Pediatric Organ Donation Potential at a Children’s Hospital*

Bennett, Erin; Sweney, Jill; Aguayo, Cecile; Myrick, C.; Antommaria, Armand H. Matheny; Bratton, Susan L.

doi:10.1097/pcc.0000000000000526

Cited by 27 publications

(43 citation statements)

References 30 publications

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“…32 While DBD is the commonest pathway in pediatric ICUs, the potential for DCD donation may actually exceed that for the DBD pathway. 33 Concerns regarding cost, resource use, and unmet expectations have been proposed to explain the low DCD rates in children. A tool that predicts likelihood and time to death from withdrawal of life support may facilitate pediatric DCD donation.…”

Section: Specific Issues Of Pediatric Dcd Lung Donation and Ltxmentioning

confidence: 99%

Donation after Brain Death versus Donation after Circulatory Death: Lung Donor Management Issues

Snell

Levvey

Levin

et al. 2018

Semin Respir Crit Care Med

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Lung transplantation (LTx) has traditionally been limited by a lack of suitable donor lungs. With the recognition that lungs are more robust than initially thought, the size of the donor pool of available lungs has increased dramatically in the past decade. Donation after brain death (DBD) and donation after circulatory death (DCD) lungs, both ideal and extended are now routinely utilized. DBD lungs can be damaged. There are important differences in the public's understanding, legal and consent processes, intensive care unit strategies, lung pathophysiology, logistics, and potential-to-actual donor conversion rates between DBD and DCD. Notwithstanding, the short- and long-term outcomes of LTx from any of these DBD versus DCD donor scenarios are now similar, robust, and continue to improve. Large audits suggest there remains a large untapped pool of DCD (but not DBD) lungs that may yet further dramatically increase lung transplant numbers. Donor scoring systems that might predict the donor conversion rates and lung quality, the role of ex vivo lung perfusion as an assessment and lung resuscitation tool, as well as the potential of donor lung quality biomarkers all have immense promise for the clinical field.

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Section: Specific Issues Of Pediatric Dcd Lung Donation and Ltxmentioning

confidence: 99%

Donation after Brain Death versus Donation after Circulatory Death: Lung Donor Management Issues

Snell

Levvey

Levin

et al. 2018

Semin Respir Crit Care Med

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“…The majority of pediatric organs are procured from donors who have been declared neurologically deceased (i.e., brain death). 7 Neurologic death may occur as the end result of numerous triggers, such as trauma, hypoxia, or infection. Regardless of etiology, the common final cascade of events involves a rapid increase in intracranial pressure followed by cerebral herniation and brainstem ischemia.…”

Section: Physiologymentioning

confidence: 99%

Endocrine Considerations of the Pediatric Organ Donor

Gupta

Dhanani

2016

J Pediatr Intensive Care

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Patients determined to be neurologically deceased exhibit potentially harmful changes in various endocrine pathways due to disruptions of the body's neurohormonal control mechanisms. These deviations from endocrine homeostasis lead to hemodynamic, metabolic, and immunologic aberrations that are associated with reduced graft procurement and function for the purposes of organ donation. Existing literature has attempted to describe the pathophysiology that associates disruptions in endocrine pathways with organ dysfunction, both to increase understanding and to identify strategies to support the donor. For example, diabetes insipidus due to arginine vasopressin deficiency is commonly encountered, and should be anticipated. The significance of abnormalities in other pathways such as those involving cortisol and thyroid hormone is less established; however, there is increasing support for treating potential organ donors with combined hormonal therapies. While there are published documents aimed at guiding management of organ donors in general, many controversies exist and pediatric-specific literature is scarce. This article aims to review several of the important endocrine-specific aspects of managing the neurologically deceased organ donor, with an emphasis on pediatrics where information is available.

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“…In Asia, pediatric DCD cases have been described in China 15,16 . Pediatric DCD programs will increase the number of organ grafts available for use in pediatric recipients 17‐19 …”

Section: Introductionmentioning

confidence: 99%

First pediatric organ donation after circulatory determination of death in Singapore: Facing challenges in the absence of a local practice guideline

Thong

Chong²,

Koh

et al. 2020

Pediatric Transplantation

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Pediatric organ donation represents only a low proportion of overall organ donation in many parts of world, unable to match the needs for pediatric organ transplantation. Pediatric organ donation after circulatory determination of death (DCD) is increasingly explored in pediatric transplantation, as it increases the availability of organ grafts. A 6‐year‐old Caucasian boy with a history of arteriovenous malformation presented with a catastrophic intracranial bleed, resulting in severe brainstem dysfunction despite maximal medical and surgical measures. He did not fulfill the criteria for brain death, which must be met for pediatric organ donation in Singapore. Due to parental request, his organs were donated after withdrawal of life support and determination of death by circulatory criteria. Pediatric organ DCD poses many challenges in the pediatric population, especially in the absence of a local practice guideline. We present the first case of a pediatric organ DCD that has occurred in Singapore. Further work is needed, particularly in establishing a national policy for pediatric organ DCD and increasing overall awareness and acceptance toward pediatric organ donations.

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Pediatric Organ Donation Potential at a Children’s Hospital*

Cited by 27 publications

References 30 publications

Donation after Brain Death versus Donation after Circulatory Death: Lung Donor Management Issues

Donation after Brain Death versus Donation after Circulatory Death: Lung Donor Management Issues

Endocrine Considerations of the Pediatric Organ Donor

First pediatric organ donation after circulatory determination of death in Singapore: Facing challenges in the absence of a local practice guideline

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