Canadians’ perceptions about heart donation after death by circulatory criteria: a mixed methods study

PurposeCardiac donation after death determination by circulatory criteria (DCC) can be performed using either direct procurement and perfusion (DPP) or normothermic regional perfusion (NRP). If broadly implemented in Canada, these procedures have the potential to reduce the cardiac transplant wait list. We aimed to evaluate the perspectives of Canadians on cardiac DCC.MethodsWe performed a convergent design mixed methods study involving 21 focus groups and surveys of 109 adults in Canada on the topic of cardiac DCC.ResultsWe found that participants were broadly supportive of both cardiac DCC protocols. Principle concerns about DPP included relatively impaired heart quality, while concerns about NRP included the perception that the procedure may be invasive and may not be acceptable to other Canadians, including donor families. Participants who self-identified as second-generation immigrants were concerned about potential lack of support for cardiac DCC, especially NRP, by other Canadians. Participants suggested strategies to increase support for organ donation and cardiac DCC specifically, including mass media campaigns, educational initiatives, encouraging the public to discuss end-of-life wishes with family members, and enlisting primary care providers and community leaders to advance public knowledge and support.ConclusionsIn this mixed methods study of people living in Canada, we found broad support for cardiac DCC. Concerns were primarily related to heart quality in DPP and perceived invasiveness of NRP. Participants identified mass media campaigns, educational material, and engagement of primary care providers and community leaders as strategies to garner support for cardiac DCC.