Neurologic Physiology after Removal of Therapy (NeuPaRT) study: study protocol of a multicentre, prospective, observational, pilot feasibility study of neurophysiology after withdrawal of life-sustaining measures.

INTRODUCTION: In donation after circulatory determination of death, death is declared 5 min after circulatory arrest. This practice assumes, but does not explicitly confirm, permanent loss of brain activity. While this assumption is rooted a strong physiological rationale, paucity of direct human data regarding temporal relationship between cessation of brain activity and circulatory arrest during the dying process threatens public and healthcare provider trust in deceased organ donation. METHODS AND ANALYSIS: In this cohort study, we will prospectively record cerebral and brainstem electrical activity, cerebral blood flow velocity and arterial blood pressure using electroencephalography (EEG), brainstem evoked potentials, transcranial doppler and bedside haemodynamic monitors in adult patients undergoing planned withdrawal of life sustaining measures in the intensive care units at five hospital sites for 18 months. We will use MATLAB to synchronise waveform data and compute the time of cessation of each signal relative to circulatory arrest. Our primary outcome is the feasibility of patient accrual, while secondary outcomes are (a) proportion of patients with complete waveform recordings and data transfer to coordinating site and (b) time difference between cessation of neurophysiological signals and circulatory arrest. We expect to accrue 1 patient/site/month for a total of 90 patients. ETHICS AND DISSEMINATION: We have ethics approval from Clinical Trials Ontario (protocol #3862, version 1.0, date 19 January 2022.) and the relevant Research Ethics Board for each site. We will obtain written informed consent from legal substitute decision makers. We will present study results at research conferences including donor family partner forum and in peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT05306327.

Controlled Donation After Circulatory Determination of Death: A Scoping Review of Ethical Issues, Key Concepts, and Arguments.

Controlled donation after circulatory determination of death (cDCDD) is an important strategy for increasing the pool of eligible organ donors.

Canada's new drug-impaired driving law: the need to consider other approaches.

OBJECTIVE: The objects of this study were: To review the state of drug-impaired driving in Canada, particularly in light of the 2008 amendments to the Criminal Code, which authorized police to demand standardized field sobriety testing and drug recognition evaluations, and to consider whether alternative enforcement models would be more effective in terms of detecting and prosecuting drug-impaired drivers and thereby achieve greater deterrence. METHOD: This article provides a review of survey data, roadside screening studies, and postmortem reports that indicate the prevalence of driving after drug use in Canada. It evaluates the Criminal Code's 2008 amendments and their impact on charges and convictions for drug-impaired driving. It then reviews some alternative enforcement models for drug-impaired driving that have been adopted in other jurisdictions, particularly toxicological testing, and evaluates them against Canada's social, political, and constitutional framework. RESULTS: Survey data, roadside screening studies, and postmortem reports indicate that driving after drug use is commonplace and is now more prevalent among young people than driving after drinking. Unfortunately, the 2008 Criminal Code amendments have not had their desired effects. The measures have proven to be costly, time-consuming, and cumbersome, and are readily susceptible to challenge in the courts. Accordingly, the charge rates for drug-impaired driving remain extremely low, and the law has had minimal deterrent effects. The review of alternative enforcement models suggests that a system of random roadside saliva screening, somewhat similar to the model used in Victoria, Australia, will be the most effective in terms of detecting and prosecuting drug-impaired drivers and most consistent with Canada's legal and constitutional system. CONCLUSIONS: Canada should establish per se limits for the most commonly used drugs, enforceable through a system of screening and evidentiary tests. This will be more efficient and cost-effective and will result in more reliable evidence for criminal trials. Although this system will inevitably be subject to constitutional challenge, existing case law suggests that it should be upheld as a reasonable limit on constitutional rights.

Minimizing impairment-related youth traffic deaths: the need for comprehensive provincial action.

Despite the progress made between the early 1980s and the mid-1990s, traffic crashes remain the single largest cause of death among 15-24 year-old Canadians. In recent years, approximately 45% of these deaths have been alcohol-related and, no doubt, additional youth crash deaths are drug-related. While young people are significantly overrepresented in impairment-related deaths as drivers, their overrepresentation is even greater as passengers, pedestrians, bicyclists, and users of recreational vehicles. These crashes are not simply a function of young people's immaturity and lack of driving experience; they also reflect young people's hazardous patterns of alcohol and drug use. Under the Canadian constitution, the provinces have extensive legislative authority over driver and vehicle licensing, traffic enforcement, liquor licensing, and off-premise alcohol sales. Moreover, research in Canada and abroad has identified legislative initiatives that can significantly reduce impairment-related youth traffic deaths. Consequently, the provinces are well positioned to protect Canadian youth from such preventable harm. The provinces need to adopt a broad approach, including a comprehensive graduated licensing program, a zero blood-alcohol restriction on drivers under 21, enhanced police powers, and more rigorous enforcement of the existing licensing legislation.