![]() This guidance includes being informed about state laws related to donor status on a driver’s license. Pediatric health care professionals can offer anticipatory guidance, counseling, and educational information to promote awareness to patients and families about organ donation. DCD requires a distinct separation of discussions about withdrawal of life-sustaining medical therapies and organ donation to avoid any perceived conflict of interest that withdrawal of medical therapies will result in death for the purpose of organ recovery. However, parents might prefer earlier discussions about donation to reach an informed decision. Separating or “decoupling” conversations about death and organ donation is common practice in adult cases. 31 Consulting the OPO is important to ensure that opportunities for donation are not lost before ruling out donation based on disease process or injury or individual opinions that the child may not be an acceptable donor. 30 Best practice (consistent with regulatory requirements) in approaching parents and families about authorization for organ donation relies on collaboration between the medical team and the OPO. Although some clinicians might find it difficult to introduce the topic of organ donation, few families of either adults or children or adolescents appear to suffer psychological harm by having the option of donation presented to them. Families might choose to engage their child’s or adolescent’s primary care physician in the decision-making process, and in some cases, family-initiated discussions about donation before death may occur when death is imminent. When parents wish to consider organ donation, health care providers can provide psychosocial support and collaborate with the OPO to explore this option. Organ donation for pediatric patients is a decision made by families in conjunction with the OPO and the medical team. Determination of brain death in the United States has been defined in guidelines from the American Academy of Pediatrics (AAP) in conjunction with other medical societies. Accurate determination of death by circulatory or neurologic criteria is essential. The Uniform Determination of Death Act defined death but left the determination of death to medical providers based on currently accepted medical standards. This model legislation was subsequently enacted as the legal standard in every state. In 1981, the Uniform Law Commission released the Uniform Determination of Death Act, which states that death is determined by the irreversible loss of entire brain function including the brain stem or the irreversible loss of circulatory and respiratory function. 7 The opportunity for organ donation primarily occurs after the determination of brain death. ![]() Organ donation in the United States is predicated on the “dead donor rule”: vital organs can only be removed for transplantation after a person is declared dead following neurologic or circulatory criteria, and recovery of organs cannot result in the death of the patient. 3, 4 Some children and adolescents will unfortunately die waiting for a life-saving organ transplant, with children younger than 1 year having the highest death rate waiting for an organ transplant. 1 Disparities also exist among racial and ethnic groups. 2 Despite seemingly matched donor to transplant numbers, as of 2021, more than 48% of pediatric patients on the waiting list have been waiting for more than 1 year (48% for kidney, 41% for heart, and 47% for liver). 1 Pediatric living organ donation from 2009 to 2015 was 27% lower than in 1995 to 2001. In 2020, pediatric deceased donors provided 2476 organs for transplant. 1 Neonates, infants, children, and adolescents of all ages who die can be organ and tissue donors if clinical criteria for donation are met. There are more than 1000 pediatric organ donors in the United States annually. Many pediatric candidates may need a donated organ from a neonate, infant, child, or adolescent, given organ size and developmental criteria. 1 Each year more than 1700 children and adolescents receive organ transplants. In 2021, more than 1800 pediatric candidates in the United States younger than 18 years were awaiting an organ transplant. Organ transplant is vital to extend the life of patients with end-organ failure. ![]()
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