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Lee LA, Okpere A, Martin DA, Mahoney M, James L, Avitzur Y, Piggott B, Tomlinson C, Urschel S, Hamiwka L. Variability in pediatric and neonatal organ offering, acceptance and utilization: a survey of Canadian pediatric transplant programs and organ donation organizations. FRONTIERS IN TRANSPLANTATION 2024; 3:1458563. [PMID: 39398972 PMCID: PMC11466726 DOI: 10.3389/frtra.2024.1458563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 08/21/2024] [Indexed: 10/15/2024]
Abstract
Introduction Solid organ transplantation in children is a lifesaving therapy, however, pediatric organ donation rates remain suboptimal. Methods We conducted a cross-sectional survey of Canadian organ donation organizations (ODOs) and pediatric transplant programs (TPs), aiming to describe policies and practices for pediatric organ allocation, acceptance, and utilization in Canada. Results Response rates were 82% and 83% respectively for ODOs and transplant programs comprising 7 kidney, 3 heart, 2 lung, 2 liver and 1 intestine programs. All 9 ODOs reported offering pediatric organs following death by neurological criteria (DNC), while 8 reported offering organs following death by circulatory criteria (DCC) for some organs. Variability was found across ODOs and TPs. There was little agreement on both absolute and organ-specific donor exclusion criteria between ODOs. There was further disagreement in organ specific acceptance criteria between ODOs and TPs and between TPs themselves. Notably, despite the development of pediatric donation after DCC guidelines, organs from DCC donors are excluded by many ODOs and TPs. Discussion Further variability in pediatric specific training, policies, and allocation guidelines are also documented. Significant areas for improvement in standardization in organ acceptance, offering, and allocation in pediatric donation and transplantation across Canada were identified.
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Affiliation(s)
- Laurie A. Lee
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Augustina Okpere
- Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dori-Ann Martin
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Meagan Mahoney
- Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatric Critical Care, Alberta Health Services, Calgary, AB, Canada
| | - Lee James
- Canadian Blood Services, Vancouver, BC, Canada
| | - Yaron Avitzur
- Division of Gastroenterology, Hepatology and Nutrition, SickKids Hospital, Toronto, ON, Canada
| | | | - Christopher Tomlinson
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Neonatal Intensive Care, Hospital for Sick Children, Toronto, ON, Canada
| | - Simon Urschel
- Pediatric Cardiology, Stollery Children’s Hospital, Edmonton, AB, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lorraine Hamiwka
- Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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Giugni C, Cecchi C, Giometto S, Lucenteforte E, Mondardini C, Chiusolo F, Giannini A, Astuto M, Figini M, Piazza M, Tosoni A, Ricci Z. What Italian PICU Healthcare Providers Think About Donation After Cardiocirculatory Determination of Death: A National Survey. Pediatr Transplant 2024; 28:e14806. [PMID: 38923333 DOI: 10.1111/petr.14806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 04/18/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Italy presently does not have a pediatric organ donation program after cardiocirculatory determination of death (pDCDD). Before implementing a pDCDD program, many centers globally have conducted studies on the attitudes of pediatric intensive care unit (PICU) staff. This research aims to minimize potential adverse reactions and evaluate the acceptance of the novel donation practice. METHODS We conducted an electronic and anonymous survey on attitudes toward pDCDD among healthcare professionals (HCPs) working at eight Italian PICUs. The survey had three parts: (I) questions about general demographic data; (II) 18 statements about personal wishes to donate, experience of discussing donation, and knowledge about donation; (III) attitudinal statements regarding two pediatric Maastricht III scenarios of organ donation. RESULTS The response rate was 54.4%, and the majority of respondents were nurses. Of those who responded, 45.3% worked in the Center, 40.8% in the North, and 12.8% in the South of Italy. In total, 93.9% supported pediatric organ and tissue donation, 90.3% supported donation after neurological determination of death (DNDD), 78.2% supported pDCDD, and 69.7% felt comfortable about the idea of participating in pDCDD on Type III patients, with a higher percentage of supportive responses in the Center (77.2%) than in the North (65.1%) and South (54.5%) of Italy (p-value < 0.004). Concerning scenarios, 79.3% of participants believed that organ retrieval took place in a patient who was already deceased. Overall, 27.3% considered their knowledge about DCDD to be adequate. CONCLUSIONS Our study provides insight into the attitudes and knowledge of PICU staff members regarding pDCDD in Italy. Despite a general lack of knowledge on the subject, respondents showed positive attitudes toward pDCDD and a strong consensus that the Italian legislation protocol for determining death based on cardiocirculatory criteria respects the "dead donor rule." There were several distinctions among the northern, central, and southern regions of Italy, and in our view, these disparities can be attributed to the varying practices of commemorating the deceased. In order to assess how practice and training influence the attitude of PICU staff members, it would be interesting to repeat the survey after the implementation of a program.
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Affiliation(s)
- Cristina Giugni
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Costanza Cecchi
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
| | - Cristina Mondardini
- Pediatric Intensive Care Unit, Hospital Department of Women's and Children's, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Fabrizio Chiusolo
- Anesthesia and Critical Care Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Giannini
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Ospedale dei Bambini ASST-Spedali Civili, Brescia, Italy
| | - Marinella Astuto
- Department of Medical and Surgical Medicine, Intensive Care Unite 1, AOU Policlinico San Marco, Catania, Italy
| | - Maria Figini
- Pediatric Intensive Care Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marcello Piazza
- Pediatric Intensive Care Unit and Trauma Center, ARNAS Civico e Di Cristina, Palermo, Italy
| | - Alvise Tosoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Padua, Italy
| | - Zaccaria Ricci
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Anesthesiology and Critical Care Medicine, Department of Health Science, University of Florence, Florence, Italy
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O'Neill S, Asgari E, Callaghan C, Gardiner D, Hartog H, Iype S, Manara A, Nasralla D, Oniscu GC, Watson C. The British transplantation society guidelines on organ donation from deceased donors after circulatory death. Transplant Rev (Orlando) 2023; 37:100791. [PMID: 37598591 DOI: 10.1016/j.trre.2023.100791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
Recipient outcomes after transplantation with organs from donation after circulatory death (DCD) donors can compare favourably and even match recipient outcomes after transplantation with organs from donation after brain death donors. Success is dependent upon establishing common practices and accepted protocols that allow the safe sharing of DCD organs and maximise the use of the DCD donor pool. The British Transplantation Society 'Guideline on transplantation from deceased donors after circulatory death' has recently been updated. This manuscript summarises the relevant recommendations from chapters specifically related to organ donation.
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Affiliation(s)
- Stephen O'Neill
- Consultant Transplant Surgeon, Belfast City Hospital, Belfast, Northern Ireland.
| | - Ellie Asgari
- Consultant Nephrologist, Guy's Hospital, London, England
| | - Chris Callaghan
- Consultant Transplant Surgeon, Guy's Hospital, London, England
| | - Dale Gardiner
- Consultant Intensivist, Queen's Medical Centre, Nottingham, England
| | - Hermien Hartog
- Consultant Transplant Surgeon, Queen Elizabeth Hospital, Birmingham, England
| | - Satheesh Iype
- Consultant Transplant Surgeon, Royal Free Hospital, London, England
| | - Alex Manara
- Consultant Intensivist, Southmead Hospital, Bristol, England
| | - David Nasralla
- Consultant Transplant Surgeon, Royal Free Hospital, London, England
| | - Gabi C Oniscu
- Consultant Transplant Surgeon, Royal Infirmary, Edinburgh, Scotland
| | - Chris Watson
- Consultant Transplant Surgeon, Addenbrooke's Hospital, Cambridge, England
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Miñambres E, Estébanez B, Ballesteros MÁ, Coll E, Flores-Cabeza EM, Mosteiro F, Lara R, Domínguez-Gil B. Normothermic Regional Perfusion in Pediatric Controlled Donation After Circulatory Death Can Lead to Optimal Organ Utilization and Posttransplant Outcomes. Transplantation 2023; 107:703-708. [PMID: 36226852 DOI: 10.1097/tp.0000000000004326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The benefits of normothermic regional perfusion (NRP) in posttransplant outcomes after controlled donation after the determination of death by circulatory criteria (cDCD) has been shown in different international adult experiences. However, there is no information on the use of NRP in pediatric cDCD donors. METHODS This is a multicenter, retrospective, observational cohort study describing the pediatric (<18 y) cDCD procedures performed in Spain, using either abdominal NRP or thoracoabdominal NRP and the outcomes of recipients of the obtained organs. RESULTS Thirteen pediatric cDCD donors (age range, 2-17 y) subject to abdominal NRP or thoracoabdominal NRP were included. A total of 46 grafts (24 kidneys, 11 livers, 8 lungs, 2 hearts, and 1 pancreas) were finally transplanted (3.5 grafts per donor). The mean functional warm ischemic time was 15 min (SD 6 min)' and the median duration of NRP was 87 min (interquartile range, 69-101 min). One-year noncensored for death kidney graft survival was 91.3%. The incidence of delayed graft function was 13%. One-year' noncensored-for-death liver graft survival was 90.9%. All lung and pancreas recipients had an excellent evolution. One heart recipient died due to a septic shock. CONCLUSIONS This is the largest experience of pediatric cDCD using NRP as graft preservation method. Although our study has several limitations, such as its retrospective nature and the small sample size, its reveals that NRP may increase the utilization of cDCD pediatric organs and offer optimal recipients' outcomes.
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Affiliation(s)
- Eduardo Miñambres
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- School of Medicine, Universidad de Cantabria, Santander, Spain
| | - Belen Estébanez
- Transplant Coordination Unit & Service of Intensive Care, University Hospital La Paz, Madrid, Spain
| | - Maria Ángeles Ballesteros
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | | | - Fernando Mosteiro
- Transplant Coordination Unit & Service of Intensive Care, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Ramón Lara
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Virgen De Las Nieves, Granada, Spain
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Leland B, Wocial L. Exploring Ethical Dimensions of Physician Involvement in Requests for Organ Donation in Pediatric Brain Death. Semin Pediatr Neurol 2022; 45:101031. [PMID: 37003625 DOI: 10.1016/j.spen.2022.101031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 12/25/2022]
Abstract
Pediatric organ transplantation remains a life-saving therapy, with donated organs being absolutely scarce resources. Efforts to both increase pediatric organ donation authorization by families of children declared dead by neurologic criteria and mitigate perception of conflicts of interest have resulted in frequent exclusion of physicians from this process. This article provides of focused review of pediatric organ donation in the setting of brain death, explores the breadth of consequences of physician exclusion in donation authorization requests, and provides an ethical framework defending physician involvement in the organ donation process for this patient population.
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Gaillard-Le Roux B, Cremer R, de Saint Blanquat L, Beaux J, Blanot S, Bonnin F, Bordet F, Deho A, Dupont S, Klusiewicz A, Lafargue A, Lemains M, Merchaoui Z, Quéré R, Samyn M, Saulnier ML, Temper L, Michel F, Dauger S. Organ donation by Maastricht-III pediatric patients: Recommendations of the Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP) and Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF) Part I: Ethical considerations and family care. Arch Pediatr 2022; 29:502-508. [DOI: 10.1016/j.arcped.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/04/2022] [Accepted: 06/18/2022] [Indexed: 11/27/2022]
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Unassisted Return of Spontaneous Circulation Following Withdrawal of Life-Sustaining Therapy During Donation After Circulatory Determination of Death in a Child. Crit Care Med 2021; 50:e183-e188. [PMID: 34369429 DOI: 10.1097/ccm.0000000000005273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the unassisted return of spontaneous circulation following withdrawal of life-sustaining treatment in a child. DESIGN Case report based on clinical observation and medical record review. SETTING Community Children's Hospital. PATIENT Two-year old child. INTERVENTIONS Following hypoxic-ischemic brain injury, the child was taken to the operating room for withdrawal of life-sustaining treatment during controlled donation after circulatory determination of death. MEASUREMENTS AND MAIN RESULTS In addition to direct observation by experienced pediatric critical care providers, the child was monitored with electrocardiography, pulse oximetry, and invasive blood pressure via femoral arterial catheter in addition to direct observation by experienced pediatric critical care providers. Unassisted return of spontaneous circulation occurred greater than 2 minutes following circulatory arrest and was accompanied by return of respiration. CONCLUSIONS We provide the first report of unassisted return of spontaneous circulation following withdrawal of life-sustaining treatment in a child. In our case, return of spontaneous circulation occurred in the setting of controlled donation after circulatory determination of death and was accompanied by return of respiration. Return of spontaneous circulation greater than 2 minutes following circulatory arrest in our patient indicates that 2 minutes of observation is insufficient to ensure that cessation of circulation is permanent after withdrawal of life-sustaining treatment in a child.
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