Paediatric Organ Donation Issues Following Donor Treatment with Extracorporeal Devices

Introduction: Extracorporeal devices provide life sustaining cardiac and respiratory support for paediatric patients.Death in the presence of such therapy raises the possibility of organ donation.Whilst donation is achievable in this setting we describe three instances when donation was planned but did not proceed. Case Report: Patient (I) was an 8-month old female suffering brainstem death following treatment with a Berlin Heart for 2 months.Parental consent for donation was granted but did not proceed due to coroner refusal as the need for autopsy was an unresolved issue. Patient (II) was a 6-month old male suffering irreversible deterioration following treatment with VA ECMO.The decision was taken to withdraw treatment with parental consent for donation granted.However prior to withdrawal inspection of the heart demonstrated signs of potential recovery.ECMO remained active and the organ recovery team stood down. Patient (III) was a 6-year old male treated with a Novalung referred for donation after circulatory death.However three hours following withdrawal the patient remained alive and the recovery team stood down. Discussion: In all cases parents agreed for withdrawal to take place in the operating theatre. This would eliminate the difficulties of transferring patients to the operating room with extracorporeal devices. The parents would be present with their child during withdrawal, with the scrubbed organ recovery team on stand-by in an adjacent room. Our experience highlights the potential for paediatric organ donation involving in situ extracorporeal devices but also the need for greater clarity in determination of circulatory death following deactivation of such devices.Additionally cooperation may need to be improved between coroner services and clinicians to facilitate donation.As well as the lost opportunity to obtain healthy organs, the failure to proceed to organ donation may place additional distress on grieving parents.