care unit f

35. Wijdicks E

Neurology

36. Wijdicks E

guideline

of the Ame

37. Young GB

neurologic

DocumenVersion:

Drafting DStatus:

t 2009 11 03 –

or Transplants

008. Available

documents/di

Legal framew

uppl 1:i68‐72.

F, Barbacini

donors in the

F, Rizzato L

Organ Donati

a G. Death a

ns. Br J Anaes

on A, Barrass

of brain stem

PJ. What are t

d PMID: 2219

Brain death: t

PMID: 221944

L; Cohen SL; S

s. JAMA. 2003

drid Resolut

tation. 2011:9

dent’s Council

sident’s Cou

ethics.george

September 2

, Logan L. Con

PMID: 221944

C, Samuels O

mia. Crit Care

C, Grosse K, Kr

is of data coll

from 2002 to

EF. Brain deat

y 2002;58:20‐

EF, Varelas PN

update: deter

erican Academ

B, Shemie SD

cal determina

Coordinatorga

nt Type: FIN


– WP5 Deceas

s. A Report f

e from http://

gitalasset/dh_

work governi

Review. PubM

S, Meroni M

Veneto regio

, Ricci A, Ve

on?”. Transpl

and organ d

th. 2012 Jan;1

L, Manderslo

death. J Neur

the issues in o

4429.

time for an int

433.

jokvist P; et a

3;290:790‐797

ion on Org

91(S11) 27.

on Bioethics.

uncil on Bi

etown.edu/pc

011).

nsent for orga

436.

OB. Reversibl

Med 2011; 39

ruger R et al.

lected on dec

2005. Transpl

th worldwide:

25.

, Gronseth GS

rmining brain

my of Neurolo

D, Doig CJ, Te

tion of death.


DeNAL

– level 1 y)

Con(scie

sed Donation

from the Org

/www.dh.gov

_082120.pdf

ing deceased

Med PMID: 22

M et al. Death

on. Min Aneste

enettoni S, N

antation Proc

donation: mee

108 Suppl 1:i8

oot G, Healy

rosurg Anesth

organ donatio

ternational co

al. The Ethics

7.

gan Donatio

. Controversie

oethics 200

be/reports/de

an donation. B

le brain dea

9:1538‐42.

How large is t

ceased with p

l Int 2007, 20:

: accepted fa

S, Greer DM, A

death in adul

ogy. Neurolog

eitelbaum J.

. Can J Anaest



ntific community

– D5

gan Donation

v.uk/prod_con

organ donat

2194434.

hs with acute

esiol 2001, 67

anni Costa A

ceedings 2010

eting the ne

88‐91. Review

M. A survey

hesiol 2011; 2

on in 2012? Br

onsensus. Br J

Study. End‐of

n and Tran

es in the dete

08. Washing

eath/Controv

Br J Anaesth.

ath after car

the organ don

primary and s

:147‐55

ct but no glo

American Aca

lts: report of t

y. 2010 ;74:19

Brief review:

th 2006; 53:62


Other: (Sp

l 2 only)

Consu

Taskforce. L

nsum_dh/grou

tion in the U

e cerebral les

:71‐78

A: “Do “Silent

0, 42: 2190–21

eds of multi

. PubMed PM

on the use o

3:286.

r J Anaesth. 20

Anaesth. 201

f‐Life Practices

nsplantation.

rmination of d

ton DC, 20

ersies%20We

2012 Jan;108

rdiopulmonary

nor potential

econdary bra

bal consensus

demy of Neur

the Quality St

911‐8.

: the role of

20‐7


ltation P

London: depa

ups/dh_digita

UK. Br J Anae

sion and hea

t” Brain Dea

191.

iethnic and m

MID: 22194437

of ancillary te

012 Jan;108 S

12 Jan;108 Su

s in European

(WHO con

death: a white

008. Availab

eb%20%282%

8 Suppl 1:i80‐7

y arrest and

in Germany?

ain damage in

s in diagnost

rology. Evide

tandards Subc

f ancillary tes

al

Public

35

rtment of

alassets/@

esth. 2012

rt‐beating

ths Affect

multi‐faith

7.

ests in the

Suppl 1:i3‐

ppl 1:i6‐9.

n Intensive

nsultation)

e paper of

ble from

29.pdf

7. Review.

d induced

Results of

intensive

ic criteria.

nce‐based

committee

sts in the

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of donors or

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45