Development of a multinational registry of pediatric deceased organ donation activity

Abstract

Background There are no currently agreed upon international standards for reporting of pediatric deceased organ donation activity. This leads to difficulty in comparisons between jurisdictions for both researchers and policy stakeholders. The goal of this project was to develop and test a standardized registry for pediatric deceased donation activity. Methods Four countries (Canada, Spain, USA, and the UK) with geographical and practice diversity were approached to participate. Iterative exchanges were used to create data fields and definitions that were acceptable to all participants. Data from 2011 to 2015 (inclusive) were requested from national health databases and analyzed on a secure, web‐based survey platform. Results Data were obtained from three of the four countries (Canada unable to provide). Total pediatric donation rates were stable over the 5‐year period, but with variation between countries. pDCD rates were the most variable, representing 32.2% of total pediatric donation in the UK, 14.4% in the United States, and 2.6% in Spain during the studied period. Most organs from pediatric donors were allocated to adult recipients, though the rates of allocation of pediatric kidneys to pediatric recipients ranged from 7% in the United States to 40% in Spain. Discussion In this limited cohort of three countries, we demonstrated substantial variation in pediatric donation rates and practice. These data highlight opportunities for practice improvement such as the development of rigorous clinical practice guidelines. Future development of this registry will seek to engage more countries, and address barriers that prevented full participation of approached jurisdictions.

Comparison of pediatric brain‐dead donors to donation after circulatory death donors in the United States

“…Additionally, the vast majority of DCD organs recovered and transplanted from pediatric donors are kidneys and livers, with most of these organs going to adult recipients as they are considered "expanded criteria" or less suitable for children. 6,14,23 In general, pediatric patients on the waiting list are given preferential access to higher quality DBD organs as opposed to an organ recovered through DCD. And although pediatric DCD donor organs may not go directly to a pediatric recipient, this practice does provide indirect benefit to the pediatric population, in that the overall number of organs available for transplantation increases, thus theoretically shortening wait-list times for critically ill pediatric patients awaiting transplant.…”

“…A recent multinational report reported rates of 0% to 6.1% for transplant of pediatric DCD recovered kidneys into pediatric patients. 6 Another study looking at outcomes of pediatric DCD organ recipients evaluated DCD kidney and liver transplants done in pediatric patients, and demonstrated no difference in outcomes compared with organs from DBD donors. 28,29 This may indicate a turning point in increasing the availability of organs recovered from DCD donors for pediatric patients.…”

“…It is important to note that on average, more organs are recovered from a DBD donor than a DCD donor. Additionally, the vast majority of DCD organs recovered and transplanted from pediatric donors are kidneys and livers, with most of these organs going to adult recipients as they are considered “expanded criteria” or less suitable for children 6,14,23 . In general, pediatric patients on the waiting list are given preferential access to higher quality DBD organs as opposed to an organ recovered through DCD.…”

“…Due to heightened awareness regarding organ shortages in pediatrics and improved preservation techniques, DCD donation has increased in response to this need for more transplantable organs, both in the United States and internationally. [4][5][6] A recent international study of pediatric DCD showed variable rates over a 5-year period ranging from 32.2% of total pediatric donation in the UK, 14.4% in the United States, and 2.6% in Spain. 6 Additionally, Australia and New Zealand recently reported a pediatric DCD rate of 8.6% of total pediatric donors over a 15-year time period.…”

“…[4][5][6] A recent international study of pediatric DCD showed variable rates over a 5-year period ranging from 32.2% of total pediatric donation in the UK, 14.4% in the United States, and 2.6% in Spain. 6 Additionally, Australia and New Zealand recently reported a pediatric DCD rate of 8.6% of total pediatric donors over a 15-year time period. 7 In the United States in 2007, The Joint Commission mandated all hospitals develop and maintain a DCD protocol as part of hospital accreditation.…”