Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
BACKGROUND AND OBJECTIVES: Organ donation after circulatory determination of death (DCDD) is increasing. DCDD offers potential for additional abdominal organ donation. We evaluated all dying patients in our hospital to estimate the entire organ donation potential from a children's hospital.
METHODS: Data were obtained from Primary Children's Hospital and Intermountain Donor Services (IDS) records for all patients dying in an intensive care unit (ICU) during 2011 and 2012. IDS guidelines were used to determine potential suitable donors. Data are reported as counts, medians, and interquartile ranges (IQR), and SPSS and Excel used for analysis.
RESULTS: There were 224 death; neonatal ICU N=82, pediatric ICU N=119, and cardiac ICU N=23. Neurologic death occurred in 23 (conversion rate 78%) , 46 died despite ongoing care, and 154 had planned withdrawal of life sustaining therapy (WLST).
Among those with care withdrawn (n=154, 69%), 15 (10%) were not referred to IDS; 21 (14%) were referred after death but were all judged retrospectively to be unsuitable potential donors. Of those evaluated prospectively by the IDS exclusions for donation were: 5% genetic diseases, 6% severe organ dysfunction 10% weight < 2 kg, 32% infection 7% cancer, 2% unstable.
Of 45 (29% of 154) dying children judged potentially suitable for DCDD, 37 (82%) died within 1 hour after WLST. 15 of 20 < 1 year of age compared to 22 (88%) of those > 1 year of age died within 1 hour. None of 7 infants < 1 month died within 20 minutes, compared to 46% of infants between 1 month – 1 year and 72% of older dying children.
33 families (73%) did not authorize potential DCDD while 12 (27%) gave authorization to donation. and among the those giving authorization all were actual donors. (conversion rate 12/37, 32%). Donors came from all ICUs.
Organs donated included: en bloc kidneys (n=10): 7 DCDD, 3 DNDD, kidneys (n=35): 9 DCDD, 26 DNDD, livers (n=15): 2 DCDD, 13 DNDD, hearts (n=10), lungs (n=1), and small bowels (n=3) solely DNDD.
CONCLUSIONS:Almost 30% of patients dying in our children's hospital after WLST were suitable for potential DCDD but only 82% died within 1 hour to be eligible. The number of suitable donors after circulatory death was greater than those eligible after neurologic death, but the actual donation rate remains much lower currently. Increasing acceptance of DCDD could increase pediatric donation.
To cite this abstract in AMA style:Aguayo C, Bennett E, Sweney J, Myrick C, Bratton S. Assessment of Actual Pediatric Organ Donation Potential: Neurologic and Circulatory Determination of Death at a Children's Hospital [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/assessment-of-actual-pediatric-organ-donation-potential-neurologic-and-circulatory-determination-of-death-at-a-childrens-hospital/. Accessed March 26, 2019.
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