Variability in pediatric and neonatal organ offering, acceptance and utilization: a survey of Canadian pediatric transplant programs and organ donation organizations

Laurie A Lee; Augustina Okpere; Dori-Ann Martin; Meagan Mahoney; Lee James; Yaron Avitzur; Bailey Piggott; Christopher Tomlinson; Simon Urschel; Lorraine Hamiwka

doi:10.3389/frtra.2024.1458563

Variability in pediatric and neonatal organ offering, acceptance and utilization: a survey of Canadian pediatric transplant programs and organ donation organizations

Front Transplant. 2024 Sep 27:3:1458563. doi: 10.3389/frtra.2024.1458563. eCollection 2024.

Authors

Laurie A Lee^{1

2

3}, Augustina Okpere², Dori-Ann Martin³, Meagan Mahoney^{2

4}, Lee James⁵, Yaron Avitzur⁶, Bailey Piggott⁵, Christopher Tomlinson^{7

8}, Simon Urschel^{9

10}, Lorraine Hamiwka^{2

3}

Affiliations

¹ Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
² Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada.
³ Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
⁴ Department of Pediatric Critical Care, Alberta Health Services, Calgary, AB, Canada.
⁵ Canadian Blood Services, Vancouver, BC, Canada.
⁶ Division of Gastroenterology, Hepatology and Nutrition, SickKids Hospital, Toronto, ON, Canada.
⁷ Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
⁸ Neonatal Intensive Care, Hospital for Sick Children, Toronto, ON, Canada.
⁹ Pediatric Cardiology, Stollery Children's Hospital, Edmonton, AB, Canada.
¹⁰ Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.

Abstract

Introduction: Solid organ transplantation in children is a lifesaving therapy, however, pediatric organ donation rates remain suboptimal.

Methods: We conducted a cross-sectional survey of Canadian organ donation organizations (ODOs) and pediatric transplant programs (TPs), aiming to describe policies and practices for pediatric organ allocation, acceptance, and utilization in Canada.

Results: Response rates were 82% and 83% respectively for ODOs and transplant programs comprising 7 kidney, 3 heart, 2 lung, 2 liver and 1 intestine programs. All 9 ODOs reported offering pediatric organs following death by neurological criteria (DNC), while 8 reported offering organs following death by circulatory criteria (DCC) for some organs. Variability was found across ODOs and TPs. There was little agreement on both absolute and organ-specific donor exclusion criteria between ODOs. There was further disagreement in organ specific acceptance criteria between ODOs and TPs and between TPs themselves. Notably, despite the development of pediatric donation after DCC guidelines, organs from DCC donors are excluded by many ODOs and TPs.

Discussion: Further variability in pediatric specific training, policies, and allocation guidelines are also documented. Significant areas for improvement in standardization in organ acceptance, offering, and allocation in pediatric donation and transplantation across Canada were identified.

Keywords: organ donation; organ donation organizations; paediatrics; pediatric recipients; pediatric transplant programs; transplant policies; transplantation.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by in-kind funding through project management, data collection, and data analysis support by Canadian Blood Services.