Pediatric organ donation: impact of medical examiner refusal.
OBJECTIVE
To examine the national Pediatric Intensive Care Unit (PICU) experience regarding Medical Examiner (ME) refusal of organ procurement from potential donors. To review our experience regarding PICU mortalities, organ donation, and impact of the ME on the organ donation process.


METHODS
National survey of PICU directors requesting demographics, type of ME system, perceptions of ME responsiveness to organ donation, and data regarding potential donors and their outcomes. Also, a retrospective chart review of all PICU deaths from 1990 to 1992 at a tertiary care center, noting the number of potential organ donors, ME cases, those harvested, rejected, and reason for rejection.


METHODS
PICU directors selected from a list of Pediatric Section members of the Society of Critical Care Medicine. The response rate was 59%. The chart review was performed in a 1000-bed hospital with a 12-bed PICU.


RESULTS
PICU directors' perceptions of ME responsiveness to organ donation were not determined by size of PICU, area served, type of hospital, ME system, or means of contacting the ME. ME refusal accounted for 15% and 16% of total refusals in the survey and chart review, respectively. Family refusal accounted for 49% and 28% in these same groups. Survey respondents' hints and suggestions to decrease denial and increase organ donation focused on improved communication (61% and 33%), and education (16% and 55%).


CONCLUSIONS
ME refusal does impact on pediatric organ donation, but not as significantly as family refusal. Increased organ procurement in ME-related cases will require improved communication between MEs, physicians, and the Organ Procurement Organizations (OPOs).
Wick
L
L
Department of Pediatrics, Children's Medical Center of the Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
Mickell
J
J
Barnes
T
T
Allen
J
J
D001291:Attitude of Health Personnel; D002648:Child; D003334:Coroners and Medical Examiners; D003710:Demography; D005190:Family; D006801:Humans; D010372:Pediatrics; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014768:Virginia