Comprehensive Options for Pediatric Donation After Circulatory Death Donors.

Area of Science:

• Pediatric Cardiology
• Organ Transplantation
• Bioethics

Background:

• Pediatric end-stage heart failure necessitates cardiac transplantation.
• Shortage of donor hearts leads to long wait times and mortality in pediatric patients.
• Donation after circulatory death (DCD) offers a potential 30% increase in available hearts.

Purpose of the Study:

• To systematically review techniques for pediatric cardiac DCD.
• To evaluate the advantages and disadvantages of different pediatric DCD methods.
• To inform strategies for improving pediatric heart transplant outcomes.

Main Methods:

• Systematic review adhering to the Cochrane Handbook.
• Searches conducted in MEDLINE, Embase, Cochrane Library, and Web of Science.
• Screening of 438 articles, with 21 selected for full-text review based on inclusion criteria.

Main Results:

• Identified four principal pediatric DCD techniques: rapid procurement/static cold storage, organ care systems, normothermic regional perfusion, and on-table reanimation.
• Each technique presents unique benefits and drawbacks.
• Techniques have evolved to address limitations of previous methods.

Conclusions:

• A comprehensive approach to pediatric cardiac DCD is crucial.
• Effective DCD strategies can enhance organ stewardship.
• Minimizing waitlist mortality and addressing ethical concerns are key objectives.