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Trends in pediatric organ donation after cardiac death
1Children's Hospital and Regional Medical Center, Division of Critical Care Medicine, W-9824, 4800 Sandpoint Way NE, Seattle, WA 98105, USA. robert.mazor@seattlechildrens.org
Insights
Pediatric donation after cardiac death (DCD) offers a potential solution to organ shortages, but data on its use in children is scarce. This study highlights the need for better data collection to develop best-practice guidelines for pediatric DCD.
Area of Science:
- Pediatric Organ Transplantation
- Organ Donation
- Public Health
Background:
- Organ donation after cardiac death (DCD) is a strategy to address organ supply shortages.
- There is a lack of specific guidelines for pediatric DCD.
- This study examines the existing pediatric DCD experience.
Purpose of the Study:
- To analyze the cumulative pediatric DCD experience from 1993-2005.
- To establish a foundation for developing pediatric DCD best-practice guidelines.
- To identify trends in pediatric DCD organ utilization.
Main Methods:
- Retrospective analysis of the Organ Procurement and Transplantation Network/United Network for Organ Sharing database (1993-2005).
- Inclusion of all donors < 18 years of age.
- Cross-referencing donor centers with the National Association of Children's Hospitals and Related Institutions membership.
Main Results:
- 683 pediatric DCD organs were identified; <5% were used for pediatric recipients.
- Kidneys and livers constituted the majority of pediatric DCD organs.
- Most centers had limited pediatric DCD donor experience (median of 1 donor).
Conclusions:
- Data on pediatric DCD organ use in pediatric recipients are limited.
- Few centers possess sufficient experience to establish standardized protocols.
- Comprehensive outcome data collection is crucial for developing evidence-based pediatric DCD guidelines.
Objective:
Organ donation after cardiac death is viewed as one way of partially closing the current gap between organ supply and demand. There are no published guidelines for organ donation after cardiac death specific to the pediatric population. The objective of this study was to examine the cumulative pediatric donation-after-cardiac-death experience to set the context for the development and sharing of best-practice guidelines.
Patients And Methods:
This was a retrospective, descriptive study that used data from the Organ Procurement and Transplantation Network/United Network for Organ Sharing database from 1993 to 2005. Organ data from all donors after cardiac death who were < 18 years of age were analyzed. The list of donor medical centers was then cross-referenced with the member list from the National Association of Children's Hospitals and Related Institutions.
Results:
There were 683 organs from donation-after-cardiac-death donors < 18 years of age. Of those, < 5% were used for pediatric recipients. In comparison, approximately 20% of non-donation-after-cardiac-death organs from pediatric donors were used for pediatric recipients. The vast majority of donation-after-cardiac-death organs donated were kidneys and livers. More than 50% of medical centers that had a pediatric organ-donation-after-cardiac-death donor had just 1. The medical center with the largest pediatric organ-donation-after-cardiac-death donation experience had 14 donors. Forty-three percent of medical centers that had > or = 1 pediatric donation-after-cardiac-death donor were members of the National Association of Children's Hospitals and Related Institutions. Fifty-six percent of all of the pediatric donation-after-cardiac-death organs were donated from the National Association of Children's Hospitals and Related Institution member centers.
Conclusions:
Data regarding the use of pediatric donation-after-cardiac-death organs for pediatric recipients remain sparse. Few medical centers have had enough donation-after-cardiac-death donor experience to report a tried-and-true approach. We advocate for comprehensive collection and reporting of outcome data for all-aged recipients of pediatric donation-after-cardiac-death organs to help facilitate the generation of evidence-based best-practice guidelines for pediatric donation after cardiac death.
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