The potential for non-heart beating organ donation within a paediatric intensive care unit

In the UK, the number of patients waiting for an organ transplant has increased by 30% since 2001. Non-heart beating organ donation (NHBD) programmes are advocated as a means of increasing the number of potential donors. Such programmes remain in their infancy within paediatrics. We examined all deaths in our paediatric intensive care unit (PICU) between January 2005 and December 2008 to establish the number of potential NHB donors. We further obtained data from UK NHS Blood and Transplant detailing all paediatric patients that became heart beating and NHB donors in the UK over the same period.

(A) Data obtained from UK NHS Blood and Transplant detailing the number of organ donors within the unit and within the UK. (B) Retrospective review of our paediatric intensive care mortality database and patient notes to identify patients aged 1-16 years who died in the PICU over the same period. Assessment of patient suitability for NHBD was made according to predetermined exclusion criteria.

During the study period, 126 children died in the PICU. Three children were referred for heart beating organ donation (two proceeded to be donors). Nine children were referred for NHBD (three proceeded to be donors). Of the remaining 114 patients, 39 (34%) were aged >1 year and died following active withdrawal of treatment. Of these 39, 27 (69%) had relative contraindications, leaving 12 patients that might have been considered as potential NHB donors. If a 50% conversion rate is used, six children may have been realised as actual NHB donors.

If this situation were replicated in the PICUs throughout the UK, it would represent a significant increase in the number of organs available for transplantation.