title: Pediatric Organ Donation Potential at a Children's Hospital.
abstract: OBJECTIVE
  To estimate the organ donation potential of patients dying at a children's hospital.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A free-standing, 271-bed, tertiary Children's Hospital with a pediatric trauma center.
  
  
  METHODS
  Patients dying in any ICU during 2011-2012.
  
  
  METHODS
  None.
  
  
  RESULTS
  Among 224 deaths, 23 (10%) met neurologic criteria for death: 18 donated organs (conversion rate 78%), 47 (19%) died without prior limitation of life-sustaining therapies, and the remaining 69% had withdrawal of life-sustaining therapies. Among those dying after withdrawal of life-sustaining therapies (n = 154), the organ procurement organization was not notified prior to death in 24%, and older patients were more likely to be referred compared to those less than 1 year old. Infection, cancer, and organ dysfunction were the most frequent conditions that disqualified dying patients from suitability for donation. Just over half of children more than 1 year old were suitable for donation after withdrawal of life-sustaining therapies compared to a fifth of infants (19%). Of 45 suitable for donation, 37 (82%) died within 1 hour. None of 7 infants younger than 1 month old died within 20 minutes, compared with 46% of infants between 1 month and 1 year (n = 6) and 72% of older children. Thirty-three families (73%) did not permit donation after circulatory criteria for death whereas 12 (27%) gave permission for donation, and all 12 were actual donors (conversion rate 12/37 [32%]).
  
  
  CONCLUSIONS
  The number of pediatric potential candidates for donation after circulatory determination of death was significantly larger than potential candidates for donation after neurologic determination of death at our hospital, but the actual donation rate was significantly lower. Increasing acceptance of donation after circulatory determination of death could increase organ donation. Among all children having withdrawal of life-sustaining therapies, donation after circulatory determination of death potential is less for infants.
authors.affiliation: 1Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT. 2Intermountain Donor Services, Salt Lake City, UT. 3Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Bennett
authors.forename: Jill
authors.initials: J
authors.lastname: Sweney
authors.forename: Cecile
authors.initials: C
authors.lastname: Aguayo
authors.forename: Craig
authors.initials: C
authors.lastname: Myrick
authors.forename: Armand H Matheny
authors.initials: AH
authors.lastname: Antommaria
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003643:Death; D046148:Donor Selection; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D028761:Withholding Treatment