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The potential for neonatal organ donation in a children's hospital
  1. E Charles1,
  2. A Scales2,3,
  3. J Brierley3
  1. 1St Georges Medical School, London, UK
  2. 2London Donation Services Team, NHS Blood and Transplant, London, UK
  3. 3Great Ormond St Children's Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Joe Brierley, Great Ormond Street Hospital for Children, Ormond Street, London WC1N 3JH, UK; brierj{at}gosh.nhs.uk

Abstract

Objective Neonatal organ donation does not occur in the UK. Unlike in other European countries, Australasia and the USA death verification/certification standards effectively prohibit use of neurological criteria for diagnosing death in infants between 37 weeks’ gestation and 2 months of age and therefore donation after neurological determination of death. Neonatal donation after circulatory definition of death is also possible but is not currently undertaken. There is currently no specific information about the potential neonatal organ donation in the UK; this study provides this in one tertiary children's hospital.

Design Retrospective mortality database, clinical document database and patient notes review.

Setting Neonatal and Paediatric Intensive Care in a tertiary children's hospital.

Patients Infants dying between 37 weeks’ gestation and 2 months of age between 1 January 2006 and 31 October 2012. Potential assessed using current UK guidelines for older children and neonatal criteria elsewhere.

Results 84 infants died with 45 (54%) identified as potential donors. 34 (40%) were identified as potential donors after circulatory definition of death and 11 (13%) were identified as being theoretical potential donors after neurological determination of death. 10 (12%) were identified as unlikely donors due to relative contraindications and 39 (46%) were definitely not potential donors.

Conclusions With around 60 paediatric organ donors in the UK annually, there does appear significant potential for donation within the neonatal population. Reconsideration of current infant brain stem death guidelines is required to allow parents the opportunity of donation after neurological determination of death, together with mandatory training in organ donation for neonatal teams, which will also facilitate donation after circulatory definition of death.

  • Neonatology
  • Ethics
  • Mortality
  • Intensive Care

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