Children as donors: a national study to assess procurement of organs and tissues in pediatric intensive care units

Abstract

Summary A shortage of size‐matched organs and tissues is the key factor limiting transplantation in children. Empirical data on procurement from pediatric donors is sparse. This study investigated donor identification, parental consent, and effectuation rates, as well as adherence to the national protocol. A national retrospective cohort study was conducted in all eight Dutch pediatric intensive care units. Records of deceased children were analyzed by an independent donation officer. Seventy‐four (11%) of 683 deceased children were found to be suitable for organ donation and 132 (19%) for tissue donation. Sixty‐two (84%) potential organ donors had been correctly identified; the parental consent and effectuation rate was 42%. Sixty‐three (48%) potential tissue donors had been correctly identified; the parental consent and effectuation rate was 27%. Correct identification increased with age (logistic regression, organs: P = .024; tissues: P = .011). Although an overall identification rate of 84% of potential organ donors may seem acceptable, the variation observed suggests room for improvement, as does the overall low rate of identification of pediatric tissue donors. Efforts to address the shortage of organs and tissues for transplantation in children should focus on identifying potential donors and on the reasons why parents do not consent.

A Comparison of the Request Process and Outcomes in Adult and Pediatric Organ Donation

“…4 Inquiry into the pediatric donation process and the specific factors influencing parental donation decisions should therefore be considered a national imperative. 5,6 Research to date has suggested that a number of factors affect parental authorization, including knowledge of organ donation and favorable donation attitudes. [6][7][8][9][10] For example, exposure to organ donation information, such as adequate knowledge of brain death, significantly predicts a favorable donation decision.…”

Challenges of paediatric organ donation

“…Recognition of the potentially suitable donor can be challenging. A Dutch study of eight PICU's demonstrated a variation in their abilities to identify suitable donors from 60 to 90% . Other conditions such as severe sepsis, metabolic conditions, genetic abnormalities, previous malignancy or congenital heart disease are likely to represent the majority of those considered unsuitable, although data to support this are lacking.…”

“…Decision makers for both adults and children consent relatively equally and the depth and detail of the donation discussion is associated with higher consent rates . Consent rates in Europe, North America, the UK and Australia for both adults and children range from 42 to 69% . In Australia, the rate is similar for adult (52.8%) and paediatric (50%) patients…”

“…30 Consent rates in Europe, North America, the UK and Australia for both adults and children range from 42 to 69%. 7,29,[31][32][33][34][35] In Australia, the rate is similar for adult (52.8%) 33 and paediatric (50%) patients. 32 The Australian Organ Donor Register is the only national register for people to record their decision about becoming an organ and tissue donor after death.…”

Najmłodsi dawcy narządów – opis przypadków oraz analiza problemu w Polsce

“…z obawy przed jeszcze większym obciążeniem emocjonalnym rodziców będących już w żałobie. Okazuje się, że pediatrzy (również za granicą) często nie są świadomi możliwości zakwalifikowania zmarłego dziecka jako dawcy narządów, co dodatkowo zmniejsza liczbę pobrań w tej grupie wiekowej [12]. Niestety psychologiczny aspekt pobrań od zmarłych dzieci nie jest tematem powszechnie poruszanym w krajowych publikacjach.…”