Pediatric Organ Donation and Transplantation

Abstract

Organ donation and transplantation is an important component of pediatric critical care. In the United States, over 100 children die annually while listed for organ transplantation, while others are too sick to be listed. The pediatric intensivist strives to ensure one of her patients is not among those, through both excellent clinical care and through advocating for organ donation. However, the intensivist must be aware of some of the ethical concerns that are present with organ donation. With donation after circulatory determination of death (DCDD) there continues to be question of when death has actually occurred, with many arguing that Uniform Declaration of Death Act’s definition of death may not have been achieved at the time of organ harvest. This would violate the Dead Donor Rule, that only organs may be harvested from dead patients. Additionally, there are practices within organ donation that are viewed as treating the patient as a means to an end, other than their own well-being. While many argue this is an altruistic goal we should all share, others argue that it should not be imposed upon a pediatric patient. Organ allocation also has ethical concerns, about selection criteria for appropriate recipients to ensure we are being the best steward of a valuable and limited resource. These allocation decisions may impact our patients awaiting transplantation. Organ donation and transplantation serves the greater good of patients and society, but we must recognize some the ethical concerns to ensure each patient is being treated with respect.