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Pediatric organ donation: retrospective study in five centers in Argentina
Mariana J Cyunel1, Sabina I Ramos Elizagaray2, Ricardo J Ponce3
1Hospital General de Niños Ricardo Gutiérrez, Autonomous City of Buenos Aires, Argentina.
Insights
Pediatric organ donation in Argentina faces challenges, with a high rate of missed opportunities. Improving donor detection, diagnosis, and evaluation is crucial to save children awaiting transplants.
Area of Science:
- Pediatric critical care medicine
- Transplantation science
- Public health policy
Background:
- Organ and tissue transplantation is a vital medical intervention.
- A critical shortage of pediatric donors in Argentina results in preventable deaths among children on transplant waiting lists.
Purpose of the Study:
- To identify factors within the organ donation process that can enhance the pediatric donation rate in Argentina.
- To address the critical need for more pediatric organ donors to save lives.
Main Methods:
- Retrospective observational study analyzing medical records of pediatric patients (0-18 years) meeting clinical criteria for death based on neurological criteria (DNC).
- Data collected from five institutions (three pediatric, two general hospitals) between January 1, 2018, and December 31, 2022.
- Included patients admitted to pediatric intensive care units (PICUs), emergency departments, and cardiovascular intensive care units.
Main Results:
- 124 patients met the criteria for death based on neurological criteria (DNC), representing 1.3% of PICU admissions and 23% of deaths.
- Only 21 patients (17%) became organ donors.
- An 83% rate of missed donation opportunities was identified, primarily in donor detection, diagnosis, and evaluation stages.
Conclusions:
- Death based on neurological criteria is infrequent in pediatric populations.
- Optimizing the evaluation, detection, and management of potential pediatric organ donors is essential.
- Implementing these improvements can significantly reduce mortality rates for children on transplant waiting lists.
Abstract:
Introduction. Advances in medicine have made organ and tissue transplantation a feasible therapeutic option. However, the shortage of pediatric donors leads to deaths among children on the organ waiting list in Argentina. The objective of this study was to identify variables related to the donation process that may offer opportunities to improve the pediatric donation rate. Population and methods. This was a retrospective observational study conducted in five institutions. Data were obtained from the medical records of patients aged 0 to 18 years who met the clinical criteria for death based on neurological criteria (DNC) in pediatric intensive care units (PICUs), emergency departments, and cardiovascular intensive care units between January 1, 2018, and December 31, 2022. Results. Among the participating centers, three were pediatric and two were general hospitals. A total of 124 patients with clinical DNC were included (1.3% of PICU admissions, 23% of deaths). Of these, 21 (17%) were donors. An 83% rate of missed donation opportunities was identified; the main areas for improvement were detection, diagnosis, and evaluation. Conclusion. DNC is an uncommon condition in pediatrics. This study identifies key areas for action to optimize the evaluation, detection, and management of potential donors-necessary steps to reduce deaths among children on transplant waiting lists.
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