Original Article
Donation after Cardiac Death: The Potential Contribution of an Infant Organ Donor Population

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Objective

To determine the percentage of deaths in level III neonatal intensive care unit (NICU) settings that theoretically would have been eligible for donation after cardiac death (DCD), as well as the percentage of these who would have been potential DCD candidates based on warm ischemic time.

Study design

We conducted a retrospective study of all deaths in 3 Harvard Program in Neonatology NICUs between 2005 and 2007. Eligible donors were identified based on criteria developed with our transplantation surgeons and our local organ procurement organization. Potential candidates for DCD were then identified based on an acceptable warm ischemic time.

Results

Of the 192 deaths that occurred during the study period, 161 were excluded, leaving 31 theoretically eligible donors. Of these, 16 patients had a warm ischemic time of <1 hour and were potential candidates for DCD of 14 livers and 18 kidneys, and 14 patients had a warm ischemic time of <30 minutes and were potential candidates for DCD of 10 hearts.

Conclusions

Eight percent of NICU mortalities were potential candidates for DCD. Based on the size of the potential donor pool, establishing an infant DCD protocol for level III NICUs should be considered.

Section snippets

Methods

The 3 institutions evaluated were Beth Israel Deaconess Medical Center (BIDMC), Brigham and Women's Hospital (BWH), and Children's Hospital Boston (CHB). BIDMC and BWH have large high-risk maternity services. Between 2005 and 2007, BIDMC had an average delivery rate of 4880 births per year and an average NICU admission rate of 856 admissions per year to its 40-bed NICU. During this same period, BWH had an average delivery rate of 8417 births per year and an average NICU admission rate of 1050

Results

Between 2005 and 2007, a total of 14 640 infants were born alive at BIDMC. Of these infants, 2569 were admitted to the NICU. There were 82 deaths, 50 of which were at >23 weeks gestation. During this same time frame, a total of 25 251 infants were born alive at BWH. Of these infants, 3151 were admitted to the NICU. There were 76 deaths, 66 of which were at >23 weeks gestation. CHB's NICU had 2145 admissions, 76 of which died.

Thus, in the 3 NICU services, a total of 192 deaths occurred in

Discussion

We determined a potential DCD rate in the delivery room and NICU populations. Previous studies that examined potential DCD donors in pediatrics focused on mortalities in pediatric intensive care units (PICUs) and cardiac intensive care units,12, 13, 14, 15 but did not address the NICU population. Our retrospective 3-year study of delivery room and NICUs in 3 hospitals found 192 total deaths, of which 31 (16%) were theoretically eligible DCD donors and 16 (8%) were potential DCD candidates. This

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The authors declare no conflicts of interest.

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