Eligible neonatal donors after circulatory determination of death (Maastricht type III): A national survey of level III NICUs

Abstract

Background: Organ donation continues to increase worldwide, but in general paediatric patients remain less likely to receive a transplant. The inclusion of neonates as donors after cDCD should be considered in an effort to increase donation rates. Methods:The survey for a cross-sectional national study of potential cDCD neonatal donors (Maastricht type III) was sent to all 90 level III Spanish neonatal units to explore: 1) protocols, education, and specific opinions on donation and 2) potential cDCD that could have been eligible over a 2-year period (2014)(2015).Results: Forty-five centers (50%) completed the survey, and 38/45 gave information about potential eligible donors. In 16% of the centers specific protocols on neonatal donation exist. All hospitals demanded more specific training, and 65% noted that the donation process could be a problem in the family's dismissal of the child.During the study period 46 805 neonates were admitted in the 38 centers, and 625 neonates died. Ninety-five born at a gestational age ≥34 weeks and above 2000 gr died after an EoL decision, 38 (40%) and 13 (14%) of them due to neonatal encephalopathy and multiple congenital anomalies, respectively. There were 31 (33%) elegible infants who died in less than 120 min due to pathologies that did not contraindicate donation.Conclusions: Neonatal cDCD could help to reduce the gap between the supply of and demand for organs according to the potentially eligible patients emerging from this study. Training in EoL and donation processes should be provided to healthcare professionals.

Implementation of a neonatal donation protocol in the neonatal intensive care unit: A single‐center experience

“…A recently published study of 90 Spanish NICUs over a 1‐year period found that 31 newborns could have been potential neonatal donors if they had been timely identified and referred. By contrast, only two potential donors were referred, resulting in a total of zero neonatal organ or tissue donations 5 . Therefore, we consider that, despite the low number of potential neonatal donors referred to the OPO from our NICU, each potential neonatal donor who may become an effective organ or tissue donor, could have a significant clinical impact on infants’ waiting list mortality.…”

“…Most published studies on neonatal donation consider eligible for neonatal organ donation those newborns with a minimum gestational age of 34 weeks and a minimum birth weight of 2 kg 3,5,6,27,28 . However, there are no universally accepted criteria for neonatal organ and tissue donation and each local OPO has its own criteria.…”

“…16 Most published studies on neonatal donation consider eligible for neonatal organ donation those newborns with a minimum gestational age of 34 weeks and a minimum birth weight of 2 kg. 3,5,6,27,28 However, there are no universally accepted criteria for neonatal organ and tissue donation and each local OPO has its own criteria. Therefore, we suggest an approach to neonatal donation in a case-by-case and organ-by-organ basis, assessing individually with the donation specialist and the OPO before discarding a potential neonatal organ donor solely on the basis of weight or gestational age, since the smallest known donor of en bloc kidneys after DCC weighed 1800 g. 29 A decisive factor influencing suitability for organ donation is the WIT.…”

“…5 Therefore, we consider that, despite the low number of potential neonatal donors referred to the OPO from our NICU, each potential neonatal donor who may become an effective organ or tissue donor, could have a significant clinical impact on infants' waiting list mortality. This study by Caserío et al 5 should be present at these discussions, as data from the pediatric donation literature suggest that family authorization rates increase when a competent and trusted member of the healthcare team and a donation specialist discuss the possibility of donation with the family. 16 Most published studies on neonatal donation consider eligible for neonatal organ donation those newborns with a minimum gestational age of 34 weeks and a minimum birth weight of 2 kg.…”

“…2,4 In this regard, a recent study involving 90 Spanish level III NICUs found that only 16% of the centers had specific neonatal donation protocols and 100% of the NICUs expressed the need for more staff training on neonatal donation. 5 In January 2019, we identified in our NICU an opportunity for improvement of neonatal end-of-life care practices, following a failed donation experience of a 15-day-old newborn with catastrophic brain damage secondary to group B streptococcal sepsis-meningitis. This newborn was unable to become an effective donor due to our inexperience and the lack of national guidelines for neonatal donation after cardiocirculatory determination of death.…”