Pediatric Imminent Death Donation: Is It Ethical?

Imminent death donation (IDD) is a form of organ donation that would occur just prior to the withdrawal of life-sustaining technology (WOLST). While IDD may offer a valuable opportunity for organ donation, for example when donation after circulatory death (DCD) is not feasible, it raises significant ethical concerns, particularly in pediatric cases. Living organ donation from minors is performed only under exceptional circumstances, and with specific criteria including age-appropriate assent and a clear benefit to both donor and recipient. Pediatric IDD, therefore, presents even greater ethical complexity. We present the case of a parental request for living related kidney donation from their teenage son who suffered severe anoxic brain injury after a cardiac arrest but did not meet guidelines for death by neurologic criteria. He was ineligible for DCD as he was expected to live for hours to days following WOLST. Clinicians from critical care, transplant surgery, palliative care and our hospital ethics committee offer differing views on how to address this family's request. We present this complex issue, and the viewpoints considered during the care of this patient and his family.