More Organs for More Kids

Organ transplants for children have increased and fewer children die waiting for organ

(RxWiki News) Organs for transplants are always in high demand. As more people sign up to be donors and technology improves, however, more children are able to get the organs they need.

A recent study found that the situation regarding organ donations for children has been improving.

The number of children receiving transplants increased between 2001 and 2010.

Also, the number of children who died waiting for a transplant decreased over that time.

"Consider becoming an organ donor."

The study, led by Jennifer K. Workman, MD, of the Department of Pediatrics at the University of Utah School of Medicine, looked at the overall trends related to organ donations for children.

The researchers used data related to organ recipients in the US from the Organ Procurement and Transplantation Network between 2001 and 2010.

They found that the number of children who had received organ transplants during that time increased from 1,170 in 2001 to 1,475 in 2010.

The researchers also found that more organs became available from donors were declared dead because their heart has permanently stopped.

One particular type of organ donation the researchers focused on also increased. That type is an organ from "donation after circulatory determination of death," or DCDD.

DCDD means that the organ was donated after the donor's heart and breathing had stopped and were certain not to begin again. It is different from when an organ is donated after brain death.

Only one organ transplant after DCDD occurred for a child in 2001, but that number increased to 31 in 2010.

The number of children receiving pediatric grafts also increased over that time period, from 799 children in 2001 to 971 children in 2010.

Meanwhile, the number of children who died while waiting for an organ decreased from 262 children in 2001 to 110 children in 2010.

Then the researchers looked at organ donors and organs donated. Fewer organs were donated from organ donors after brain death, with a decrease of 13 percent over the time period.

However, the number of organs donated from DCDD donors increased from 50 organs in 2001 to 137 organs in 2010.

The number of grafts donated from children decreased from 3,042 in 2001 to 2,751 in 2010. There was also a decrease in the number of adults receiving grafts from child donors: from 2,243 in 2001 to 1,780 in 2010.

The researchers then looked at the number of adults and children who received transplants of grafts from DCDD donors and found both numbers increased.

While 50 adults had received DCDD grafts from children in 2001, a total of 128 adults received them in 2010. No children received them in 2001, but 9 children received them in 2010.

Overall, the authors concluded, the number of children receiving organs from other child donors has increased.

However, most child donors' organs are still being transplanted into adults, and fewer children's organs are being donated.

Meanwhile, the increasing number of organs becoming available from DCDD are almost entirely being used for adults.

"Improving the overall process of donation and increasing organ recovery allows for more pediatric transplants and fewer pediatric waitlist deaths," the authors wrote.

While the public and the donor family may assume that children's donor organs are going to child recipients, "...hard data shows the majority of pediatric organs go to adults," said Naveen Mittal, the Medical Director of Pediatric Liver Transplant Program at the University of Texas Health Science Center at San Antonio, who was not associated with the study.

Dr. Mittal noted that the alternative donor source of organs from DCDD has not significant helped children on the wait list because it is mostly used to donate child DCDD graft organ types (liver, kidney, lung, etc.) to adult recipients.

"Most pediatric programs still rely on Live Donors and/or reduction techniques to shape an adult liver to fit into a dying child with liver failure," he said. "To reduce the waitlist mortality of children, allocation policies and ranking system on the waitlist need to be modified in favor of children to get a higher proportionate of pediatric organs to children."

Modifying the way the waitlist works would also likely better correspond to the wishes of the families of a donor child.

"Rescuing a dying child gets the most life years of any donated organ, a wish most donor families have at the time of donation," Dr. Mittal said.

"Delay in giving the organ needed to the child negatively impacts growth and development of the child. Adults do not suffer in that manner," he said. "The health of a society is judged by the way it gives priority to a vulnerable population, such as children."

This study was published May 20 in the journal Pediatrics.

The research did not receive external funding. One author is a consultant for the Organ Donation and Transplantation Alliance and has received royalties from Up To Date. No other disclosures were reported by the other authors.

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Review Date: 
May 18, 2013