Impact of a pediatric donation after cardiac death program

Pleacher, Kristine M.; Roach, Elizabeth; Werf, Willem Van der; Antommaria, Armand H. Matheny; Bratton, Susan L.

doi:10.1097/pcc.0b013e318194800b

Cited by 43 publications

(24 citation statements)

References 22 publications

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“…The only study thus far that determined a PICU DCDD consent rate found it to be 53% at 1 center. 17 We found a wide range of consent rates for donation activity in our region. These rates varied from 38% (DCDD consent rate at regional PICUs) to 68% (consent rate for donation after brain death in our PICU).…”

Section: Discussionmentioning

confidence: 75%

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Hanley¹,

Kim

Willey

et al. 2014

Pediatrics

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BACKGROUND: Over 96 000 patients await kidney transplantation in the United States, and 35 000 more are wait-listed annually. The demand for donor kidneys far outweighs supply, resulting in significant waiting list morbidity and mortality. We sought to identify potential kidney donors among newborns because en bloc kidney transplantation donation after circulatory determination of death (DCDD) may broaden the donor pool. METHODS: We reviewed discharges from our 84-bed NICU between November 2002 and October 2012 and identified all deaths. The mode of death among potential organ donors (weight ≥1.8 kg) was recorded. Patients undergoing withdrawal of life support were further evaluated for DCDD potential. After excluding patients with medical contraindications, those with warm ischemic time (WIT) less than 120 minutes were characterized as potential kidney donors. RESULTS: There were 11 201 discharges. Of 609 deaths, 359 patients weighed ≥1.8 kg and 159 died after planned withdrawal of life support. The exact time of withdrawal could not be determined for 2 patients, and 100 had at least 1 exclusion criterion. Of the remaining patients, 42 to 57 infants were potential en bloc kidney donors depending on acceptance threshold for WIT. Applying a 40% to 70% consent rate range would yield 1.7 to 4 newborn DCDD donors per year. CONCLUSIONS: A neonatal DCDD kidney program at our institution could provide 2 to 4 paired kidneys for en bloc transplantation each year. Implementing a DCDD kidney donation program in NICUs could add a new source of donors and increase the number of kidneys available for transplantation.

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Section: Discussionmentioning

confidence: 75%

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Hanley¹,

Kim

Willey

et al. 2014

Pediatrics

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“…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%

“…22 Conversely, the development of a DCDD protocol at a single pediatric transplant center increased donor rates by .50%. 23 In addition, recent data suggest that longterm recipient and graft survival for both pediatric kidney and liver transplants with the use of DCDD donors may be equivalent to DNDD organs. 24,25 Pediatric DCDD donors are an important component to increasing the donor pool, but it is unclear how these organs are being used on a national level.…”

mentioning

confidence: 99%

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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“…Recent estimates suggest that DCD could increase the supply of transplantable organs by 20%. 6 A number of subsequent reports and consensus statements have addressed points of controversy, such as the waiting period before the declaration of death and the use of premortem interventions to improve graft function. [7][8][9][10] More recent pediatric studies reporting similar graft survival in kidneys and livers from donors declared dead according to neurologic and cardiovascular criteria have further increased interest in DCD.…”

Section: Introductionmentioning

confidence: 99%

Ethical Controversies in Organ Donation After Circulatory Death

Antommaria¹,

Fallat²,

Katz³

et al. 2013

Pediatrics

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The persistent mismatch between the supply of and need for transplantable organs has led to efforts to increase the supply, including controlled donation after circulatory death (DCD). Controlled DCD involves organ recovery after the planned withdrawal of life-sustaining treatment and the declaration of death according to the cardiorespiratory criteria. Two central ethical issues in DCD are when organ recovery can begin and how to manage conflicts of interests. The “dead donor rule” should be maintained, and donors in cases of DCD should only be declared dead after the permanent cessation of circulatory function. Permanence is generally established by a 2- to 5-minute waiting period. Given ongoing controversy over whether the cessation must also be irreversible, physicians should not be required to participate in DCD. Because the preparation for organ recovery in DCD begins before the declaration of death, there are potential conflicts between the donor’s and recipient’s interests. These conflicts can be managed in a variety of ways, including informed consent and separating the various participants’ roles. For example, informed consent should be sought for premortem interventions to improve organ viability, and organ procurement organization personnel and members of the transplant team should not be involved in the discontinuation of life-sustaining treatment or the declaration of death. It is also important to emphasize that potential donors in cases of DCD should receive integrated interdisciplinary palliative care, including sedation and analgesia.

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Impact of a pediatric donation after cardiac death program

Abstract: Although a small percentage of dying patients are eligible for and will undergo DCD, such a program can markedly increase the number of organ donors at a children's hospital.

Cited by 43 publications

References 22 publications

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

Pediatric Organ Donation and Transplantation

Ethical Controversies in Organ Donation After Circulatory Death

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