Potential for 'uncapped' newborn organ donations with uk guideline review


Potential for 'uncapped' newborn organ donations with uk guideline review

In the UK, organ donation from newborns is practically unheard of. New research from the Great Ormond Street Hospital in London suggests that this is primarily due to current death verification and certification standards. But the study authors say such guidelines need to be revised as there is "significant uncapped potential" for newborn organ donation in the UK.

This is according to a study recently published online in the Fetal & Neonatal Edition of Archives of Disease in Childhood - a journal of the BMJ.

There are fewer children on the waiting list for donated organs than adults. But the study authors note there are also significantly fewer potential donors for children.

Many newborns and infants awaiting transplantation can only accept donor organs of a certain size.

"For an infant awaiting a heart transplant, only a small-sized infant organ can be used, whereas as children approach adolescence, an adult organ becomes a viable option," the researchers explain.

The need for an organ of a certain size limits the chances of transplantation. But the investigators say that in the UK, this is not the only restricting factor.

UK guidelines restrict child organ donations

The majority of deceased organ donations come from individuals who have died from neurological causes. This is known as donation following neurological determination of death (DNDD).

However, UK national guidelines from the Academy of Medical Royal Colleges suggest that it is "rarely possible to confirm death using neurological criteria in infants under 2 months of age."

This means that unlike other European countries, Australia and the US, the use of neurological criteria to diagnose the death of infants between 37 weeks' gestation and 2 months of age is prohibited in the UK.

The researchers note that the shortage of organ donations in the UK has led to an uptake in donation after circulatory determination of death (DCDD) - organ donation from individuals whose death has been diagnosed and confirmed using cardiorespiratory criteria.

But although DCDD is possible for newborns under 2 months of age, the researchers say it is not currently in practice.

With these factors in mind, the research team decided to assess all infants who passed away in a neonatal or pediatric intensive care unit (ICU) at Great Ormond Street Hospital (GOSH) between 2006 and 2012.

The aim was to see how many of these children could have been a potential DCDD organ donor, or if they fulfilled criteria for neurological death, how many could have been a potential DNDD donor.

Results 'question validity of current guidelines'

Results of the analysis revealed that during the study period, 84 infants aged between 37 weeks' gestation and 2 months died. Of these, 45 (54%) could have been potential organ donors.

The team found that 34 (40%) of the infants were potential DCDD donors, while 11 (13%) were potential DNDD donors.

All of the DNDD donors had extensive brain damage, had been in a coma, could not breathe without assistance and had evidence of neurological impairment.

They all died within minutes of their life support being ceased, and the authors say all of them would have fulfilled the criteria for neurological death, which suggests "current guidelines are preventing consideration of suitable donors in the UK."

The study authors write:

These results call into question the validity of such guidelines, particularly when they are at odds with other modern health care systems such as those of the US, France and Australia.

Review of these guidelines could increase the donor numbers in the UK and remove the need to turn to Europe for the provision of neonatal hearts, as is the current practice."

The researchers say the results of this study come from just one specialist center, so there must be "unrealized potential" in similar centers and most ICUs over the UK.

"Even with a conservative conversion rate of 50%, these organs would significantly increase the overall total of small-sized organs donated in the UK," they add.

Medical-Diag.com recently reported on a study suggesting that transplanting donor lungs from heavy smokers does not affect patient outcomes and should be considered for expanding donor organ availability.

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