Pediatric organ donation: A national survey examining consent rates and characteristics of donor hospitals*

Webster, Patricia A.; Markham, Lori

doi:10.1097/pcc.0b013e318198b06b

Cited by 33 publications

(38 citation statements)

References 12 publications

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“…Due to lack of data on eligible deaths, consent rates (i.e., percentage of eligible donors who are consented) cannot be determined. Webster and colleagues (28) report consent rates of 69.2% for pediatric donors in the U.S. If we assume that all patients in our study whose families were asked to donate were indeed eligible donors, our findings suggest that our overall consent rate is low; however, it is also possible that some families were asked about their willingness to donate before full evaluation and subsequently their child was determined to be ineligible.…”

Section: Discussionmentioning

confidence: 71%

“…If we assume that all patients in our study whose families were asked to donate were indeed eligible donors, our findings suggest that our overall consent rate is low; however, it is also possible that some families were asked about their willingness to donate before full evaluation and subsequently their child was determined to be ineligible. In Webster’s report (28), hospitals with level I trauma programs and pediatric critical care medicine fellowship programs had higher numbers of eligible donors and higher consent rates than hospitals without these programs. All CPCCRN clinical centers have level 1 trauma programs and pediatric critical care fellowship programs; thus the presence or absence of these programs does not account for the variability in organ donation practices observed across sites.…”

Section: Discussionmentioning

confidence: 99%

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End-of-Life Practices Among Tertiary Care PICUs in the United States

Meert

Keele

Morrison

et al. 2015

Pediatric Critical Care Medicine

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Objective To describe variability in end-of-life practices among tertiary care pediatric intensive care units (PICUs) in the U.S. Design Secondary analysis of data prospectively collected from a random sample of patients (n=10,078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network (CPCCRN) between December 4, 2011 and April 7, 2013. Setting Seven clinical centers affiliated with the CPCCRN Patients Patients included in the primary study were <18 years of age, admitted to a PICU, and not moribund on PICU admission. Patients included in the secondary analysis were those who died during their hospital stay. Interventions None. Measurements and Main Results Two hundred and seventy-five (2.7%, range across sites 1.3%–5.0%) patients died during their hospital stay; of these, 252 (92%, 76%–100%) died in a PICU. Discussions with families about limitation or withdrawal of support occurred during the initial PICU stay for 173 (63%, 47%–76%, p=0.27) patients who died. Of these, palliative care was consulted for 67 (39%, 12%–46%); pain service for 11 (6%, 10 of which were at a single site); and ethics committee for 6 (3%, from 3 sites). Mode of death was withdrawal of support for 141 (51%, 42%–59%), failed CPR for 53 (19%, 12%–28%), limitation of support for 46 (17%, 7%–24%), and brain death for 35 (13%, 8%–20%); mode of death did not differ across sites (p=0.58). Organ donation was requested from 101 (37%, 17%–88%, p<0.001) families. Of these, 20 (20%, 0%–64%) donated. Sixty-two (23%, 10%–53%, p<0.001) deaths were medical examiner cases. Of non-medical examiner cases (n=213), autopsy was requested for 79 (37%, 17%–75%, p<0.001). Of autopsies requested, 53 (67%, 50%–100%) were performed. Conclusions Most deaths in CPCCRN-affiliated PICUs occur after life support has been limited or withdrawn. Wide practice variation exists in requests for organ donation and autopsy.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

End-of-Life Practices Among Tertiary Care PICUs in the United States

Meert

Keele

Morrison

et al. 2015

Pediatric Critical Care Medicine

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“…93,97 The Uniform Determination of Death Act (UDDA), released in 1981, helped establish what is known as the “Dead Donor Rule,” which states that “vital organs should only be taken from dead subjects and, correlatively, living subjects must not be killed by organ retrieval.” However, the UDDA did not adequately discuss the unique aspects of declaring brain death in infants and children. 98 Subsequently, the guidelines for the determination of brain death in children were published in 1987, and updated in 2011.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life and Bereavement Care in Pediatric Intensive Care Units

Suttle

Jenkins

Tamburro

2017

Pediatric Clinics of North America

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Most childhood deaths in the United States occur in hospitals and the majority of these in intensive care settings. Pediatric intensive care unit (PICU) clinicians must anticipate, identify and effectively treat the dying child’s pain and suffering, as well as support the psychosocial and spiritual needs of the child and their family. Such timely therapy and support may facilitate comfort and a peaceful death, and also help family members adjust to their loss. Effective communication that is candid and compassionate is paramount to successful end of life (EOL) care, as is creating an environment that encourages parent participation in their child’s care and fosters meaningful family interactions. Despite these supportive efforts, parents whose children die often experience reduced mental and physical health during bereavement. Finally, many ethical issues surround EOL care in the PICU, and as such, several professional societies have published recommendations and policies addressing these issues. PICU clinicians should stay current on these recommendations and policies and maintain a working understanding of their implications.

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“…While it might be argued that many of the reasons for lower consent rates in UK child organ donation compared with other countries are societal,7 it is also the case that organ donation organisations place strong emphasis on training and competency for staff who raise the possibility of donation with bereaved families.…”

Section: Introductionmentioning

confidence: 99%