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Potential for liver and kidney donation after circulatory death in infants and children
Paul M Shore1, Rong Huang, Lonnie Roy
1Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA. paul.shoremd@tenethealth.com
Insights
Organ donation after circulatory death (DCD) could significantly increase kidney and liver donors in pediatric intensive care units (PICUs). This strategy, depending on consent rates, offers a substantial boost to organ availability for children awaiting transplants.
Area of Science:
- Pediatric critical care medicine
- Transplantation science
- Organ donation research
Background:
- Pediatric organ transplantation relies on a consistent donor supply.
- Organ donation after circulatory death (DCD) is an alternative donor pathway.
- The potential impact of DCD on pediatric donor numbers requires investigation.
Purpose of the Study:
- To evaluate the potential increase in kidney and liver donors from DCD in a pediatric intensive care unit (PICU).
- To analyze the influence of consent rates and stricter criteria on DCD donor numbers.
Main Methods:
- Retrospective review of all deaths in a pediatric intensive care unit over 11 years.
- Assessment of deceased children against DCD eligibility criteria (physiologic and time).
- Sensitivity analysis incorporating varying consent rates and stricter criteria.
Main Results:
- 131 children met basic DCD criteria, representing 9% of all deaths.
- Estimated DCD donors ranged from 24 to 85, a 28%–99% increase over brain-dead donors.
- Potential for 30–88 additional kidneys and 8–56 additional livers, increasing donation by 21%–80%.
Conclusions:
- DCD could significantly augment the number of organ donors in pediatric intensive care settings.
- The actual increase in DCD donors is highly dependent on consent rates.
- Further exploration of DCD protocols in pediatric critical care is warranted.
Objective:
To determine the potential effect of organ donation after circulatory death (DCD) on the number of kidney and liver donors in a PICU.
Patients And Methods:
All deaths in the PICU of an academic, tertiary care children's hospital from May 1996 to April 2007 were retrospectively reviewed. Patient demographics, premortem physiology, and end-of-life circumstances were recorded and compared with basic criteria for potential organ donation. A sensitivity analysis was performed to examine the effect of more strict physiologic and time criteria as well as 3 different rates of consent for donation.
Results:
There were 1389 deaths during 11 years; 634 children (46%) underwent withdrawal of life support, of whom 518 had complete data and were analyzed. There were 131 children (25% of those withdrawn, 9% of all deaths) who met basic physiologic and time criteria for organ donation (80 kidney; 107 liver). Consideration of consent rates in sensitivity analysis resulted in an estimated 24 to 85 organ donors, an increase of 28% to 99% over the 86 actual brain-dead donors during the same time period. Assuming historical rates of organ recovery, these DCD donors might have produced 30 to 88 additional kidneys and 8 to 56 additional livers, an increase of 21% to 60% in kidney donation and 13% to 80% in livers above the number of organs recovered from brain-dead donors.
Conclusions:
Although relatively few children may have been eligible for DCD, they might have increased the number of organ donors from our institution, depending greatly on consent rates. DCD merits additional discussion and exploration.
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