Pediatric organ donation: A national survey examining consent rates and characteristics of donor hospitals

Objective: To characterize the eligible pediatric donor pool in the United States by age, consent rate, location, and cause of donor loss. Study Design: Survey. Setting: Organ procurement organizations in the United States. Patients: Pediatric patients who suffered brain death in the United States in 2005 and who were medically suitable for organ donation. Interventions: None. Measurements and Main Results: We determined the number of patients, age <= 17 yrs, who were eligible for organ donation and the consent rate by age. Each hospital in which donation occurred was characterized by the presence of a pediatric intensive care unit (PICU), a pediatric critical care medicine (PCCM) fellowship, solid organ transplant programs, and level I trauma programs. Additional information was obtained on the number of donation after cardiac death donors and eligible donors lost due to medical examiner refusals and deterioration before organ recovery. The number of reported eligible pediatric donors in 2005 was 1330. The consent rate was 69.2% with higher consent rates in eligible donors 12 yrs of age and older. Eligible donors were spread across a large number of hospitals with few having ten or more eligible donors. Variability exists among hospitals in consent rate and number of donors per 100 PICU beds. The presence of a level I trauma program and/or a PCCM fellowship was associated with higher numbers of donors per 100 PICU beds. Ninety-four eligible donors were lost before recovery of organs due to medical examiner denials or cardiac arrest. Donation after cardiac death accounted for 37 donors. Conclusions: Overall pediatric consent rates were 69.2% but varied by age. Eligible donors were found most often in hospitals with level I trauma programs or PCCM fellowship programs. Few hospitals had > 10 eligible donors in a 12-month period. This study is the first to describe in detail the U.S. pediatric donor population. (Pediatr Crit Care Med 2009; 10:500-504)