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Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Donation after cardiac death in pediatric critical care
Nikoleta S Kolovos1, Patricia Webster, Susan L Bratton
1Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Insights
Donation after cardiac death (DCD) offers a vital solution to the pediatric organ shortage. Implementing DCD policies in children's hospitals can increase organ availability for transplantation and support grieving families.
Area of Science:
- Pediatric transplantation
- Organ donation ethics
- Critical care medicine
Background:
- Significant unmet need for pediatric organs for transplantation.
- Limited availability of organs from brain-dead donors.
- Increasing interest in donation after cardiac death (DCD) as a supplementary source.
Purpose of the Study:
- Describe the unmet need for pediatric organs.
- Review the history and implementation of DCD policies in children's hospitals.
- Analyze current U.S. experience with pediatric DCD.
Main Methods:
- Literature review of existing studies on DCD.
- Analysis of national data on pediatric organ transplantation candidates and DCD donors.
- Examination of DCD policies and experiences in three children's hospitals and a national organ procurement network.
Main Results:
- Growing interest and endorsement of DCD by medical groups due to organ scarcity.
- Increased implementation of DCD as an end-of-life care option and donation strategy.
- Promising preliminary reports on organ function from DCD donors, with increasing DCD utilization.
Conclusions:
- DCD is crucial for addressing the gap in pediatric organ availability.
- Children's hospitals should consider DCD policies to support donor families and increase transplants.
- Successful DCD programs require collaboration and support from critical care providers.
Objective:
To describe the unmet need for pediatric organs, the history of donation after cardiac death (DCD), implementation of DCD policies in children's hospitals, and the current U.S. experience with DCD in children.
Design:
Review of existing literature and national data regarding DCD.
Setting:
Three children's hospitals and a national organ procurement network.
Patients:
Nationwide review of pediatric candidates for transplantation and pediatric DCD donors.
Interventions:
None.
Measurements And Main Results:
Interest in DCD has greatly increased over the past several years due to limited organ availability for transplantation. Leading medical groups have evaluated and endorsed DCD, and more hospitals are offering DCD as part of end-of-life care options for dying patients and to increase donation. Children's hospitals need to evaluate this concept and develop ethically sound polices to meet the needs of patients and families. Preliminary reports regarding organ function from DCD donors are promising, and DCD is increasing.
Conclusions:
The widening gap between the need for organs and the availability of organs from brain-dead donors has led to a resurgence of both interest in and use of organs donated after cardiac death. Children's hospitals need to explore DCD as an option in select circumstances to serve grieving families who would like to donate and to increase organ availability for transplantation. DCD programs are dependent on input and support from critical care providers.
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