Donation after cardiac death in pediatric critical care*

Kolovos, Nikoleta S.; Webster, Patricia A.; Bratton, Susan L.

doi:10.1097/01.pcc.0000256624.08878.40

Cited by 29 publications

(19 citation statements)

References 12 publications

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“…The reasons for this discrepancy are not entirely clear, although concern for decreased graft survival in the 1990s foradult DCDD liver transplant recipients has been noted. 15 More recent studies suggest that for both pediatric and adult recipients, graft and patient survival for DCDD kidney and liver transplants is equivalent to DNDD organs. 23,24,[43][44][45][46] Perhaps as DCDD becomes a more common practice, children will directly benefit from organs recovered by this method of donation.…”

Section: Figurementioning

confidence: 99%

“…Although it remains a secondary pathway to donation, DCDD has become an accepted way of recovering more organs for transplantation and is contributing to the national pool of donor organs. Advances in DCDD have been challenging for potential pediatric donors for several reasons, including: limited health professional experience and comfort; lack of standardized protocols 15 ; concern for potential compromised DCDD graft survival 16,17 ; and amplified ethical concerns, including parental emotions surrounding unanticipated, often traumatic, death that create a highly charged and potentially conflicted environment, which can be a burden to grieving families. 18,19 Although most national standards for DCDD programs and protocols were developed for adults, children comprise a critical percentage of those waiting and dying on the transplant list, and potential pediatric donors are often lost to the donor pool.…”

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confidence: 99%

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Pediatric Organ Donation and Transplantation

et al. 2013

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BACKGROUND AND OBJECTIVES: There is increasing unmet need for solid organ donation. Alternative donor sources, such as donation after circulatory determination of death (DCDD), are needed. The objective of this study was to examine the impact of DCDD on trends in pediatric organ donation and transplantation. METHODS: Data were obtained from the Organ Procurement and Transplantation Network for US organ recipients and donors from 2001 to 2010 stratified according to age, organ, and deceased donor type (DCDD or donation after neurologic determination of death). Additional data included transplant wait-list removals due to death. RESULTS: From 2001 to 2010, pediatric organ transplant recipients increased from 1170 to 1475. Organs from DCDD donors were transplanted into children infrequently but increased from 1 to 31. Pediatric donation after neurologic determination of death decreased by 13% whereas DCDD increased by 174% (50 to 137). Recipients of pediatric grafts decreased from 3042 to 2751. Adults receiving grafts from pediatric donors decreased from 2243 to 1780; children receiving pediatric grafts increased from 799 to 971. Transplant recipients receiving pediatric DCDD grafts were few but increased annually from 50 to 128 adults and 0 to 9 children. Pediatric candidates dying waiting for an organ decreased from 262 to 110. CONCLUSIONS: From 2001 to 2010, children received more solid organ transplants and fewer children died waiting. Organ recovery from pediatric and adult DCDD donors increased. The number of pediatric recipients of DCDD grafts remains small. Adults primarily receive the direct benefit from pediatric DCDD but other changes in organ allocation have directly benefited children.

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Section: Figurementioning

confidence: 99%

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confidence: 99%

Pediatric Organ Donation and Transplantation

et al. 2013

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“…Our findings should be seen as a first rough indication of the pediatric DCD potential in the Netherlands, since donation after circulatory death is a relatively new topic that raises new questions about the identification of potential donors and about medical doctors’ attitudes toward donation [15]. We and others believe that it is important to present the option of DCD to families [17].…”

Section: Discussionmentioning

confidence: 92%

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

Siebelink

Albers

Roodbol³

et al. 2012

Transplant International

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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.

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“…The majority of the papers emphasised the importance of the first step in the donation process: timely identification of potential donors in the PICU and timely referral to an organ procurement organisation to increase organ donation rates .The need for improved identification and timely referral of potential donors in neonatal intensive care units (NICUs) was highlighted in two papers . Antommaria et al.…”

Section: Resultsmentioning

confidence: 99%

“…Most authors agreed that the process of delivering the bad news about the child's anticipated death and the question of organ donation must be separated . The majority of the authors referred to donation as an opportunity for grieving families to obtain solace, hope and comfort during a terrible time . Sarnaik also emphasised the importance of supporting the patient's and family's interests without considering any potential benefit to others.…”

Section: Resultsmentioning

confidence: 99%

Literature overview highlights lack of paediatric donation protocols but identifies common themes that could guide their development

2018

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AimPaediatric donation is a unique and extremely sensitive process that requires specific knowledge and competencies. Most countries use protocols for organ and tissue donation to ensure optimal care for the donor and family, but these mainly focus on adults. However, the donation process for children differs from adults in many ways. An overview of the literature was performed to identify protocols for the paediatric population.MethodsPubMed, Web of Science, EMBASE and the Internet were searched up to March 2016 for papers or other sources in English related to specific organ and tissue donation protocols for children and neonates. This comprised title, abstract and then full‐text screening of relevant data.ResultsWe included 12 papers and two electronic sources that were mainly from North America and Europe. Most discussed donations after cardiac death. The recurring themes included identifying potential donors, approaching parents, palliative care and collaboration with organ procurement organisations. Most papers called for paediatric donation policies to be standardised.ConclusionScientific publications in English on paediatric donation protocols are very scarce. No comprehensive paediatric donation protocol was found. We identified several recurring themes in the literature that could be used to develop such protocols.

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Donation after cardiac death in pediatric critical care*

Cited by 29 publications

References 12 publications

Pediatric Organ Donation and Transplantation

Pediatric Organ Donation and Transplantation

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

Literature overview highlights lack of paediatric donation protocols but identifies common themes that could guide their development

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