The Potential Benefits of the Pediatric Nonheartbeating Organ Donor

Objective. To examine the population of the pediatric intensive care unit in a large children's hospital to determine the potential importance of pedi- atric nonheartbeating organ donors (NHBDs). Study Design. We analyzed retrospectively the 6307 admissions to the pediatric intensive care unit at the Children's Hospital of Philadelphia from January 1992 to July 1996 to identify all deaths. The hospital records of the children who had died were then reviewed to deter- mine the mode of death, organ donation rate of heart- beating donors, and the number of potential NHBDs. Criteria for the NHBD included the decision to forgo life-sustaining therapy, death occurring within 2 hours of withdrawal of life support, and the absence of sepsis, HIV, hepatitis, or extracranial malignancy. Results. Of 319 deaths, 102 (32.0%) died with resusci- tation, 84 (26.3%) were brain-dead, 111 (34.8%) had with- drawal of life support, and 22 (6.9%) were on do-not- resuscitate orders. Of the 84 brain-dead children, 74 (88.1%) were medically suitable heartbeating donors, and 43 (58.1%) donated organs. Of the 111 patients who had life support withdrawn, 31 (27.9%) qualified for NHBDs. Conclusions. The routine use of the NHBD has the potential to increase organ donation at our institution by 42%. We discuss the ethical issues relating to NHBDs required to properly include these patients as potential organ donors. Pediatrics 1998;101:1049 -1052; nonheart- beating organ donor, pediatrics, organ donation, trans- plantation, withdrawal of life support.