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Neurologic Physiology After Removal of Therapy

NeuPART

1

PURPOSE

The purpose of the NeuPaRT study is to evaluate the feasibility of using multimodal neuromonitoring, including EEG, transcranial Doppler, and evoked potentials, to assess the timing of brain activity cessation in relation to circulatory arrest during planned withdrawal of life-sustaining measures in the ICU. By capturing synchronized neurophysiological and hemodynamic data, the study aims to improve understanding of brain function at the end of life and support ethically sound practices in organ donation after circulatory determination of death (DCDD).

2

PROGRESS

104

140

patients enrolled

(as of Oct. 2025)

3

FUTURE

Findings from this feasibility study will inform the design of a larger multicentre observational trial aimed at validating the temporal relationship between brain activity cessation and circulatory arrest. If successful, this future research could strengthen clinical guidelines for death determination in DCDD, enhance donor protection, and build public trust in organ donation processes. The expanded study will also explore variability across ICU settings, contributing to more consistent and evidence-based end-of-life care.

What is NeuPART?

NeuPART is a multicentre trial aiming to determine when brain function stops compared to when the heart stops by monitoring electrical brain activity in patients who are taken off life support and progress to death in the ICU.

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Why is this important?

In the past, organ donation was only possible after brain death, however, in response to a large need for organs a type of organ donation called "donation after circulatory determination of death" is now being conducted. It occurs when a person who is severely ill, is breathing with the help of a ventilator, and a decision is made to take them off the ventilator. At this time, the family may be asked if they would agree to have their family member become an organ donor. If the family agrees, when the ventilator is removed and the patient's heart stops, 5 minutes after they have been declared dead, their organs are removed and transplanted into other patients who need them.

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What is involved in the study?

During this study the NeuPART team will monitor 2/4 of the following: video-electroencephalogram to measure brain waves (Figure 1.), a transcranial doppler ultrasound to examine the blood flow in the brain (Figure 2.), evoked potentials to measure brainstem function, and event-related potentials to assess the possibility of a conscious experience (Figure 3.). 

EEG-01.png
TCD3-01.png
Figure 1. Video-EEG
Figure 2. Transcranial Doppler
BAEP5 final1-01.png
SSEP5-01.png
Figure 3. Evoked and Event-Related Potentials

How did we get here?

DePPaRT

Jan 2021

In our international study, we looked at what happens to the heart after life support is withdrawn in critically ill patients. Surprisingly, we found that in about 1 in 7 cases, the heart briefly restarted on its own- even after it had stopped beating. This activity was usually very short and not noticeable without special equipment. While rare, these findings help confirm that current organ donation practices are safe and scientifically sound, and they give us new insight into how the body shuts down at the end of life.

Neuro-DePPaRT

June 2025

In this study, we closely monitored patients in the ICU as life support was withdrawn to better understand how the brain and heart shut down. We found that brain blood flow always stopped before or at the same time as the heart stopped, and brain activity ended shortly after blood flow ceased. These findings support current guidelines for determining death and reassure us that patients are beyond suffering before organ donation begins. Our work also helps address ethical concerns around newer donation practices by showing that brain function has already ended before any interventions take place.

NeuPART

Present

In our ongoing NeuPaRT study, we’re working with ICUs across Canada to better understand what happens in the brain during the dying process after life support is withdrawn. Using advanced brain monitoring tools, we’re measuring brain activity and blood flow in real time to determine exactly when these functions stop in relation to the heart. Our goal is to ensure that current organ donation practices are safe, ethically sound, and based on solid scientific evidence. This research is helping build trust with families, healthcare providers, and the public.

Check out NeuPaRT's site

Meet the NeuPaRT Team and more!

Making Headlines

Publications

2024

  • Murphy NB; Shemie SD; Capron A; Truog R; Nakagawa T; Healey A; Gofton T; Bernat JL; Fenton K; Khush K; Schwartz B; Wall SP. Advancing the scientific basis for determining death in controlled organ donation after circulatory determination of death. Transplantation. 2024. In press.

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2023

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2022

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2021

  • Murphy N, Weijer C. Grey matter: The problems of incidental findings in neuroimaging research. The Journal of Law, Medicine & Ethics 2021; 49: 282-284. 

  • Murphy N, Weijer C, Smith M, Chandler J, Chamberlain E, Gofton T, Slessarev M. Controlled donation after circulatory determination of death: A scoping review of ethical issues, key concepts, and arguments. Journal of Law, Medicine & Ethics 2021; 49(3): 418-440 

  • Basmaji J, Weijer C, Skaro A, Healey A, Shemie SD, Slessarev M. Paving the road for the adoption of normothermic regional perfusion in Canada. Critical Care Explorations 2021; 3(11): e0553. 

  • Murphy NB; Weijer C. Grey matter: The problems of incidental findings in neuroimaging research. The Journal of Law, Medicine and Ethics. 2021; 49:282-284. 

Protocol

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