• Neonatology
• Neonatal Organ Donation

We read with interest the article by Charles et al. 1 We agree with their statement that there is significant potential for donation among the UK neonatal population that is not being realised. We report a case of successful neonatal organ donation which happened recently in our unit. This is the first ever neonatal organ donation after circulatory determination of death reported in the UK. The kidneys and hepatocytes were transplanted/transfused to two suitable recipients.

The mother presented at term with reduced/absent fetal movements. An emergency caesarean section was performed as the cardio-tocographic trace was pathological. A baby girl weighing 3.1 kg was delivered in a very poor condition. After successful initial resuscitation, it became clear that she had suffered a severe antenatal hypoxic insult. She was profoundly encephalopathic with an isoelectric cerebral function monitoring trace. She underwent therapeutic hypothermia for 72 h, which did not make any difference to her neurological status. Although there was some rise in troponin and liver enzymes, she never needed any inotropic support. Her renal functions were normal throughout. Repeated examinations revealed no spontaneous movements, with no response to stimulation and fixed and dilated pupils. Regular discussion with the parents about her condition led to a decision of redirection towards palliative care.

It was at this point that we discussed the possibility of organ donation. A very careful and realistic plan was prepared in association with the organ donation team and presented to the parents. This included taking extreme care towards the comfort of the baby and expectations of the parents. Nursing staff caring for the baby were hugely helpful by ensuring the needs of the family were met at each step. The parents consented for this extraordinary generosity. They also met with our onsite psychologist in view of the sensitive nature of this decision. A specialist nurse from the National Health Service Blood and Transplant team did a full assessment of the infant according to their guidelines to confirm the suitability of the organs for donation. It was agreed that kidneys and hepatocytes will be retrievable. Suitable recipients were located in the country. On sixth day after her birth, these organs were successfully retrieved with the help of an experienced surgeon from the National Organ Retrieval Service, after circulatory determination of her death. Both kidneys and hepatocytes were transplanted/transfused to two suitable recipients. A postmortem examination and a postmortem MRI revealed severe hypoxic ischaemic injury of the brain.

It is due to the extreme generosity of the parents and a wonderful professional collaboration between the neonatal team and organ donation team that this process was successful. This case has set a milestone in the care of newborns in the UK. A significant proportion of babies who die in neonatal units are potential organ donors.1 Although the long-term data regarding graft function are not yet available, we feel that potential neonatal organ donation should be a part of management for all withdrawals. This child’s condition might have been compatible with a neurological confirmation of death, but the current guidance does not permit that.2 The Royal College of Paediatrics working group is expected to publish the guidelines on ‘Diagnosis of death by neurological criteria in infants between 37 weeks and two months’ by the end of 2014.3 This will potentially facilitate the formulation of a pathway to standardise neonatal organ donation. We hope that neonatal units across the UK will actively start thinking about this noble cause, which makes the grieving family’s journey easier and has the potential to transform another life.4