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Diagnosis of Brain Death and Organ Donation After Circulatory Death

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Pediatric Critical Care

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Abstract

Determination of death and provision of organ transplantation can result in controversy for the pediatric provider caring for a critically ill or injured child. Despite accepted legal definitions for death and guidelines for neurologic and circulatory determination of death, there remains an evolving and, at times, contentious dialogue among medical experts and the community. We provide the historical context and summarization of several legal and clinical aspects to define death and discussion of potential ethical controversies regarding death by neurologic and circulatory criteria. We highlight conflicts and controversies raised by both family and healthcare team members that are becoming increasingly prevalent in our practice of critical care medicine. We offer insight and proposed solutions into matters of autonomy, maleficence, non-beneficence, and the respectful, dignified care of the sick and dying child and their family.

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Abbreviations

AAP:

American Academy of Pediatrics

CPR:

Cardiopulmonary resuscitation

DCD:

Donation after circulatory determination of death

DND:

Donation after neurologic determination of death

DNR:

Do not resuscitate

OPO:

Organ procurement organization

PICU:

Pediatric intensive care unit

SCCM:

Society of Critical Care Medicine

UAGA:

Uniform Anatomical Gift Act

UDDA:

Uniform Determination of Death Act

WLST:

Withdrawal of life-sustaining therapies

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Conflict of Interest

Dr. Sochet: None

Dr. Nakagawa: Received funding from Up To Date and Fresenius Kabi. Dr. Nakagawa is the Assistant Medical Director for Carolina Donor Services.

Ms. Glazier: None

Author information

Authors and Affiliations

  1. Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Anthony A. Sochet & Thomas A. Nakagawa

  2. Division of Pediatric Critical Care Medicine, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA

    Anthony A. Sochet & Thomas A. Nakagawa

  3. New England Donor Services, Waltham, MA, USA

    Alexandra K. Glazier

Authors
  1. Anthony A. Sochet
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  2. Alexandra K. Glazier
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  3. Thomas A. Nakagawa
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Corresponding author

Correspondence to Thomas A. Nakagawa .

Editor information

Editors and Affiliations

  1. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA

    Christopher W. Mastropietro

  2. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA

    Kevin M. Valentine

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Sochet, A.A., Glazier, A.K., Nakagawa, T.A. (2019). Diagnosis of Brain Death and Organ Donation After Circulatory Death. In: Mastropietro, C., Valentine, K. (eds) Pediatric Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-96499-7_19

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  • DOI: https://doi.org/10.1007/978-3-319-96499-7_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96498-0

  • Online ISBN: 978-3-319-96499-7

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