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Management of the potential pediatric organ donor

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


The management of potential donors is as complex as that of any other patient cared for in an intensive care unit (ICU). A major paradigm shift in strategy occurs after neurologic death. The goal of antemortem management is to maintain cerebral perfusion pressure, while the postmortem goal is to maintain the perfusion of all potential donor organs (table 1). Following neurologic death, circulatory collapse occurs within hours if there is no medical intervention.

Optimal management of the potential organ donor is a continuum of care that requires coordination between the medical and nursing teams in the ICU and the organ procurement organization (OPO). This allows for early identification of potential donors, timely determination of neurologic death, donation discussions with the family that are appropriately timed and sensitive to the family's emotional needs, medical interventions to preserve organ function, evaluation to determine donor potential and suitability, and recovery and placement of organs. The goals of this coordinated approach are to preserve the option of donation, enhance the likelihood of donation and organ recovery, and also to support grieving families with issues and decisions surrounding end-of-life care.

The process and timing of organ recovery is a complex task. In the absence of pediatric support, every effort should be made to transfer the child to a local pediatric critical care unit. If this is not possible due to patient instability, the local pediatric critical care unit should offer consultation or consider traveling to the referring unit to provide expertise in patient management. Organ recovery depends on the physiological stability of the donor. An unstable donor may require early organ recovery to avoid losing potential transplantable organs, whereas a stabilized donor with optimal management can be maintained for a longer period of time. In many instances, organizing appropriate laboratory and diagnostic testing, acceptance and placement of donor organs, coordination of organ recovery teams, and availability of an operating suite may require active medical management of the donor for 24 hours or longer. Prolonging the time interval between neurologic death and organ retrieval has not been associated with decreased organ procurement rates nor compromised quality of organ function [1,2].

The pathophysiology of neurologic death and management of the potential pediatric organ donor are discussed here. The determination of neurologic death and assessment of the pediatric patient for potential organ donation are discussed separately. (See "Diagnosis of brain death" and "Assessment of the pediatric patient for potential organ donation".)


Regardless of the initial cerebral insult, the end point of neurologic death is complete ischemia and irreversible loss of brainstem function. In some countries (eg, the United States) the term and medicolegal definitions focus on whole "brain death" (brain and brainstem), while in others (eg, the United Kingdom) the term and concept of "brainstem death" is used.

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Literature review current through: Nov 2017. | This topic last updated: Sep 06, 2016.
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