Paediatric care

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Paediatric Organ Donation

The Organ Donation Task Force (2008) saw an associated 50% increase in donation within the overall population, this was not reflected in paediatrics where rates did not increase until 2013 – 14.

Deceased paediatric donors, transplants and active transplant list in the UK

There are 27 Paediatric Intensive Care Units (PICU) across the country with around 13,000 children admitted each year; nearly half of those being under one year of age. It is relatively rare for children to die in a Paediatric Intensive Care Unit; compared to adults admitted to intensive care, the survival rates for paediatric patients are much higher, with over 95% survival. (source: Paediatric Intensive Care Medicine - Royal College of Paediatrics and Child Health).

UK consent rates for paediatric organ donation fall below the national average for the adult population.

DBD and DCD consent/authorisation rates by age group and donor type, 1 April 2015 to 31 March 2017

End of life care guidance and practice does differ from adult practice and care of the family unit as a whole is a core key principle. PICU systems should never prevent families being offered the opportunity to donate if this is a possibility.

Useful Resources
External links

Paediatric Intensive Care Society

Paediatric Donation after Circulatory Death

Donation following Circulatory Death (DCD) in children has increased in line with adult trends, becoming a significant area of donation. In part a contribution to this increase has been advances in DCD donation in very small infants and neonates which has been noted since 2012.

The reason for the increase in donation from small infants has been attributed to advances and development of techniques in en-bloc renal transplantation, development of hepatocyte transplantation from this age group and media coverage which has enabled families to feel empowered to come forward to seek information on the option of organ donation.

Donors aged less than 16 years by financial year and donor type - 1 April 2010 to 31 March 2017

In the absence of clear ethical framework for donation in paediatrics UK Donation Ethics Committee published a position paper in June 2015 to examine ethical issues that may arise taking into account how practices in end of life care in children can affect decision making. It provides a framework for decision making while respecting any known wishes or beliefs the child may have had.

The specialist nurses receive specific training to increase awareness and understanding of paediatric and neonatal systems to ensure they are well equipped to support and facilitate donation in this environment. In addition to this teams should ensure robust policies are available in all units to ensure we provide opportunities for donation, where possible, to be included in the care of families facing the death of a child.

Donation after Neurological Determination of Death

The AoMRC guidance document should be used to determine the death by neurological criteria in > 2months post term. 

In April 2015 guidance was released for determination of death by neurological criteria by the RCPCH. This guidance relates specifically to infants from 37 weeks gestational age (including corrected gestational age) to 2 months post term.

Donors aged less than 16 years by financial year and donor type - 1 April 2010 to 31 March 2017

 

Useful Resources

Donation from infants with antenatal diagnosis of life limiting abnormalities

There have been cases where babies diagnosed with anencephaly and other life limiting conditions have been able to donate organs and tissues following their death. However, this remains a rare event and the likelihood of donation occurring under these circumstances is small. Further guidance has been given from the UK Donation Ethics Committee which can be found below.

Our Organ Donation and Babies with Congenital and Life Limiting Conditions guidance document is currently focused on supporting families in decisions around end of life care, should organ donation be something that a family requests, information and support will be given in line with this guidance.

Useful resources

Donation in Infants and Neonates

Organ donation from infants less than 6 months of age including those in the neonatal period has increased since 2012. The reason for this has in part been attributed to advances and development of techniques in en-bloc renal transplantation, development of hepatocyte transplantation from very young donors and also an increased awareness has enabled families to feel empowered to come forward to seek information on donation as an option.

In April 2015 guidance was published by the Royal College of Paediatric and Child Health on the determination of death by neurological criteria in infants from 37 weeks corrected gestational age to 2 months post term. This guidance has the potential to increase the possibility of greater options for transplantation from these patients.

The donation process remains unchanged; however there are considerations that must be taken into account when facilitating donation from very small infants and these are detailed in the standard operating procedure .

Please follow the link for the optimisation care bundle for use on patients >37 weeks CGA - 15 years. The cardiothoracic SCOUT project phase 2 does not apply to patients under 16 years of age.

Donors aged less than 6 months by financial year and donor type - 1 April 2010 to 31 March 2017

There has also been an increase in donation from infants with conditions diagnosed during antenatal care that will ultimately lead to the death of the infant shortly after birth, for example anencephaly.

Paediatric Donor Optimisation

In addition to ensuring the opportunity for donation is offered in all cases where it is possible we need to consider the focus of treatment following neurological determination of death. The focus changes from life saving to the optimisation of organs for transplantation. We have a commitment to provide the highest number of organs in the best possible condition through optimisation of donor physiology.

In the UK the mean number of organs per donor in adults are DBD 3.29 / DCD 2.18 in paediatric patients this is increased to DBD 5.27 / DCD 3.33.

Mean number of organs transplanted per donor by age group and donor type - 1 April 2015 to 31 March 2017

The principles of optimization are unchanged from adults but specific consideration for paediatric patients and paediatric practice is important. Local protocols which are agreed with clinical, nursing and pharmacy staff are important to ensure optimization objectives are clearly met.

Please follow the link for the optimisation care bundle for use on patients >37 weeks CGA - 15 years. The cardiothoracic SCOUT project phase 2 does not apply to patients under 16 years of age.

Mean number of organs transplanted per donor by age group and donor type, 1 April 2016 to 31 March 2017