Emotional considerations and attending involvement ameliorates organ donation in brain dead pediatric trauma victims

Purpose. The purpose of this study was to ascertain a strategy for maximizi ng parental consent for organ donation in traumatically injured children su ffering from brain death. Our hypothesis was that appropriate attending sur geon involvement and delay in evaluating children for brain death leads to an increased percentage of organ donors. Methods: From January 1993 to August 1999, the records of all children who died in a Level I trauma center were evaluated. Those children suffering br ain death that were suitable for organ donation were entered into the study . Cases were reviewed for patient demographics, time to entry into brain de ath protocol (measured from time of admission), time to parent notification about brain death (measured from time of admission), specific attending in volved in the case (with level of involvement), and success of organ donati on request. In all, 43 charts were reviewed. Results. Of 43 deaths, 33: were deemed suitable for! donation. Age of suita ble donors ranged from 1 month: to 18 years. In all, 11 attending physician s were involved in the care of these children. Overall, 20 of 33 were organ donors (60%). When the attending surgeon was involved, donation success fo r organ retrieval was 86%, whereas if the attending was not involved person ally, the success rate dropped to 23% (p < 0.04). One senior pediatric surg eon obtained a success rate of 12 of 12 children. It was this surgeon's pol icy to not initiate brain death protocols in children immediately on entry into the emergency room, but rather to delay initiation until family could be gathered and spend time with the affected child in order that the family could recover from the initial shock of trauma (always at least overnight) . When time to initiation of brain death protocol was examined, success was obtained when a delay of 15.5 hours was respected, versus 7.0 hours when d onation was requested but denied (p < 0.03). Conclusion: These data indicate that attending involvement is important whe n parents of brain dead children are asked about organ retrieval (p < 0.04) . Delay in initiating brain death protocols in order for family members to deal with the shock of the initial trauma appears to increase willingness t o participate in organ donation.