Introduction: The need for pediatric organs continues to exist as children die waiting for a needed organ transplant. In the United States (US), efforts to increase pediatric donation continue. More than 1,900 children are waiting for an organ transplant. In 2019, 1,923 pediatric organs were transplanted from 917 deceased pediatric donors. Pediatric donors following circulatory determination of death accounted for 17.5% (n=161) of all donors. Ninety-nine children died waiting for an organ transplant, and 58 children were removed from the waiting list because they became too sick to transplant. We present a pediatric donor case where 9 organs were recovered and transplanted.
Case presentation: A 13-year-old suffered a self-inflicted gunshot wound to the head. Unlikely neurologic recovery was discussed with the family who suggested organ donation.The family desired to wait for brain death testing to maximize donation opportunities. Brain death was confirmed with 2 neurologic examinations as recommended by US pediatric brain death guidelines, and a cerebral blood flow study revealed no cerebral blood flow. Blood pressure was supported with norepinephrine and diabetes insipidus (DI) was treated with desmopressin. Donor management included a levothyroxine infusion allowing vasopressor weaning and conversion to vasopressin for DI. Nine organs: 2 lungs, 2 kidneys, heart, liver, pancreas, intestines, and abdominal wall were recovered. Nine organs: 2 lungs, split liver (2), 1 kidney, heart, pancreas, intestine, and abdominal wall vascular composite allograft (VCA) were transplanted. Anatomical issues precluded transplantation of one kidney.
Discussion: Nine recovered and transplanted organs from this pediatric donor demonstrates how good donor management and a collaborative approach with the organ procurement organization (OPO) can impact organ recovery. Advances in donation and transplantation include VCA. Bilateral VCA hand transplants have occurred in a pediatric patient, and face and extremity transplants continue to evolve. Penile and uterus transplants are occurring, and babies have been born to women following uterus transplantation. Increasing organ availability for children is focusing more on neonatal donation. Recovery of en-bloc kidneys, liver for liver cell transfusion therapy, and heart and heart valves are occurring in neonates following circulatory and neurologic death. Organs from anencephalic infants, HIV, hepatitis B and C positive donors have been recovered and transplanted. Ex-vivo support for pediatric organs should be considered for future research. Work continues with medical examiners/coroners to reduce denial for organ donation. Reducing discards from damage during organ recovery and improved imaging may assist with anatomic issues that preclude donation. Collaboration between the intensive care team and the OPO can maximize pediatric donation opportunities resulting in more lives saved by transplantation.