Introduction: Donation after circulatory death (DCD) is a currently expanding donation modality. Recent improvements in its specific protocols and the use of normothermic regional perfusion have improved clinical outcomes in most organs used for DCD. Nevertheless, its application in the field of pediatric transplantation has taken place progressively after its acceptance in adults, following more exhaustive and conservative protocols and conditions. For this reason, reported experiences with DCD in pediatric transplantation are still very limited. Our aim was to review our experience using DCD in pediatric transplantation from a multidisciplinary point of view.
Methods: Our series of DCD transplants for pediatric recipients was reviewed, identifying the transplanted organ as liver, heart, kidney, or intestine. Demographic variables of donors and recipients were studied, as well as technical and clinical variables throughout their follow-up.
Results: 10 DCD transplants were performed between 2017 and 2022. We identified 2 cases of liver transplantation (hepatocarcinoma, Alagille syndrome), 2 of heart transplantation (dilated cardiomyopathy, transposition of great arteries with biventricular obstruction), 5 kidneys (nephronophthisis, nephrocalcinosis, focal segmental glomerulosclerosis, neonatal hypovolemic shock, Kearnes–Sayre syndrome) and the world's first multivisceral DCD transplant ((short bowel syndrome due to jejunal atresia and meconium cyst). 
Recipients had a median age of 144 months (2-214) and 34.65 kg (3.4-85.6), while donors had a median age and weight of 15 years (0-39) and 38 kg (4-60).
With a mean follow-up of 10 months (0-65), there have been two deaths (liver transplant due to Alagille syndrome, heart transplant due to dilated cardiomyopathy) for early clinical and technical complications unrelated to the DCD donation modality. The rest of the patients maintain their graft and function and have not presented any clinical event of interest, except for mild self-limited cutaneous GVHD in the case of multivisceral transplantation.
Conclusion: DCD represents a valid source of organs to increase the pool of donors in pediatric transplantation. Although limited, preliminary data suggest that its results are not inferior to those obtained from other donation modalities. Larger series and meta-analyses are needed to establish the most appropriate conditions for its use in pediatric recipients.