Projects – Organ Donation and Transplantation

I am the current holder of the Bertram Loeb Chair. In 2003, the Bertram Loeb Organ & Tissue Donation Institute (BLOTDI) made a generous gift to the University of Ottawa to support the creation of this research chair focused on the ethical and social issues surrounding organ and tissue donation.

Bertram Loeb was a well-known Ottawa philanthropist and business owner who helped to create BLOTDI in January 2002. “I wanted the money to be used to fund public and professional education and awareness resulting in an increase in the rate of organ and tissue donations for transplantation in Canada,” said Mr. Loeb. The inaugural Chair was Dr. Sam D. Shemie, a Canadian pediatric critical care physician and leader in the fields of medicine and policy surrounding organ and tissue donation. Dr. Shemie continues to lead in the field as the Medical Advisor for deceased organ donation at Canadian Blood Services.

The Bertram Loeb Chair supports a stream of research devoted to the ethics, law and public policy considerations of advanced biomedical technologies in the areas of organ donation and transplantation and in the brain sciences. The vision is to develop novel ideas that expand our understanding of the social impact and role of these technologies, as well as to develop practical knowledge to help stakeholders use them to best promote the well-being of people.

The Chair's research is collaborative and multidisciplinary, benefiting from the participation of clinical experts, policy-makers, and diverse experts from sciences, social sciences and humanities. A key role for the Chair is to support the development of excellent students to become the thinkers and policy leaders of the future.

Canadian family experiences with donation after cardiac death (DCD)

This project involves 40 interviews with Canadian families who had to make the decision to withdraw ventilation from a family member with devastating neurological injuries, and then to also decide whether or not to attempt organ donation following cardiac death. This project explores family experiences relating to decision-making, withdrawal of ventilation and attempted organ donation. The objective is to understand family experiences and to determine what might be done to support families. The research team includes physicians, lawyers, and social scientists.

Premortem interventions in donation after cardiac death (DCD)

This project looks at the whole spectrum of interventions that may be undertaken before death to try to (a) preserve donation opportunity or (b) improve transplant outcomes after donation. The challenge of these premortem interventions (PMIs) is that they are performed prior to death, but are not for the direct medical benefit of the patient. This project probes the ethical and legal considerations that arise in this context. It involves a systematic scoping review of the ethico-legal literature, as well as a set of interviews with nurses and physicians practising in critical care and emergency medicine.

The neurophysiology of the dying process, and the determination of death (NeuPaRT)

This project (PI: Marat Slessarev, Western University) looks at the electrophysiology of the brain during the process of dying after withdrawal of ventilation. The objective is to understand the process and timing of loss of brain function at that time, and to understand its relationship to other indicators such as cardio-circulatory function. These physiological parameters are important to the legal definition of death. They are also important for the safe and ethical practice of organ donation following death. The legal work, conducted in collaboration with Dean Erika Chamberlain (Western University) is analyzing the legal significance of this physiological information.

The impact of opt-out (presumed consent) systems on organ donation in Nova Scotia

This Health Canada funded project (PI: Matthew-John Weiss, Université Laval and Steven Beed, Nova Scotia Health) is entitled “Legislative Strategies to Improve Deceased Organ Donation in Canada: A special focus on evaluating the impact of opt-out legislation in Nova Scotia.” The Chair is contributing to this work through examination of different legal approaches to opt-out or presumed consent systems for organ donation, as well as an ethical and legal assessment of the implications of moving to this approach.

Policy – Organ Donation and Transplantation

As the Bertram Loeb Chair, I participate in multiple policy initiatives relevant to organ donation and transplantation. Ongoing activities are listed below:

  • Chair, Ethics Committee, Canadian Society of Transplantation
    The Ethics Committee works on public policy statements on ethics issues related to transplantation in Canada. Most recently the Committee has developed a White Paper on ethical and legal considerations for alcohol and cannabis use in solid organ listing and allocation.
  • Co-Lead, Legal/Ethics Working Group, Guideline Development: A Brain-Based Definition of Death and Criteria for its Determination after Arrest of Circulation and Neurologic Function (Canadian Blood Services, Canadian Critical Care Society and Canadian Medical Association)
    The ethics and legal working group is co-led by Prof Jennifer A Chandler and Dr. Christy Simpson, Dalhousie University. We are examining the ethical and legal issues raised by the development of a new definition of death and criteria for its determination. The project kicked off in November 2020, and is expected to continue for 18 months.
  • Member, Legal/Ethics Working Group, Rapid Response Recommendations for COVID-19 and Organ and Tissue Donation and Transplantation (Canadian Blood Services, Canadian Donation and Transplantation Research Program and the Canadian Society of Transplantation)
    This initiative launched in the spring, 2020, in response to the pandemic to provide evidence-based expert recommendations that are updated as evidence evolves, as well as to identify knowledge gaps and research needs.
  • Member, Alcohol Use in Liver Transplantation Steering Committee (Canadian Society of Transplantation, Canadian Transplant Liver Network)
    This group was created in March 2020 to develop a Canadian consensus policy on alcohol abstinence requirements prior to liver transplantation.
  • Member, TGLN Bioethics Advisory Group, Trillium Gift of Life Network of Ontario
    Through periodic meetings, this group offers bioethics advice on issues related to organ and tissue donation and transplantation in Ontario.