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Assessment of the pediatric patient for potential organ donation

Harish Vyas, DM, FRCP, FRCPCH
Thomas A Nakagawa, MD, FAAP, FCCM
Section Editor
George B Mallory, MD
Deputy Editor
Alison G Hoppin, MD


Organ transplantation has become the treatment of choice for end-stage organ failure, transforming the outlook and quality of life for affected children. Organ transplantation procedures were first performed in adults in the 1950s and in children in the 1960s. Since then, advances in surgical techniques and immunosuppressive therapies have led to a marked increase in successful transplantation of organs and patient survival.

Unfortunately, many individuals continue to die while waiting for a needed organ because of the increasing gap between donors and recipients [1]. This is particularly true in children where size and weight constraints, technical challenges of transplantation in smaller children, and organ supply and organ demand issues continue to exist. Obstacles to recovery of organs from donors include: family or cultural resistance to organ donation, issues related to authorization or consent of families (including inappropriate timing and confusion regarding death of their child), medical staff perceptions and misunderstanding about organ donation, missed opportunities for donation (including medical examiner denials in child abuse cases), and inadequate donor management resulting in loss of viable organs for transplantation.

There has been a substantial reduction in donation after neurologic determination of death (DNDD), also referred to as "brain dead" or "standard criteria" donors (SCD), in the last decade in the United Kingdom and the United States [1,2]. The decline in donors exists for several reasons. Morbidity and mortality in children has been reduced from improved medical therapies, eradication of life-threatening diseases including antibiotic therapies, more effective immunizations, use and refinement of passenger safety restraint systems, helmets, and other safety measures. Additionally, care provided by specialists trained in pediatric intensive care has significantly improved chances for survival of children with life-threatening disease [3]. Adverse publicity associated with reports of unauthorized or inappropriate use of organs may have also contributed to families and loved ones denying consent for donation [4].

The increasing gap between organ availability and recipient need has resulted in more people dying while waiting for a needed organ [5], making it a necessity to maximize the recovery of organs from the existing donor pool. Therefore, the option of donation should be preserved for all families facing end-of-life issues with their child. Decisions about organ donation are influenced by individual factors as well as cultural beliefs. When approached in a sensitive manner, most families report that organ donation is a "positive experience" [6-9].

The assessment of the pediatric patient for potential organ donation is discussed in this chapter. The determination of death by neurologic criteria and management of the potential organ donor are discussed separately. (See "Diagnosis of brain death" and "Management of the potential pediatric organ donor".)


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