Pediatric Organ Donation and Transplantation

Abstract

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.

Identifying Potential Kidney Donors Among Newborns Undergoing Circulatory Determination of Death

“…This increase could be much more significant than that recently projected and observed in PICUs implementing DCDD programs. [20][21][22] There are several technical limitations that may limit the widespread utilization of newborn donors. These include increased surgical complexity in vascular anastomoses, increased risk of thrombosis, too small of an inferior vena cava, and requirement for additional backbench preparation of the graft.…”

Organ donation in children: The next frontier

“…As protocols for organ donation were developed for adults, potential pediatric donors are lost to the donation pool [1]. Transplantation of Human Organs Act was passed in India in 1994, making it possible to retrieve organs from brain-dead donors, but only few pediatric donors are there so far.…”

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

“…Furthermore, most organs donated by pediatric patients are allocated to adults. 2 Although recent changes to allocation policies have led to decreased pediatric wait list mortality, 3 these same policies have unintentionally reduced the number of living donors and therefore the number of organs available for transplantation for both adult and pediatric patients. 4 Inquiry into the pediatric donation process and the specific factors influencing parental donation decisions should therefore be considered a national imperative.…”