April 01, 2010
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AAP provides recommendations for pediatric organ donation, transplantation

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The high number of children requiring organ transplants has prompted the American Academy of Pediatrics to issue recommendations on organ supply and procurement; physician involvement throughout the process; family concerns; and public awareness about organ donation.

Children from birth to 17 years old make up about 2% to 3% of the national waiting list for organs, according to an AAP policy statement, and more than 70% on the list are waiting for vital organs such as a liver, kidney or small bowel.

Consequently, the AAP encourages organizations or health care professionals that deal with children to contribute to public awareness using posters in waiting rooms, handouts and other public campaigns. Pediatricians should be educated on when organ donation and transplantation are appropriate and should also be aware of their regions’ transplant centers, committee members wrote.

The AAP also acknowledged the need to approach families that are considering organ donation in a professional and understanding manner, noting that the decision to donate belongs to the family. The staff should have the proper education and training and be prepared to address medical, ethical, social, cultural and religious issues with donor and recipient families, according to committee members. Physicians should also ensure that death notification and organ donation remain separate conversations.

Another way to boost consent for donation is timely referral to organ procurement organizations. Tackling the process early on allows families to discuss organ donation with physicians and other health care professionals without feeling rushed, and it increases the likelihood that they will consent to donation, AAP members noted.

Timely notification of neurologic death not only assures that viable organs are not lost, but delays can slow down the grieving process for families. Treating physicians should be on hand to discuss determination of brain or cardiac death with families. “Care of the pediatric donor is a natural extension of care for a critically ill or injured child and the child’s family,” the AAP wrote.

Donation after cardiac death also provides an avenue for increasing the number of organs acquired for donation, especially for livers and kidneys, according to the researchers, with the Institute of Medicine and the American College of Critical Care Medicine backing the process.

Programs that offer sufficient support for donor families and recipients that involve primary care physicians are recommended. These pediatricians are integral to the follow-up of a donor family, according to the committee. Furthermore, they said that financial resources should be available for transplantation and lifetime follow-up.

The committee emphasized that protocols must be established for cases that require forensic investigation, such as those involving suspected abuse, to ensure that examination of evidence and injuries and that organ donation can be conducted successfully.

Eichner JM. Pediatrics. 2010;125:822-828.

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