Pediatric Organ Donation and Transplantation Policy Statement: More Questions, not Answers

Abstract

The American Academy of Pediatrics (AAP) released a policy statement regarding pediatric organ donation and transplantation1 in which several strategies to increase the supply of transplantable organs from pediatric donors were endorsed. A significant increase in the supply of transplantable organs from pediatric donors is also necessary to meet the demands of adults awaiting organ transplant.2 Although the AAP opted to not address unresolved problems in pediatric organ donation, the policy statement generated additional questions by positing that (1) an accurate and timely declaration of neurologic death in heart-beating donation (HBD) or circulatory-respiratory death in non–HBD (NHBD) (also known as donation after cardiac death or donation after circulatory death) is essential, (2) organ donation is an integral part of end-of-life care, (3) timely referral to organ-procurement organizations (OPOs) is critical, and (4) consent should be handled by procurement professionals. In the policy statement, HBD and NHBD were identified as appropriate venues of pediatric organ procurement, but the statement was explicitly silent on recent scientific controversies about both types of procurement practices. Both the validity of the criteria and the accuracy of the clinical standards of determining neurologic or circulatory-respiratory death in donors have been challenged.3,–,10 In the absence of scientific evidence that donors are truly dead, new philosophical, teleologic justifications have been proposed to defend redefinitions of human death for the purpose of organ procurement.3,11 …