|Department of Foreign Affairs|
The waiting game can be a long haul for children in need of organ transplants and a third of these children will die waiting. Recent figures from the Transplant Programs and Organ Procurement Service indicate that about 16% of adults die while waiting for a donor1.
Reducing that waiting period and increasing the number of organ donors is important. That's why understanding who makes the decision to donate organs on behalf of an adult or pediatric patient is important. A new study published this month in Pediatrics explores the decision-making process. Smirnoff et al. (doi:10.1542/peds.2014-3652) conducted phone interviews with 1,601 family decision makers (FDM), relatives who had the authority to decide whether or not to donate on behalf of an adult or pediatric patient who met brain death criteria. The FDM were approached between January 2009 and March 2012 and represented requests from nine different organ procurement centers in the USA. The authors examined the request process, the FDM’s perceptions and ultimate decision for the donor patient. The authors sought to ascertain FDM differences comparing decisions made for adult and pediatric donors and non-donors.
The authors mailed a study description to FDM several months after the donation decision had been made. Most of the FDM who participated in the study were deciding for adult donor patients (1369, 85.5%). FDM deciding on behalf of pediatric donor patients accounted for a minority of decisions (232, 14.5%). The mean ages of donor patients for whom FDM decided were 49 years for adults and14 years for children
FDM making the donation decision were usually female and most reported Christian religious affiliations. FDM for pediatric donations tended to be younger and were more likely to be divorced, separated or never married.
Overall 84.1% of the FDM authorized the donation, but pediatric decision makers were more likely to do so than were adult counterparts (89.7% vs. 83.2%). Decision makers for pediatric donor patients were also more likely to report willingness to donate their own organs posthumously and to raise the issue of organ donation. Pediatric FDM were also more likely to express satisfaction with the interpersonal skills of the person requesting the donation, provision of grief support and to not regret the donation decision later.
The choice facing a FDM who must decide on organ donation for an adult or child family member is difficult. It includes the need to deal with the loss of a family member, what meaning and comfort a family may associate with organ donation and how donation can shape the grieving process. This study suggests that the communication process and how the organ donation is requested are important factors authorizing an organ donation.
1. Organ Procurement and Transplantation Network. Date Reports. 31 January 2014. optn.transplant.hrsa.gov/latestData/ViewDateReports.asp
- A Comparison of the Request Process and Outcomes in Adult and Pediatric Organ Donation
- Pediatric Organ Donation and Transplantation