Donation after Cardiac Death: The Potential Contribution of an Infant Organ Donor Population

Objective

To determine the percentage of deaths in level III neonatal intensive care unit (NICU) settings that theoretically would have been eligible for donation after cardiac death (DCD), as well as the percentage of these who would have been potential DCD candidates based on warm ischemic time.

Study design

We conducted a retrospective study of all deaths in 3 Harvard Program in Neonatology NICUs between 2005 and 2007. Eligible donors were identified based on criteria developed with our transplantation surgeons and our local organ procurement organization. Potential candidates for DCD were then identified based on an acceptable warm ischemic time.

Results

Of the 192 deaths that occurred during the study period, 161 were excluded, leaving 31 theoretically eligible donors. Of these, 16 patients had a warm ischemic time of <1 hour and were potential candidates for DCD of 14 livers and 18 kidneys, and 14 patients had a warm ischemic time of <30 minutes and were potential candidates for DCD of 10 hearts.

Conclusions

Eight percent of NICU mortalities were potential candidates for DCD. Based on the size of the potential donor pool, establishing an infant DCD protocol for level III NICUs should be considered.

BIDMC, Beth Israel Deaconess Medical Center, BWH, Brigham and Women's Hospital, CHB, Children's Hospital Boston, DBD, Donation after brain death, DCD, Donation after cardiac death, NEOB, New England Organ Bank, NICU, Neonatal intensive care unit, OPTN, Organ Procurement and Transplantation Network, PICU, Pediatric intensive care unit, UNOS, United Network for Organ Sharing