Paediatric Intensive Care Society Standards for Organ Donation

PaediatricIntensiveCareSocietyStandardsforOrgan Donation

TheOrganDonationTaskForce(2008)associatedincreaseindonationhasnotbeenreflectedinchild-donation,whererateshaveactuallydecreased.SomealterationsthathaveincreasedadultICUdonationhavenotbeenadoptedinPICU,whereperformanceinthisarearemainshugelyvaried.AlthoughUKconsentratesforpaediatricorgandonationarerelativelylow,PICUsystemsshouldneverpreventfamiliesbeingofferedtheopportunitytodonate.

Thisisreflectedin bothNICEandDoHpolicystatements.

UKPICSconsidersthe followingstatementstorepresent best practice:

1)Organandtissuedonationisaroutinepartofchildhood end oflifecare.

2)Every UKPICU musthave anamedconsultantwithSPAtimededicatedtomakingorgandonationaroutinepartofendoflifecare(PICSstandards2011).ThisIntensivistmustworkcloselywiththeSpecialistNurseinOrganDonation(SNOD)andtheClinicalLeadfor OrganDonation(CLOD)oftheir hospital, iftheyarenot inthisrolethemselves.

Theyshould:

a.Establishlocal paediatricpolicies and practicebased on nationalguidelines

b.Facilitateeducationandtraining to allrelevantstaff.

c.Ensureorgandonationisoffered viaexpertteamsinallappropriatesituations

3)Everychildthatmaybepotentially‘braindead’shouldundergobrainstemdeath(BSD)testing, inaccordancewithnational guidelines.

4)EverychildwithfixeddilatedpupilsinwhomBSDtestingisbeingconsideredmustbereferredtotheSNOD(NICEguidance2010).

5)Thereshouldbea discussionwiththespecialistteamfororgandonationineverycaseinwhichthereistheintentiontowithdrawlifesustainingtreatmentandwheredeathisthoughtlikelytooccurinashortperiodoftime(e.g.withinfourhours)(NICEGuidance2010)

6)Thediscussionaboutorgandonationwiththeparents/thosewithparentalresponsibilityshouldoccurwithexpertsindonation.Therefore,eithercollaborativediscussionwiththefamilyandboth thePICUteamandSNODtogether,orwiththeSNODalone,ifthePICUteamarehappy,oughttooccur.AsaminimumthereshouldbeanagreedplanbetweenSNODandPICUteam regardinganyapproach.

7)ManagementofthebrainstemdeaddonorshouldbeinaccordancewithNationalguidelines(e.g.MapofMedicine)andcanbeguidedbytheSNODandotherdonorphysiologyteams.

January2014