Pediatric Organ Donation After Circulatory Death in the United States

Area of Science:

• Transplantation research
• Pediatric medicine
• Organ donation science

Background:

• Technological advancements in organ preservation have increased the utilization of organs from donation after circulatory death (DCD).
• There is a need to understand temporal trends in pediatric DCD (pDCD) in the United States.

Purpose of the Study:

• To characterize temporal trends in pediatric DCD (pDCD) in the United States.
• To analyze the number and proportion of pediatric DCD donors and organs recovered and transplanted.

Main Methods:

• Utilized Organ Procurement and Transplantation Network data from 2000-2025.
• Identified all pediatric deceased organ donors (age < 18 years).
• Calculated annual numbers and proportions of pediatric donation after brain death (pDBD) and pDCD donors, and recovered/transplanted organs.

Main Results:

• Annual pDBD donors decreased from 985 (2000) to 530 (2025), while pDCD donors increased from 21 to 244.
• By 2025, pDCD organs constituted a significant proportion of recovered pediatric organs: kidneys (32%), livers (19%), lungs (16%), hearts (14%), and pancreata (12%).
• pDCD transplants increased, accounting for 3% of pediatric kidney, 2% of liver, and 8% of heart transplants by 2025.

Conclusions:

• Pediatric DCD donors have increased more than tenfold over 25 years, contrasting with a decline in pDBD donors.
• The rise in pDCD necessitates the development of supportive ethical and communication frameworks for families and healthcare teams.
• Addressing these needs is crucial for optimizing pediatric organ transplantation opportunities.