Donation and Procurement Posters

Tuesday July 03, 2018 from 16:30 to 17:30

Room: Hall 10 - Exhibition

P.582 Opportunities to increase organ availability from neonatal donors. The United States experience

Thomas A. Nakagawa, United States

Professor, Anesthesiology and Critical Care. Chief, Pediatric Critical Care Medicine. Director, Pediatric Critical Care. Johns Hopkins All Children's Hospital
Division of Pediatric Critical Care Medicine
Johns Hopkins All Children's Hospital

Abstract

Opportunities to Increase Organ Availability From Neonatal Donors. The United States Experience

Thomas Nakagawa1.

1Anesthesiology and Critical Care, Division of Pediatric Critical Care, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States

Introduction: There is a dire need to recover more transplantable organs from donors to decrease the number of people waiting for a transplant and reduce deaths on the waitlist.  Neonatal donation continues to be explored in the United States as another opportunity to increase the number of available organs for transplantation. Neurologic death in neonates (defined as birth to 4 weeks of age) is a rare occurrence, however organs recovered from neonates following circulatory death (DCD) have been recovered with good success.
Methods: A literature review was performed to evaluate potential for neonatal donation opportunities and actual transplantation of neonatal organs following neurologic or circulatory death. Additionally, data from the United Network of Organ Sharing (UNOS) was compiled and reviewed.
Results: The total annual number of neonatal donors in the United States is few. Size, weight, and technical difficulties with smaller grafts limit the ability to recover and transplant organs from the neonatal donor. There is a trend of increasing neonatal donation specifically following circulatory death.  Several studies evaluated the potential for neonatal donation to increase organ availability, specifically neonatal en-bloc kidney and heart recovery. En-bloc kidneys have been successfully recovered and transplanted from neonatal donors.  Liver for liver cell transplantation research is also occurring for patients with inborn errors of metabolism.  Hearts from neonatal donors following circulatory death have been recovered and transplanted with good success. Tissues such as heart valves are also being recovered from neonatal organ donors. Organ donation following circulatory death from anencephalic infants is occurring in the United States. Although few organs are recovered from anencephalic donors, the opportunity for donation should be considered in this patient population. Continued lost opportunities for neonatal and pediatric donors continue to exist because of medical examiner and coroner denials. There is a need for education of neonatal providers to reduce the potential for missed donation opportunities.
Conclusion: Neonatal donors make up a very small number of pediatric donors.  Opportunity exists to increase the potential number of neonatal donors that can provide additional organs and tissues for transplantation. Educational awareness about neonatal donation for perinatologists and neonatologists to ensure potential donation opportunities are not missed is paramount. There is an ongoing need to work with medical examiners and coroners to ensure that organ donation can occur when cause of death is being investigated by forensic teams. 

Presentations by Thomas A. Nakagawa



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