An analysis of paediatric deceased organ donation at a South African Tertiary Public Sector Hospital over a 14-year period
Thozama Siyotola1,3, Tinus du Toit2, Jessica Barrell2.
1Division of paediatric surgery , University of Cape Town, Cape Town, South Africa; 2Department of general surgery, Transplant, University of Cape Town, Cape Town, South Africa; 3Redcross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
Background:Transplantation has been shown to be a successful treatment option for end stage organ failure in both adult and paediatric populations. (1, 3, 4, 5, 7, 11, 13, 15) Recently, the number of patients on transplant waiting lists has increased while the number of deceased donors has plateaued, resulting in a mismatch in supply and demand of donor organs for the purpose of transplantation. (1, 6, 8, 9, 10, 12,14,17). Multiple factors may influence outcomes during the organ donation process. Delay in identifying potential organ donors and lack of appropriate referral system to the transplant coordinator teams may lead to lower conversion rates (1, 2, 3, 6, 8, 11, 13, 16). While most major religions are not opposed to organ donation or transplantation, certain religious sectors have specific objections related to the removal of organs and interference with burial rituals(2). Our aim to identify and define the key factors preventing referred paediatric donors from becoming actual solid organ donors. Observing trends in the number of referrals, donor demographics cause of death, eligibility for solid organ donation and consent rates.
Methods:This is a retrospective descriptive study of consecutive deceased donor referrals at Red Cross Hospital over a 14-year period.
Results:Over the 14-year period 94 patients were referred to the transplant coordinators for organ retrieval. Patients referred and not medically suitable were 28% (26/94). Potentially eligible donors included 72% (68/94). Forty-four families declined consent for organ donation for their child at 47% (44/94) of the original’s referrals to the transplant coordinator. The consent decline at 64% (44/68) of the total eligible donors. Consent was obtained in 22% (21/94) of families approached(fig1). The 96 patients referred 28% (26/94) girls, 61% (57/94) boys and 14% (13/94) had no documented sex. A median age of 7 years and range between (5months-12 years). Patients referred from the trauma unit were 23% (22/94), intensive care unit at 76% (71/94) and 1% (1/94) for E2 ward(fig2).
The patients referred for organ donation as a result of trauma related injuries. The mechanism related to the cause of death included motor vehicle collision at (36%), pedestrian vehicle collision (13%), fall from height (6%), blunt trauma (8%), gunshot wound (3%). Non-trauma cause of brain death included: brain tumours, congenital cerebral conditions, drowning with hypoxic brain injury, intracranial bleed suspected to result from vascular malformation and severe sepsis in 33% (31/94).
Conclusion:Transplantation activity is reflective of a countries healthcare system. Interventions to improve organ donation activities in South Africa especially in the paediatric population. Efforts need to be made on a national level across both public and private healthcare institutions. Government support is required and appropriate transplant coordination programs.
Red Cross War Memorial Children’s hospital, Division of General surgery. Department of generation surgery, Transplant division, Groote Schuur Hospital, Cape Town.
[1] O’Neill F, Colreavy F, Cunningham P et al. Health Service Executive. Audit of potential organ donors Republic of Ireland 2009. [Internet]. 2009. [cited 18 February 2020]. Available from: https://www.lenus.ie/bitstream/handle/10147/85814/reportpotentialorga ndonors_2009.pdf?sequence=1 online]. 2017; 4(2). DOI: 10.1177/2055102917742918.
[2] Kiani M, Abbasi M, Ahmadi M, Salehi B. Organ transplantation in Iran: Current state and challenged with a view on ethical considerations. J Clin Med. [serial online]. 2018; 7(3). DOI: 10.3390/jcm7030045.
[3] Kentish-Barnes N, Siminoff LA, Walker W et al. A narrative review of family members’ experience of organ donation request after brain death in the critical care setting. Intensive Care Med. [serial online]. 2019; 45(3): 331-342. DOI: 10.1007/s00134-019-05575-4.
[4] Samaik A. Neonatal and pediatric organ donation: Ethical perspectives and implications for policy. Front Pediatr. [serial online]. 2015; 3:100. DOI: 10.3389/fped.2015.00100. -230. DOI: 10.1590/S0325- 00752014000300005.
[5] Sachdeva A. Organ donation in children: The next frontier. Indian Pediatr. [serial online]. 2017; 54(9): 721. DOI: 10.1007/s13312-017- 1161-8
[6] Lopez JS, Soria-Oliver M, Aramayona B, Gargia-Sanchez R, Martinez JM, Martin MJ. An integrated psychosocial model of relatives’ decisions about deceased organ donation (IMROD): Joining pieces of the puzzle. Front Psychol. [serial online]. 2018; 9: 408. DOI: 10.3389/fpsyg.2018.00408
[7] Siebelink MJ. The child as a donor. [unpublished PHD thesis on the Internet]. University of Groningen. 2013 [cited 18 February 2020]. Available from: https://pdfs.semanticscholar.org/862b/b2f8d3cf98bad2545a16ee4ee09 d86bf88ab.pdf#page=90.
[8] Marc M, Fudali K, Gajdek M, Rekas M, Fafara A. Knowledge and attitudes of students of the Rzeszow University about the transplantation of organs. Transplant Proc. [serial online]. 2018; 50(7): 1933-1938. DOI: 10.1016/j.transproceed.2018.03.116. Med. [serial online]. 2013; 18: 1-7. DOI: 10.1164/rccm.201304-0714ST.
[9] Carone L, Alurkar S, Kigozi P, Vyas H. Organ and tissue donation in a regional paediatric intensive care unit: evaluation of practice. Eur J Pediatr. [serial online]. 2018; 177(5): 709-714. DOI: 10.1007/s00431- 017-3084-8.
[10] McDiarmid SV, Cherikh WS, Sweet SC. Preventable death: children on the transplant waiting list. Am J Transplant. [serial online]. 2008; 8(12): 2491-2495. DOI: 10.1111/j.1600-6143.2008.02443.x.
[11] Pregernig A, Karam O. Potential pediatric organ donors after cardiac death. Transplant Proc. [serial online]. 2016; 48(8): 2588-2591. DOI: 10.1016/j.transproceed.2016.06.049.
[12] Bellali T, Papazoglou I, Papadatou D. Empirically based recommendations to support parents facing the dilemma of paediatric cadaver organ donation. Intensive Crit Care Nurs. [serial online]. 2007; 23(4): 216-225. DOI: 10.1016/j.iccn.2007.01.002.
[13] Labrecque M, Parad R, Gupta M, Hansen A. Donation after cardiac death: the potential contribution of an infant organ donor population. J Pediatr. [serial online]. 2011; 158(1): 31-36. DOI: 10.1016/j.jpeds.2010.06.055.
[14] Nakagawa TA, Shemie SD, Dryden-Palmer K, Parshuram CS, Brierley J. Organ donation following neurologic and circulatory determination of death. Pediatr Crit Care Med. [serial online]. 2018; 19: 26-32. DOI: 10.1097/PCC.0000000000001518.
[15] Workman JK, Myrick CW, Meyers RL, Bratton SL, Nakagawa TA.Pediatric organ donation and transplantation. Pediatrics. [serial online].2013; 131(6): 1723-1730. DOI: 10.1542/peds.2012-3992.
[16] Rodrigue JR, Cornell DL, Howard RJ. Pediatric organ donation: What factors most influence parents’ donation decisions? Pediatr Crit Care Med. [serial online]. 2008; 9(2): 180-185. DOI:10.1097/PCC.0b013e3181668605.
[17] Moosa MR, Kidd M. The dangers of rationing dialysis treatment: The dilemma facingadevelopingcountry.KidneyInt2006;70(6):1107-1111.https://doi.org/10.7196/SAMJ.2016.v106i2.9928
