The decision to donate: helping families make meaning during neonatal loss. In response to: anencephalic organ donation after cardiac death: practicalities and ethics-a case report

Heart Transplantation and Donation After Circulatory Death in Children. A Review of the Technological, Logistical and Ethical Framework

Heart transplant for adults following Donation after Circulatory Death (DCD) is well established in many parts of the world, including the United Kingdom (UK). Small child DCD hearts have now been recovered in the UK and internationally utilising novel technologies. Despite these recent advances, extension of this practice to pediatric cardiac transplantation has been slow and difficult despite the severe shortage of donors for children leading to a high number of deaths annually of children waiting for heart transplant. This is in direct contrast with the thriving UK programme of adult DCD heart transplant and pediatric DCD donation for non-cardiac organs. There has been insufficient action in addressing this inequality thus far. Barriers to development of a pediatric cardiac DCD programme are multifaceted: ethical concerns, technological paucity, financial and logistical hurdles. We describe the background, live issues, current developments and how we are driving resources toward a sustainable DCD programme for small children in the UK to provide valuable insights to other countries of the elements and principles at play. This is a call to responsible bodies to take urgent and achievable actions to establish an equitable paediatric DCD cardiac programme for donors, recipients and their families.

Barrett's Power Theory: Re-Conceptualizing the Pediatric Organ Donation Experience With Letter Writing

Pediatric organ donation is often a time of reported turbulence and isolation for both families involved. Communication through letter writing is a way for those families to connect and heal, if they choose to participate. Barrett's Power as Knowing in Participation in Change Theory, with its accompanying health patterning, is applicable to this experience by facilitating awareness, choices, freedom to act intentionally, and involvement in the change process related to the pediatric organ donation process. Two families' experiences connected through organ donation and letter writing, as conceptualized through the lens of Barrett's Power Theory, supported future use of patterning of knowing participation in change for families.