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Pediatric organ donation: impact of medical examiner refusal
1Department of Pediatrics, Children's Medical Center of the Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
Objectives:
To examine the national Pediatric Intensive Care Unit (PICU) experience regarding Medical Examiner (ME) refusal of organ procurement from potential donors. To review our experience regarding PICU mortalities, organ donation, and impact of the ME on the organ donation process.
Design:
National survey of PICU directors requesting demographics, type of ME system, perceptions of ME responsiveness to organ donation, and data regarding potential donors and their outcomes. Also, a retrospective chart review of all PICU deaths from 1990 to 1992 at a tertiary care center, noting the number of potential organ donors, ME cases, those harvested, rejected, and reason for rejection.
Participants:
PICU directors selected from a list of Pediatric Section members of the Society of Critical Care Medicine. The response rate was 59%. The chart review was performed in a 1000-bed hospital with a 12-bed PICU.
Results:
PICU directors' perceptions of ME responsiveness to organ donation were not determined by size of PICU, area served, type of hospital, ME system, or means of contacting the ME. ME refusal accounted for 15% and 16% of total refusals in the survey and chart review, respectively. Family refusal accounted for 49% and 28% in these same groups. Survey respondents' hints and suggestions to decrease denial and increase organ donation focused on improved communication (61% and 33%), and education (16% and 55%).
Conclusions:
ME refusal does impact on pediatric organ donation, but not as significantly as family refusal. Increased organ procurement in ME-related cases will require improved communication between MEs, physicians, and the Organ Procurement Organizations (OPOs).
Insights
Medical Examiner (ME) refusal impacts pediatric organ donation, though family refusal is more significant. Improved communication between MEs, physicians, and Organ Procurement Organizations (OPOs) is key to increasing organ donation rates.
Area of Science:
- Pediatric critical care medicine
- Organ donation and transplantation
- Medical Examiner system
Background:
- Medical Examiner (ME) refusal is a barrier to organ procurement in pediatric intensive care units (PICUs).
- Understanding the factors influencing ME refusal and its impact on pediatric organ donation is crucial.
Purpose of the Study:
- To examine the national PICU experience with ME refusal of organ procurement.
- To review the impact of ME decisions on pediatric organ donation outcomes.
Main Methods:
- A national survey of PICU directors assessed perceptions of ME responsiveness and organ donation data.
- A retrospective chart review analyzed PICU deaths, organ donation, and ME involvement.
Main Results:
- ME refusal accounted for 15-16% of total organ donation refusals, while family refusal was higher (28-49%).
- PICU characteristics did not significantly influence ME responsiveness.
- Improved communication and education were suggested to increase organ donation.
Conclusions:
- ME refusal affects pediatric organ donation, but less so than family refusal.
- Enhanced communication among MEs, physicians, and OPOs is essential for improving organ procurement in ME-related cases.