Organ donation in paediatric traumatic brain injury

Abstract

Listen

Translate article

We read with interest the paper by Kompanje et al. [1] describing their experience with organ donation in adults with traumatic brain injury (TBI), subarachnoid haemorrhage and intracerebral haemorrhage. We would like to report our findings in the United Kingdom on organ donation in children with TBI. We undertook a national audit of severe TBI in children (up to 16 years old) over a period of 12 months in all 25 paediatric intensive care units (PICU) and a number of adult units admitting children. Demographic, severity and mortality data were collected on 721 children in 2001–2002 [2]. There were 52 deaths (7.2%), 46 in PICUs and 6 in adult units. In 40 of the PICU cases we have information on whether criteria of brainstem death were met, whether organ donation was discussed with the family, and whether the child became an organ donor. In 26 of the 40 children criteria for the diagnosis of brainstem death were met. In 23 of the 40 cases the possibility of organ donation was discussed with the family, and in 12 of these cases organ donation followed. That is, approximately one-half the children dying in UK ICUs as a result of TBI meet criteria for brainstem death and almost one-half of these children go on to organ donation. We do not know the reasons behind the refusal to donate organs in the other 11 cases but, in keeping with the findings of Kompanje et al. [1], our personal experience is that the majority of these cases are the result of refusal by families who commonly believe that their child “has suffered enough already.” A significant number of children die while waiting for transplantation because there is a shortage of available organs. Our data indicate that the number of potential donations from children sustaining severe TBI is small and is unlikely to increase. This conclusion may seem surprising given that TBI is the leading cause of death between the age of 1 and 14 years [3]; however, the majority of these deaths occur before the child reaches hospital. References