Potential and actual neonatal organ and tissue donation after circulatory determination of death

Justin Stiers, Cecile Aguayo, Angela Siatta, Angela P. Presson, Richard V Perez, Robert DiGeronimo

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

IMPORTANCE The need for transplants continues to exceed organ and tissue donor availability. Although recent surgical advances have resulted in successful transplants using very small pediatric donors, including neonates, the actual practice of neonatal organ donation after circulatory determination of death (DCDD) remains uncommon. OBJECTIVE To describe the percentage of neonates potentially eligible for DCDD, including those who underwent successful donation, and reasons for ineligibility in those who did not in a single neonatal intensive care unit (NICU). DESIGN, SETTING, AND PARTICIPANTS We obtained data from the Children's Hospital Neonatal Database and Intermountain Donor Services (IDS) organ procurement records. The 136 deaths that occurred in the NICU of the Primary Children's Hospital, Salt Lake City, Utah, from January 1, 2010, through May 7, 2013, were reviewed retrospectively from January 12 through July 1, 2014, to determine potential eligibility for DCDD as determined by IDS minimum eligibility criteria (requirement of life-sustaining interventions and weight >2 kg). For patients who did not undergo DCDD, we reviewed records to determine the reasons for ineligibility. MAIN OUTCOMES AND MEASURES Potential eligibility for DCDD among neonates who died in the study NICU. RESULTS Of 136 deaths in the NICU, 60 (44.1%) met criteria for DCDD; however, fewer than 10% were referred appropriately to the regional organ procurement organization for evaluation. Forty-five neonates (33.1%) ultimately died within 90 minutes of withdrawal of life-sustaining interventions and thus would have been eligible for organ donation based on warm ischemic time. The most common causes of death among the 60 potentially eligible neonatal donors were neonatal encephalopathy (n = 17) and multiple congenital anomalies (n = 14). Nonreferral or late referral by the medical team was the most frequent reason for donor ineligibility, including 49 neonates (36.0%). Overall, only 4 neonates (2.9%) underwent successful DCDD. CONCLUSIONS AND RELEVANCE Although almost half of all neonatal deaths identified met minimum IDS criteria, most of these patients were not referred or were referred too late for evaluation. Although small size remains the primary reason for exclusion from DCDD, improved education with regard to criteria and the importance of timely referral by neonatologists and other members of the NICU team would likely result in a significant increase of future donations.

Original languageEnglish (US)
Pages (from-to)639-645
Number of pages7
JournalJAMA Pediatrics
Volume169
Issue number7
DOIs
StatePublished - Jul 1 2015

Fingerprint

Tissue and Organ Procurement
Tissue Donors
Neonatal Intensive Care Units
Newborn Infant
Referral and Consultation
Transplants
Warm Ischemia
Death Certificates
Brain Diseases
Cause of Death
Organizations
Databases
Pediatrics
Education
Weights and Measures

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Potential and actual neonatal organ and tissue donation after circulatory determination of death. / Stiers, Justin; Aguayo, Cecile; Siatta, Angela; Presson, Angela P.; Perez, Richard V; DiGeronimo, Robert.

In: JAMA Pediatrics, Vol. 169, No. 7, 01.07.2015, p. 639-645.

Research output: Contribution to journalArticle

Stiers, Justin ; Aguayo, Cecile ; Siatta, Angela ; Presson, Angela P. ; Perez, Richard V ; DiGeronimo, Robert. / Potential and actual neonatal organ and tissue donation after circulatory determination of death. In: JAMA Pediatrics. 2015 ; Vol. 169, No. 7. pp. 639-645.
@article{93a90e77a7914afda97fba67a48027e1,
title = "Potential and actual neonatal organ and tissue donation after circulatory determination of death",
abstract = "IMPORTANCE The need for transplants continues to exceed organ and tissue donor availability. Although recent surgical advances have resulted in successful transplants using very small pediatric donors, including neonates, the actual practice of neonatal organ donation after circulatory determination of death (DCDD) remains uncommon. OBJECTIVE To describe the percentage of neonates potentially eligible for DCDD, including those who underwent successful donation, and reasons for ineligibility in those who did not in a single neonatal intensive care unit (NICU). DESIGN, SETTING, AND PARTICIPANTS We obtained data from the Children's Hospital Neonatal Database and Intermountain Donor Services (IDS) organ procurement records. The 136 deaths that occurred in the NICU of the Primary Children's Hospital, Salt Lake City, Utah, from January 1, 2010, through May 7, 2013, were reviewed retrospectively from January 12 through July 1, 2014, to determine potential eligibility for DCDD as determined by IDS minimum eligibility criteria (requirement of life-sustaining interventions and weight >2 kg). For patients who did not undergo DCDD, we reviewed records to determine the reasons for ineligibility. MAIN OUTCOMES AND MEASURES Potential eligibility for DCDD among neonates who died in the study NICU. RESULTS Of 136 deaths in the NICU, 60 (44.1{\%}) met criteria for DCDD; however, fewer than 10{\%} were referred appropriately to the regional organ procurement organization for evaluation. Forty-five neonates (33.1{\%}) ultimately died within 90 minutes of withdrawal of life-sustaining interventions and thus would have been eligible for organ donation based on warm ischemic time. The most common causes of death among the 60 potentially eligible neonatal donors were neonatal encephalopathy (n = 17) and multiple congenital anomalies (n = 14). Nonreferral or late referral by the medical team was the most frequent reason for donor ineligibility, including 49 neonates (36.0{\%}). Overall, only 4 neonates (2.9{\%}) underwent successful DCDD. CONCLUSIONS AND RELEVANCE Although almost half of all neonatal deaths identified met minimum IDS criteria, most of these patients were not referred or were referred too late for evaluation. Although small size remains the primary reason for exclusion from DCDD, improved education with regard to criteria and the importance of timely referral by neonatologists and other members of the NICU team would likely result in a significant increase of future donations.",
author = "Justin Stiers and Cecile Aguayo and Angela Siatta and Presson, {Angela P.} and Perez, {Richard V} and Robert DiGeronimo",
year = "2015",
month = "7",
day = "1",
doi = "10.1001/jamapediatrics.2015.0317",
language = "English (US)",
volume = "169",
pages = "639--645",
journal = "JAMA Pediatrics",
issn = "2168-6203",
publisher = "American Medical Association",
number = "7",

}

TY - JOUR

T1 - Potential and actual neonatal organ and tissue donation after circulatory determination of death

AU - Stiers, Justin

AU - Aguayo, Cecile

AU - Siatta, Angela

AU - Presson, Angela P.

AU - Perez, Richard V

AU - DiGeronimo, Robert

PY - 2015/7/1

Y1 - 2015/7/1

N2 - IMPORTANCE The need for transplants continues to exceed organ and tissue donor availability. Although recent surgical advances have resulted in successful transplants using very small pediatric donors, including neonates, the actual practice of neonatal organ donation after circulatory determination of death (DCDD) remains uncommon. OBJECTIVE To describe the percentage of neonates potentially eligible for DCDD, including those who underwent successful donation, and reasons for ineligibility in those who did not in a single neonatal intensive care unit (NICU). DESIGN, SETTING, AND PARTICIPANTS We obtained data from the Children's Hospital Neonatal Database and Intermountain Donor Services (IDS) organ procurement records. The 136 deaths that occurred in the NICU of the Primary Children's Hospital, Salt Lake City, Utah, from January 1, 2010, through May 7, 2013, were reviewed retrospectively from January 12 through July 1, 2014, to determine potential eligibility for DCDD as determined by IDS minimum eligibility criteria (requirement of life-sustaining interventions and weight >2 kg). For patients who did not undergo DCDD, we reviewed records to determine the reasons for ineligibility. MAIN OUTCOMES AND MEASURES Potential eligibility for DCDD among neonates who died in the study NICU. RESULTS Of 136 deaths in the NICU, 60 (44.1%) met criteria for DCDD; however, fewer than 10% were referred appropriately to the regional organ procurement organization for evaluation. Forty-five neonates (33.1%) ultimately died within 90 minutes of withdrawal of life-sustaining interventions and thus would have been eligible for organ donation based on warm ischemic time. The most common causes of death among the 60 potentially eligible neonatal donors were neonatal encephalopathy (n = 17) and multiple congenital anomalies (n = 14). Nonreferral or late referral by the medical team was the most frequent reason for donor ineligibility, including 49 neonates (36.0%). Overall, only 4 neonates (2.9%) underwent successful DCDD. CONCLUSIONS AND RELEVANCE Although almost half of all neonatal deaths identified met minimum IDS criteria, most of these patients were not referred or were referred too late for evaluation. Although small size remains the primary reason for exclusion from DCDD, improved education with regard to criteria and the importance of timely referral by neonatologists and other members of the NICU team would likely result in a significant increase of future donations.

AB - IMPORTANCE The need for transplants continues to exceed organ and tissue donor availability. Although recent surgical advances have resulted in successful transplants using very small pediatric donors, including neonates, the actual practice of neonatal organ donation after circulatory determination of death (DCDD) remains uncommon. OBJECTIVE To describe the percentage of neonates potentially eligible for DCDD, including those who underwent successful donation, and reasons for ineligibility in those who did not in a single neonatal intensive care unit (NICU). DESIGN, SETTING, AND PARTICIPANTS We obtained data from the Children's Hospital Neonatal Database and Intermountain Donor Services (IDS) organ procurement records. The 136 deaths that occurred in the NICU of the Primary Children's Hospital, Salt Lake City, Utah, from January 1, 2010, through May 7, 2013, were reviewed retrospectively from January 12 through July 1, 2014, to determine potential eligibility for DCDD as determined by IDS minimum eligibility criteria (requirement of life-sustaining interventions and weight >2 kg). For patients who did not undergo DCDD, we reviewed records to determine the reasons for ineligibility. MAIN OUTCOMES AND MEASURES Potential eligibility for DCDD among neonates who died in the study NICU. RESULTS Of 136 deaths in the NICU, 60 (44.1%) met criteria for DCDD; however, fewer than 10% were referred appropriately to the regional organ procurement organization for evaluation. Forty-five neonates (33.1%) ultimately died within 90 minutes of withdrawal of life-sustaining interventions and thus would have been eligible for organ donation based on warm ischemic time. The most common causes of death among the 60 potentially eligible neonatal donors were neonatal encephalopathy (n = 17) and multiple congenital anomalies (n = 14). Nonreferral or late referral by the medical team was the most frequent reason for donor ineligibility, including 49 neonates (36.0%). Overall, only 4 neonates (2.9%) underwent successful DCDD. CONCLUSIONS AND RELEVANCE Although almost half of all neonatal deaths identified met minimum IDS criteria, most of these patients were not referred or were referred too late for evaluation. Although small size remains the primary reason for exclusion from DCDD, improved education with regard to criteria and the importance of timely referral by neonatologists and other members of the NICU team would likely result in a significant increase of future donations.

UR - http://www.scopus.com/inward/record.url?scp=84937440621&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937440621&partnerID=8YFLogxK

U2 - 10.1001/jamapediatrics.2015.0317

DO - 10.1001/jamapediatrics.2015.0317

M3 - Article

C2 - 25961731

AN - SCOPUS:84937440621

VL - 169

SP - 639

EP - 645

JO - JAMA Pediatrics

JF - JAMA Pediatrics

SN - 2168-6203

IS - 7

ER -