Infant Organ Donation After Death by Circulatory Criteria: A Literature Scoping Review

Infant organ donation is rare but when it does occur, infants are more commonly eligible for donation after circulatory death (DCD) than donation after neurological death. The aims of this scoping review were to identify: 1) existing research, ethical, and policy information about infant organ DCD and 2) knowledge gaps to guide future research.

A literature search of MEDLINE, Embase, CINAHL, Scopus, and the Web of Science up to 2024. No other date or search limits were applied. A gray literature search for policy and clinical guideline documents was also conducted.

Two reviewers independently screened titles and abstracts, then article full texts. The search yielded 8176 unique publications of which 33 were included in this review. The gray literature search yielded six relevant documents.

Data were extracted by one reviewer according to the type of article (e.g., donor audit; time to death studies; transplant outcome studies; ethical commentary; position; or policy statements).

The article narratives fell into six topics, including: 1) donor audits and criteria; 2) donor care and referral practices; 3) predictors of time to death; 4) transplant outcomes; 5) ethical issues; and 6) strategies to increase infant organ donation. Donor audits suggest that infant donors are under-recognized, despite good transplantation outcomes in transplant reports. While some predictors of time to death were identified, further research is needed. Several ethical issues were highlighted including debate about permanence vs. irreversibility of death as a requirement for DCD. Families of all potentially eligible infants should be offered the option for donation as part of routine care, with high-quality end-of-life care provided regardless of whether donation occurs.

Infant DCD remains an uncommon practice worldwide. Ongoing research is crucial to furthering the field of infant DCD and increasing the number of available organs.