Clinicians from a leading UK children's hospital have called for European countries to change the way they tackle the shortage of organ donations from children, after a review, published in the September issue of Acta Paediatrica, found a large number of legal, ethical and cultural barriers.
Great Ormond Street Hospital's clinical lead for organ donations, consultant paediatric intensivist Dr Joe Brierley, teamed up with Dr Vic Larcher, consultant in general paediatrics and ethics, to review the discrepancies between and within European countries.
Their review, which also drew on the experiences of countries like the USA, Australia and Canada, considered the complex issues around organ donations from dead and dying children. The authors also explored the controversial option of living donations from competent children, which can sometimes be the only way to save another child's life.
"Organ transplants offer children in acute or chronic severe organ failure similar opportunities to adults" explains Dr Brierley. "However far fewer deceased donors exist for children compared to adults. Incompatible organ size and relatively low donation rates mean that, despite living parental donation and innovations to reduce donated organ size, children often die before organs become available.
"The severity of the situation is compounded by restrictions on living donations from children, the inconsistent application of brain-death criteria across Europe and concerns about the increasing use of organs after the donor has suffered circulatory death.
"In the UK, the Department of Health's Organ Donation Task Force suggested that outstanding ethical and legal issues needed to be resolved to increase the number of organs available for adult transplants. However, it made no specific recommendations about children and there is no consistent approach or centralised agency to oversee organ donations from children throughout Europe."
Key findings of the review carried out by Dr Brierley and Dr Larcher, who specialise in clinical ethics at the London-based hospital, include:
"Medical and social changes mean the increased requirement for organ donations from children coexist with both improved road safety and medical advances in children's intensive care" says Dr Larcher. "These have decreased brain-death rates and reduced the number of available organs. This means that it is important to ensure that parents are always offered the chance to donate organs, if possible, if their child is sadly dying.
"Excellent palliative care and organ donation can be compatible if the legal, ethical and cultural barriers to donation are addressed in a way that is mindful of the fundamental care that dying children receive."