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Pediatric Donation After Circulatory Determination of Death: A Scoping Review
Matthew J Weiss1, Laura Hornby, William Witteman
11Division of Pediatric Critical Care, Departement of Pediatrics, Centre Mère-Enfant Soleil du Centre Hospitalier Universitaire de Québec, Québec, QC, Canada. 2Research Center of the CHU de Québec, Reproduction, Mother and Youth Health Axis, Québec, QC, Canada. 3Department of Pediatrics, Faculty of Medicine, Université Laval, Québec, QC, Canada. 4Canadian pDCDD Guideline Development Committee, Canadian Blood Services, Ottawa, ON, Canada. 5DePPaRT Study, Pediatric Critical Care, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada. 6Deceased Donation, Organs and Tissue, Canadian Blood Services, Ottawa, ON, Canada. 7Division of Critical Care, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre and Research Institute, Montreal, QC, Canada. 8Department of Pediatrics, McGill University, Montreal, QC, Canada. 9Deceased Donation, Organs and Tissues, Canadian Blood Services, Ottawa, ON, Canada.
Insights
Pediatric donation after circulatory determination of death (DCD) is increasing, but specific guidelines are lacking. This review maps the literature, identifies knowledge gaps, and informs future pediatric DCD guideline development.
Area of Science:
- Organ transplantation
- Pediatric critical care
- Bioethics
Background:
- Pediatric donation after circulatory determination of death (DCD) is becoming more frequent.
- There is a lack of specific national or international guidelines for pediatric DCD.
- This necessitates a comprehensive understanding of the existing literature.
Purpose of the Study:
- To conduct a scoping review of the pediatric DCD literature.
- To identify knowledge gaps within the pediatric DCD field.
- To inform the development of pediatric-specific DCD guidelines.
Main Methods:
- Searched Embase, MEDLINE, and PubMed for pediatric DCD literature from 1980 to May 2014.
- Analyzed 7,597 references, retaining 85 for qualitative analysis.
- Excluded studies not focused on pediatric patients, animal research, surgical techniques, or local protocols.
Main Results:
- Identified key themes including donor estimates, ethical considerations, physiology, cardiac DCD, and neonatal DCD.
- Pediatric DCD is less common than brain death donation but can expand the organ pool.
- Outcomes of organs from pediatric DCD appear comparable to those from brain death donation; ethical practice is supported by professional societies.
Conclusions:
- This review offers a comprehensive overview of pediatric DCD literature.
- It highlights critical knowledge gaps.
- Findings will aid in developing crucial pediatric-specific DCD guidelines.
Objective:
Although pediatric donation after circulatory determination of death is increasing in frequency, there are no national or international donation after circulatory determination of death guidelines specific to pediatrics. This scoping review was performed to map the pediatric donation after circulatory determination of death literature, identify pediatric donation after circulatory determination of death knowledge gaps, and inform the development of national or regional pediatric donation after circulatory determination of death guidelines.
Data Sources:
Terms related to pediatric donation after circulatory determination of death were searched in Embase and MEDLINE, as well as the non-MEDLINE sources in PubMed from 1980 to May 2014.
Study Selection:
Seven thousand five hundred ninety-seven references were discovered and 85 retained for analysis. All references addressing pediatric donation after circulatory determination of death were considered. Exclusion criteria were articles that did not address pediatric patients, animal or laboratory studies, surgical techniques, and local pediatric donation after circulatory determination of death protocols. Narrative reviews and opinion articles were the most frequently discovered reference (25/85) and the few discovered studies were observational or qualitative and almost exclusively retrospective.
Data Extraction:
Retained references were divided into themes and analyzed using qualitative methodology.
Data Synthesis:
The main discovered themes were 1) studies estimating the number of potential pediatric donation after circulatory determination of death donors and their impact on donation; 2) ethical issues in pediatric donation after circulatory determination of death; 3) physiology of the dying process after withdrawal of life-sustaining therapy; 4) cardiac pediatric donation after circulatory determination of death; and 5) neonatal pediatric donation after circulatory determination of death. Donor estimates suggest that pediatric donation after circulatory determination of death will remain an event less common than brain death, albeit with the potential to substantially expand the existing organ donation pool. Limited data suggest outcomes comparable with organs donated after neurologic determination of death. Although there is continued debate around ethical aspects of pediatric donation after circulatory determination of death, all pediatric donation after circulatory determination of death publications from professional societies contend that pediatric donation after circulatory determination of death can be practiced ethically.
Conclusions:
This review provides a comprehensive overview of the published literature related to pediatric donation after circulatory determination of death. In addition to informing the development of pediatric-specific guidelines, this review serves to highlight several important knowledge gaps in this topic.
