Related Experiment Video
Updated: Aug 18, 2025
Study of Experimental Organ Donation Models for Lung Transplantation
Published on: March 15, 2024
Organ Dysfunction Among Children Meeting Brain Death Criteria: Implications for Organ Donation
Taylor E Nickerson1, Marlina E Lovett2, Nicole F O'Brien2
1Division of Critical Care Medicine, Department of Pediatrics, Cohen Children's Medical Center at Northwell, Zucker School of Medicine at Hofstra, New Hyde Park, NY.
Insights
Pediatric brain death (BD) criteria often accompany multiple organ dysfunction syndrome (MODS). Despite MODS, over half of children meeting BD criteria successfully donated organs, highlighting potential for broader eligibility.
Area of Science:
- Pediatric critical care medicine
- Organ donation and transplantation
- Neurology and critical care
Background:
- Brain death (BD) criteria are used for over 70% of pediatric organ donors.
- Neurologic injuries leading to BD frequently cause multiple organ dysfunction syndrome (MODS).
- Characterizing organ dysfunction in pediatric BD donors is crucial for optimizing organ utilization.
Purpose of the Study:
- To compare organ dysfunction in pediatric organ donors meeting BD criteria with those ineligible for donation.
- To identify the extent of organ dysfunction in children declared brain dead.
- To inform potential adjustments to organ donation eligibility criteria.
Main Methods:
- Retrospective cohort study of pediatric patients meeting BD criteria (2012-2018).
- Analysis of demographics, comorbidities, PRISM-III scores, and injury mechanisms.
- Quantification of organ dysfunction using peak daily organ-specific variables.
Main Results:
- All 58 included pediatric patients with BD had MODS; 59% (34/58) became organ donors.
- Donors showed varying degrees of dysfunction: 52% of kidney donors had acute kidney injury; liver donors had elevated ALT/AST.
- Medically ineligible patients for liver donation exhibited significantly higher peak ALT and AST levels compared to liver donors.
Conclusions:
- Pediatric patients meeting BD criteria universally experience MODS, yet a majority remain eligible for organ donation.
- Further research is needed to assess transplant outcomes from these "dysfunctional" organs.
- Standardizing organ donation eligibility criteria may benefit from considering transplant outcomes of organs with existing dysfunction.
Objectives:
Over 70% of pediatric organ donors are declared deceased by brain death (BD) criteria. Patients with these devastating neurologic injuries often have accompanying multiple organ dysfunction. This study was performed to characterize organ dysfunction in children who met BD criteria and were able to donate their organs compared with those deemed medically ineligible.
Design:
Retrospective cohort study.
Setting:
PICU at a quaternary care children's hospital.
Patients:
Patients with International Classification of Diseases , 9th Edition codes corresponding to BD between 2012 and 2018 were included.
Measurements And Main Results:
Demographics, comorbidities, Pediatric Risk of Mortality (PRISM)-III, and injury mechanisms were derived from the medical record. Organ dysfunction was quantified by evaluating peak daily organ-specific variables. Fifty-eight patients, from newborn to 22 years old, were included with a median PRISM-III of 34 (interquartile range [IQR], 26-36), and all met criteria for multiple organ dysfunction syndrome (MODS). Thirty-four of 58 BD children (59%) donated at least one organ. Of the donors (not mutually exclusive proportions), 10 of 34 donated lungs, with a peak oxygenation index of 11 (IQR, 8-23); 24 of 34 donated their heart (with peak Vasoactive Inotrope Score 23 [IQR, 18-33]); 31 of 34 donated kidneys, of whom 16 of 31 (52%) had evidence of acute kidney injury; and 28 of 34 patients donated their liver, with peak alanine transferase (ALT) of 104 U/L (IQR, 44-268 U/L) and aspartate aminotransferase (AST) of 165 U/L (IQR, 94-434 U/L). Organ dysfunction was similar between heart and lung donors and respective medically ineligible nondonors. Those deemed medically ineligible to donate their liver had higher peak ALT 1,518 U/L (IQR, 986-1,748 U/L) ( p = 0.01) and AST 2,200 U/L (IQR, 1,453-2,405 U/L) ( p = 0.01) compared with liver donors.
Conclusions:
In our single-center experience, all children with BD had MODS, yet more than one-half were still able to donate organs. Future research should further evaluate transplant outcomes of dysfunctional organs prior to standardizing donation eligibility criteria.
More Related Videos
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...