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Vermilion P, Boss R. Pediatric Perspectives on Palliative Care in the Neurocritical Care Unit. Neurocrit Care 2024:10.1007/s12028-024-02076-1. [PMID: 39138717 DOI: 10.1007/s12028-024-02076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/09/2024] [Indexed: 08/15/2024]
Abstract
Pediatric neurocritical care teams care for patients and families facing the potential for significant neurologic impairment and high mortality. Such admissions are often marked by significant prognostic uncertainty, high levels of parental emotional overload, and multiple potentially life-altering decision points. In addition to clinical acumen, families desire clear and consistent communication, supported decision-making, a multidisciplinary approach to psychosocial supports throughout an admission, and comprehensive bereavement support after a death. Distinct from their adult counterparts, pediatric providers care for a broader set of rare diagnoses with limited prognostic information. Decision-making requires its own ethical framework, with substitutive judgment giving way to the best interest standard as well as "good parent" narratives. When a child dies, bereavement support is often needed for the broader community. There will always be a role for specialist palliative care consultation in the pediatric neurocritical care unit, but the care of every patient and family will be well served by improving these primary palliative care skills.
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Affiliation(s)
- Paul Vermilion
- Department of Medicine, Pediatrics, and Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 687 , Rochester, NY, USA.
| | - Renee Boss
- Department of Pediatric Palliative Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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2
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Gettis MA, Basu R, Welling S, Wall E, Dutreuil V, Calamaro CJ. Pediatric Death and Family Organ Donation: Bereavement Support Services in One Pediatric Health System. J Patient Exp 2024; 11:23743735241226987. [PMID: 38361833 PMCID: PMC10868482 DOI: 10.1177/23743735241226987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Health care providers need to support families and provide resources when facing their child's death and potential organ donation. Aims of this retrospective chart review in a tertiary health care system were: (1) describe characteristics of pediatric organ donors compared to those who were not; (2) determine differences between services utilized by families who selected organ donation versus those who did not. From 2017 to 2023 of 288 pediatric deaths, 76 were organ donors and 212 did not donate. Organ donors' mean age at admission was 6.3 ± 5.8 years. Thirty-four (44.7%) participated in Honor Walks. Significant differences existed between organ donors and non-organ donors in patients who were diagnosed with SIDS (3.9% vs 13.2%; P = .025). This study provides additional data to help further our understanding of bereavement support services for families making difficult decisions regarding organ donation.
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Affiliation(s)
| | - Rajit Basu
- Division Critical Care Medicine, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Eryn Wall
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Valerie Dutreuil
- Emory University Pediatric Biostatistics Core, Emory School of Medicine, Atlanta, GA, USA
| | - Christina J Calamaro
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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3
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Pullen BLC. Opening a Door: Organ Donation, Transplantation, and Pediatricians. Am J Transplant 2023; 23:1819-1821. [PMID: 37890787 DOI: 10.1016/j.ajt.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
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4
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Neefjes V. Parental Ethical Decision Making and Implications for Advance Care Planning: A Systematic Review and Secondary Analysis of Qualitative Literature from England and Wales, Germany, and the Netherlands. J Palliat Med 2023; 26:1728-1743. [PMID: 37262127 DOI: 10.1089/jpm.2022.0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Background: Clinicians and parents are expected to make medical treatment decisions in the child's best interests. To reach their decisions, clinicians typically apply a principled approach outlined by Beauchamp and Childress. How parents make ethical decisions is an under-researched area. A possible model for parental decision making is the Ethics of Care (EoC) theory. Ethical decision making within this framework aims to preserve the caring relationship. What is right or wrong depends on the circumstances at the time. Objective: To identify the parental ethical values and determine whether parental decision making is consistent with EoC, a systematic review and secondary analysis of qualitative research from England and Wales, the Netherlands, and Germany was performed. As part of a larger project investigating conflicts between parents and clinicians about children's medical treatment, the choice of countries was determined by differences in litigation. Methods: Eight databases were searched for articles published between 2010 and 2020 reporting on at least one medical treatment decision made by parents of a child with any life-limiting condition and analyzed using reflexive thematic analysis. Twelve included articles directly addressing advance care planning (ACP) were reanalyzed to investigate whether this specific decision parents are increasingly being asked to make is also consistent with EoC. Results: Forty-three articles were included. Parents use the same 6 ethical values which, consistent with EoC, are mostly in the context of their relationship with the child. All values contributed to the previously identified theme of "being a good parent/person." Analysis of parental decision making in ACP confirmed consistency with EoC. Conclusion: The parental decision-making process is consistent with EoC. That parental decisions aim to maintain the caring relationship and are dependent on the circumstances at the time has implications for parental decision making in ACP and should be reflected in future policies.
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Affiliation(s)
- Veronica Neefjes
- Center for Social Ethics and Policy, Department of Law, School of Social Sciences, The University of Manchester, Manchester, United Kingdom
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5
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Crouch EE, Damas C, Bartrug WC, Shamiyeh A, Scelfo M, Dreyfus M, Gano D, Segal S, Franck LS. Parents' Views on Autopsy, Organ Donation, and Research Donation After Neonatal Death. JAMA Netw Open 2023; 6:e2341533. [PMID: 37930699 PMCID: PMC10628732 DOI: 10.1001/jamanetworkopen.2023.41533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/24/2023] [Indexed: 11/07/2023] Open
Abstract
Importance Parents who experience neonatal loss have the option to participate in autopsy, organ donation, and research donation. However, clinicians are uncomfortable discussing autopsy and may not be aware of research and organ donation opportunities. Objective To capture the perspectives of parents who had experienced neonatal loss about autopsy, organ donation, and research donation. Design, Setting, and Participants This qualitative study used virtual focus groups with parents who attended a local bereavement support group in the US. Participants were recruited from Helping After Neonatal Death, a support group with a local chapter. Participants self-selected from an email request if they met the following criteria: aged 18 years or older, English speaking, at least 6 months elapsed since neonatal death, and access to a video conference device with internet. Focus groups took place between April and September 2021. The recorded sessions were analyzed using a grounded theory-informed approach by the research team that included parents with experience of neonatal loss. Data were analyzed from December 2021 through December 2022. Results A total of 14 mothers engaged in the focus group; 9 (75%) were aged 30 to 39 years, and 8 (66%) were White. The mothers were overall well educated. The first main theme grew from the lived experience of neonatal loss, specifically the importance of offering all parents the option to donate, rather than prejudging who would or would not be interested. Parents of neonates who die have few opportunities to parent that child and make loving decisions for them. Participants emphasized that the conversation about autopsy, organ donation, and research donation, albeit difficult, can offer a meaningful parenting experience. A second main theme that emerged related to how organ or tissue donation could provide additional meaning to a child's life. These choices contributed to building a legacy to honor their child's memory, which also helped with grief and coping with their loss. A third theme included recommendations to clinicians and health systems for improving communication, including written information for parents and communication training for health care professionals. Conclusions and Relevance In this qualitative study, parents who experienced neonatal loss endorsed the importance of offering parents the choice of autopsy, organ donation, or research donation with skillful and empathetic communication. They provided practical recommendations to improve communication and empower families.
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Affiliation(s)
- Elizabeth E. Crouch
- Department of Pediatrics, University of California San Francisco
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California San Francisco
| | - Carlos Damas
- Department of Pediatrics, University of California San Francisco
| | | | - Anne Shamiyeh
- Helping After Neonatal Death of the Bay Area, Redwood City, California
| | - Meghan Scelfo
- Department of Pediatrics, University of California San Francisco
| | | | - Dawn Gano
- Division of Pediatric Neurology, Department of Neurology, Benioff Children’s Hospital, University of California San Francisco
| | - Summer Segal
- Department of Pediatrics, Stad Center for Pain Palliative and Integrative Medicine, University of California San Francisco
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6
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Bluhme E, Henckel E, Jorns C. Potential of neonatal organ donation and outcome after transplantation. Pediatr Transplant 2023; 27:e14486. [PMID: 36792069 DOI: 10.1111/petr.14486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 02/17/2023]
Abstract
Organ transplantation is limited by access to suitable organs. Infant recipient waitlist mortality is increased due to the scarcity of size-matched organs. Neonatal organ donors have been proposed as an underutilized source of donor organs. However, the literature on the actual prevalence and outcome of neonatal organ donation and transplantation is fragmented and not well analyzed. This literature review aims to summarize the available literature on the potential of neonatal organ donation and to analyze published cases of neonatal organ transplantation. A systematic search of the Medline and Cochrane databases yielded 2964 articles, which were screened for eligibility. In total, 86 articles were considered eligible, of which 34 were included in the literature review: 8 articles describing the potential of neonatal organ donation programs, and 26 articles describing clinical transplantation. Current evidence suggests there is a large pool of potential neonatal organ donors. In contrast, the literature on neonatal organ donor utilization is sparse. However, case series of successful kidney, heart, liver, hepatocyte, and multivisceral transplantation using organs from neonatal donors are summarized. Although good posttransplant organ function was achieved, the use of neonatal organs is associated with increased risk of thrombosis in both kidney and liver transplantation. Neonatal organ donation is a promising alternative for expanding the current donor pool. Experience is limited, but reported patient and graft survival are acceptable and more research on the subject is warranted.
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Affiliation(s)
- Emil Bluhme
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Ewa Henckel
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Carl Jorns
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
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Leland B, Wocial L. Exploring Ethical Dimensions of Physician Involvement in Requests for Organ Donation in Pediatric Brain Death. Semin Pediatr Neurol 2022; 45:101031. [PMID: 37003625 DOI: 10.1016/j.spen.2022.101031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 12/25/2022]
Abstract
Pediatric organ transplantation remains a life-saving therapy, with donated organs being absolutely scarce resources. Efforts to both increase pediatric organ donation authorization by families of children declared dead by neurologic criteria and mitigate perception of conflicts of interest have resulted in frequent exclusion of physicians from this process. This article provides of focused review of pediatric organ donation in the setting of brain death, explores the breadth of consequences of physician exclusion in donation authorization requests, and provides an ethical framework defending physician involvement in the organ donation process for this patient population.
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Knihs NDS, Feisther LC, Santos JD, Silva RMD, Paim SMS, Schirmer J, Pessoa JLE, Bellaguarda MLDR. Brain death communication with parents of children and adolescents: care strategies. Rev Bras Enferm 2022; 75:e20210943. [PMID: 36169503 DOI: 10.1590/0034-7167-2021-0943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to identify care strategies developed by professionals from critically ill patients' units in communicating BD with parents of children and adolescents. METHODS an exploratory and descriptive research with a qualitative approach, carried out in two health institutions between October and December 2019, through semi-structured interviews. Data analysis took place through content analysis. RESULTS twenty-one professionals participated. Three care strategies were identified: actual clinical situation in suspected brain death; sensitizing families to the real clinical situation after brain death diagnosis; and time to assimilate the death information. FINAL CONSIDERATIONS the care strategies for communicating brain death to families identified in this study present the possibility of subsidizing health managers in training and support promotion for professionals in care practice. Moreover, they can be incorporated and validated in the care practice of the studied context.
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Affiliation(s)
| | | | - Juliana Dos Santos
- Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil
| | | | | | - Janine Schirmer
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
| | - João Luis Erbs Pessoa
- Secretaria de Saúde do Estado de São Paulo, Central Estadual de Transplantes. São Paulo, São Paulo, Brazil
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Giugni C, Cecchi C, Santucci C, Giometto S, Lucenteforte E, Ricci Z. Why is corneal donation so rare in children's hospices? A survey of multidisciplinary team members attitudes, knowledge, practice, and experience. Pediatr Transplant 2022; 26:e14217. [PMID: 34994059 DOI: 10.1111/petr.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Corneal donation is a rare event among pediatric patients dying in children's hospices in Italy. Previous research suggests that lack of knowledge and negative attitude of Health Care Professionals (HCPs) are the most relevant factors for low donation rates in hospice, rather than patient ineligibility or public refusal. We conducted a national survey to explore children's hospice staff's knowledge and attitude toward corneal donation, to survey HCPs confidence in discussing the subject with patients and families, to investigate whether staff members receive specific training about corneal donation and its potential impact on the willingness to raise the topic with patients and families. METHODS An anonymous web-based survey with multiple-choice responses was delivered to the team members of seven Italian children's hospices to test their knowledge and attitude about corneal donation. RESULTS Of the seven children's hospices approached, four agreed to participate with a response rate of 48.5%. Among respondents, 70% declared that they had not received specific training about corneal donation. Results of statistical analysis showed that there were no significant differences in responses between trained and non-trained staff and among the different professionals (nurses, doctors, psychologists, AND social workers) regarding confidence in discussing the subject with patients and families. CONCLUSIONS In our sample of HCPs working in Italian children's hospices, there was no difference in self-reported trust between professionals who reported receiving specific cornea donation training and those who did not. It is remarkable that training on corneal donation was endorsed by a minority of the sample.
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Affiliation(s)
- Cristina Giugni
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Costanza Cecchi
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Claudia Santucci
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Zaccaria Ricci
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy.,Anesthesiology and Critical Care medicine, Department of Health Science, University of Florence, Florence, Italy
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10
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da Silva Knihs N, Schuantes Paim SM, Dos Santos J, Dos Reis Bellaguarda ML, Silva L, Magalhães ALP, Treviso P, Schirmer J. Care bundle for family interview for pediatric organ donation. J Pediatr Nurs 2022; 64:56-63. [PMID: 35152001 DOI: 10.1016/j.pedn.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE to develop a care bundle for best practices in conducting the family interview for organ and tissue donation with the families of children and adolescents. DESIGN AND METHODS methodological study, with a qualitative approach, developed in Brazil, in three stages: literature review, qualitative study with professionals and family members, and development of the care bundle. RESULTS Nine studies were selected and 17 health professionals and nine family members were interviewed. With this data, the care bundle was developed in three categories: communication of death, emotional support and information about organ and tissue donation. The recommendations were evaluated by five external professionals and all of them assessed the bundle as having the highest possible quality. CONCLUSIONS the care bundle was built following the stages of integrative literature review and interviews with professionals working in this scenario and family members who have already gone through a family interview for organ and tissue donation of children and adolescents. PRACTICE IMPLICATIONS the use of this material is seen as an important resource to support the professional during the conduction of the family interview in a scenario as sensitive and challenging as the care to family members facing death and the decision of organ and tissue donation of children and adolescents. Furthermore, the care bundle can increase the quality of family interviews and impact the reduction of family refusals. DESCRIPTORS Practice Guideline as Topic. Tissue and Organ Procurement. Patient Care Team. Nursing. Pediatrics. Communication.
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Affiliation(s)
| | | | - Juliana Dos Santos
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Lucía Silva
- Federal University of São Paulo, São Paulo, São Paulo, Brazil.
| | | | - Patrícia Treviso
- Vale dos Sinos University, Porto Alegre, Rio Grande do Sul, Brazil
| | - Janine Schirmer
- Federal University of São Paulo, São Paulo, São Paulo, Brazil.
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11
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Knihs NDS, Feisther LC, Santos JD, Silva RMD, Paim SMS, Schirmer J, Pessoa JLE, Bellaguarda MLDR. Comunicação da morte encefálica junto aos pais de crianças e adolescentes: estratégias de cuidados. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0943pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivos: identificar estratégias de cuidados desenvolvidas pelos profissionais das unidades de pacientes críticos na comunicação da morte encefálica junto aos pais de crianças e adolescentes. Métodos: pesquisa exploratória e descritiva com abordagem qualitativa, realizada em duas instituições de saúde entre outubro e dezembro de 2019, por meio de entrevistas semiestruturadas. A análise dos dados ocorreu através da análise de conteúdo. Resultados: participaram 21 profissionais. Foram três estratégias de cuidados identificadas: real situação clínica na suspeita de morte encefálica; sensibilizando a família da real situação clínica após o diagnóstico de morte encefálica; e tempo para assimilar a informação da morte. Considerações Finais: as estratégias de cuidados para comunicação de morte encefálica às famílias identificadas neste estudo apresentam a possibilidade de subsidiar gestores de saúde na promoção de capacitações e apoio aos profissionais na prática assistencial. Além disso, podem ser incorporadas e validadas na prática assistencial do contexto estudado.
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12
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Dame C, von der Hude K, Kliemann M, Rösner B, Bührer C, Garten L. [... because We Should not Forget! Neonatal Organ Donation]. Z Geburtshilfe Neonatol 2021; 225:366-370. [PMID: 34384134 DOI: 10.1055/a-1509-3688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Obwohl sich fast 40% aller Todesfälle im Kindes- und Jugendalter während der Neugeborenenperiode ereignen, kommt es in der Neonatologie nur selten zur Organspende. Wir berichten über ein Neugeborenes, bei dem nach perinataler Asphyxie der endgültige, nicht behebbare Ausfall der Gesamtfunktion des Großhirns, des Kleinhirns und des Hirnstamms ("Hirntod") gemäß Transplantationsgesetz diagnostiziert wurde. Das Herz wurde nach der sogenannten zweiten richtliniengemäßen "Hirntoddiagnostik" zur Organspende entnommen und erfolgreich transplantiert. Besondere juristische Herausforderungen ergaben sich aus dem Umstand der anonymen Geburt, den notwendigen Regelungen der Vormundschaft sowie der Zuordnung des Totenfürsorgerechts. Medizinisch standen die speziellen Regelungen der Diagnostik des irreversiblen Hirnfunktionsausfalls bei Neugeborenen und der optimale Erhalt der Organfunktion vor Entnahme im Vordergrund. Für die Pflegenden stellte sich der Ablauf grundlegend anders dar als bei einer Therapiezieländerung mit anschließender palliativen Versorgung in Anwesenheit der Eltern. Angesichts der großen emotionalen Herausforderungen erwiesen sich die Einbindung aller Beteiligten in die Entscheidungsabläufe und die Übernahme der besonderen Verantwortung als hilfreich.Although almost 40% of all deaths prior to 18 years of age occur within the neonatal period, organ donation is rare in neonatology. Herein we report about a newborn infant with perinatal asphyxia and permanent, irreversible loss of brain function (cerebrum, cerebellum and brain stem), managed according to the criteria and instructions defined by the German law of donor organ transplantation. After confirmation of irreversible loss of brain function, the heart was successfully transplanted. Specific legal challenges resulted from the instance of an anonymous birth, the guardianship required, and the specific regulations of welfare of the deceased individual. The most prominent medical challenges consisted in the specific regulatory purposes for the diagnosis of the irreversible loss of brain function in neonates and the optimal maintenance of organ functions prior to donation. From the nursing point of view, the proceeding differed entirely compared to redirection of care into palliation while parents are present. Involving all stakeholders in every step of decision making was regarded as emotionally helpful.
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Affiliation(s)
- Christof Dame
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Kerstin von der Hude
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Markus Kliemann
- Region Nord-Ost, Deutsche Stiftung Organtransplantation, Frankfurt, Deutschland
| | - Bianka Rösner
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Christoph Bührer
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Lars Garten
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Spaulding AB, Zagel AL, Cutler GJ, Brown A, Zier JL. Organ Donation Authorization After Brain Death Among Patients Admitted to PICUs in the United States, 2009-2018. Pediatr Crit Care Med 2021; 22:303-311. [PMID: 33332867 DOI: 10.1097/pcc.0000000000002648] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To identify trends in and factors associated with pediatric organ donation authorization after brain death. DESIGN Retrospective cohort study of data from Virtual Pediatric Systems, LLC (Los Angeles, CA). SETTING Data from 123 PICUs reporting to Virtual Pediatric Systems from 2009 to 2018. PATIENTS Patients less than 19 years old eligible for organ donation after brain death. MEASUREMENTS AND MAIN RESULTS Of 2,777 eligible patients, 1,935 (70%) were authorized for organ donation; the authorization rate remained unchanged over time (ptrend = 0.22). In a multivariable logistic regression model, hospitalizations lasting greater than 7 days had lower odds of authorization (adjusted odds ratio, 0.5; p < 0.001 vs ≤ 1 d) and White patients had higher odds than other race/ethnicity groups. Authorization was higher for trauma-related encounters (adjusted odds ratio, 1.5; p < 0.001) and when donation was discussed with an organ procurement organization coordinator (adjusted odds ratio, 1.7; p < 0.001). Of 123 hospitals, 35 (28%) met or exceeded a 75% organ donation authorization target threshold; these hospitals more often had an organ procurement organization coordinator discussing organ donation (85% vs 72% of encounters; p < 0.001), but no difference was observed by PICU bed size. CONCLUSIONS Organ donation authorization after brain death among PICU patients was associated with length of stay, race/ethnicity, and trauma-related encounter, and authorization rates were higher when an organ procurement organization coordinator was involved in the donation discussion. This study identified factors that could inform initiatives to improve the authorization process and increase pediatric organ donation rates.
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Affiliation(s)
| | - Alicia L Zagel
- Children's Minnesota Research Institute, Minneapolis, MN
| | | | - Angela Brown
- Critical Care Department, Children's Minnesota, Minneapolis, MN
| | - Judith L Zier
- Critical Care Department, Children's Minnesota, Minneapolis, MN
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14
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Darlington A, Randall D, Leppard L, Koh M. Palliative and end of life care for a child: Understanding parents' coping strategies. Acta Paediatr 2021; 110:673-681. [PMID: 32564398 DOI: 10.1111/apa.15429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/03/2020] [Accepted: 06/16/2020] [Indexed: 12/21/2022]
Abstract
AIM Understanding of coping strategies that parents use before the death of their child is crucial and will enable us to best provide support. The current study aimed to explore parents' coping strategies, and map these onto an existing theoretical framework. METHODS Bereaved parents and parents of a child with a life-limiting/threatening condition were interviewed to investigate coping strategies, recruited through Intensive Care Units (2 Neonatal, 2 Paediatric, 1 Paediatric Cardiac) and a children's hospice. Analysis focused on coping strategies and mapping these onto the framework. RESULTS 24 parents of 20 children were interviewed and identified. Parents use a variety of coping strategies (n = 25) such as humour, staying positive, advocating and staying strong for others, expressing emotions and preparing, while also living life to the full, supported by others. The themes were successfully mapped onto the theoretical framework, which focuses on the constructs of approach and avoidance, as well as coping for self and others. CONCLUSION The findings have provided a detailed account of the breadth and depth of coping strategies parents use, including those classed as avoidance. The strategies were successfully mapped onto the theoretical framework. Future research should investigate changes over times, and associations to negative long-term outcomes.
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Affiliation(s)
| | - Duncan Randall
- School of Health Sciences University of Southampton Southampton UK
| | - Lisa Leppard
- Neonatal Intensive Care Unit University Hospital Southampton Southampton UK
| | - Michelle Koh
- University Hospital SouthamptonNaomi House Hospice Southampton UK
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Vileito A, Hulzebos CV, Toet MC, Baptist DH, Verhagen EAA, Siebelink MJ. Neonatal donation: are newborns too young to be recognized? Eur J Pediatr 2021; 180:3491-3497. [PMID: 34105002 PMCID: PMC8589733 DOI: 10.1007/s00431-021-04139-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/03/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
Neonatal organ and tissue donation is not common practice in the Netherlands. At the same time, there is a transplant waiting list for small size-matched organs and tissues. Multiple factors may contribute to low neonatal donation rates, including a lack of awareness of this option. This study provides insight into potential neonatal organ and tissue donors and reports on how many donors were actually reported to the procurement organization. We performed a retrospective analysis of the mortality database and medical records of two largest neonatal intensive care units (NICUs) in the Netherlands. This study reviewed records of neonates with a gestational age >37 weeks and weight >3000g who died in the period from January 1, 2005 through December 31, 2016. During the study period, 259 term-born neonates died in the two NICUs. In total, 132 neonates with general contra-indications for donation were excluded. The medical records of 127 neonates were examined for donation suitability. We identified five neonates with documented brain death who were not recognized as potential organ and/or tissue donors. Of the remaining neonates, 27 were found suitable for tissue donation. One potential tissue donor had been reported to the procurement organization. In three cases, the possibility of donation was brought up by parents.Conclusion: A low proportion (2%) of neonates who died in the NICUs were found suitable for organ donation, and a higher proportion (12%) were found suitable for tissue donation. We suggest that increased awareness concerning the possibility of neonatal donation would likely increase the identification of potential neonatal donors. What is Known: • There is an urgent need for very small organs and tissues from neonatal donors What is New: • A number of neonates who died in the NICU were suitable organ or/and tissue donors but were not recognized as donors. • Knowledge on neonatal donation possibilities is also important for proper counseling of parents who sometimes inquire for the possibility of organ and tissue donation.
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Affiliation(s)
- Alicija Vileito
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700, RB, Groningen, the Netherlands.
| | - Christian V. Hulzebos
- Department of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - Mona C. Toet
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dyvonne H. Baptist
- Department of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - Eduard A. A. Verhagen
- Department of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - Marion J. Siebelink
- University Medical Center Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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16
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Robertson EG, Wakefield CE, Tsoli M, Kellie SJ, Alvaro F, Gifford AJ, Weber MA, Rodriguez M, Kirby M, Ziegler DS. Parents' experiences of postmortem tumor donation for high-grade gliomas: benefits and suggested improvements. Neurooncol Adv 2021; 3:vdab087. [PMID: 34458732 PMCID: PMC8386242 DOI: 10.1093/noajnl/vdab087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pediatric high-grade glioma is a devastating diagnosis. There has been no improvement in outcomes for several decades, with few children surviving 2 years postdiagnosis. Research progress has been hampered by a lack of tumor samples, which can be used to develop and test novel therapies. Postmortem tumor donations are therefore a valuable opportunity to collect tissue. In this study, we explored Australian parents' experiences of donating their child's tumor for research after their child had died. METHODS We collected qualitative data from 11 bereaved parents who consented to donate samples of their child's high-grade glioma for research postmortem. We asked parents about their perceived benefits/burdens of the autopsy, recommendations for improving consent discussions, and decision regret. RESULTS Parents hoped that their donation would help to find a cure for future children with high-grade glioma. They described feeling comforted knowing that their child's suffering may help others. Some parents also felt that the donation would help them better understand their child's tumor. Although some parents described discomfort about procedures leading up to the autopsy, parents reported minimal regret regarding their decision to donate their child's tumor. Parents provided recommendations to improve consent discussions, such as providing more information about the autopsy logistics and why the donation was needed. CONCLUSION Parents consented to autopsy for altruistic reasons, although donation may also assist parents in their grieving. There is a strong need to improve access to tumor donations for any family who wishes to donate.
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Affiliation(s)
- Eden G Robertson
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, New South Wales, Australia
| | - Maria Tsoli
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Children’s Cancer Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Stewart J Kellie
- Children’s Cancer Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Frank Alvaro
- Children’s Cancer and Blood Disorders, John Hunter Children’s Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Andrew J Gifford
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Children’s Cancer Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Anatomical Pathology, NSW Health Pathology East (Prince of Wales Hospital), Sydney, New South Wales, Australia
| | - Martin A Weber
- Anatomical Pathology, NSW Health Pathology East (Prince of Wales Hospital), Sydney, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Michael Rodriguez
- Anatomical Pathology, NSW Health Pathology East (Prince of Wales Hospital), Sydney, New South Wales, Australia
| | - Maria Kirby
- Department of Haematology and Oncology, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
| | - David S Ziegler
- School of Women’s and Children’s Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Children’s Cancer Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
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17
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Vileito A, Siebelink MJ, Vermeulen KM, Verhagen AAE. Lack of knowledge and experience highlights the need for a clear paediatric organ and tissue donation protocol in the Netherlands. Acta Paediatr 2020; 109:2402-2408. [PMID: 32124464 PMCID: PMC7687146 DOI: 10.1111/apa.15241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 12/15/2022]
Abstract
Aim This study explored the attitudes of medical professionals to organ and tissue donation in paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs) in the Netherlands. It also examined their compliance with the existing Dutch donation protocol and assessed whether a paediatric donation protocol was needed. Methods We invited 966 professionals working in all eight PICUs and the two largest NICUs to complete an online survey from December 2016 until April 2017. Results A quarter (25%) took part and they included PICU intensivists, neonatologists, nurses and other health and allied professionals. Most were female and nurses. More than half (54%) of the PICU respondents considered paediatric organ donation to be very important and 53% supported tissue donation. In contrast, only 22% of the NICU respondents believed that both neonatal organ and tissue donation were very important. Familiarity and compliance with the existing national donation protocol were low. PICU nurses had significantly less experience than PICU intensivists and felt less comfortable with the donation process. None of the NICU respondents had prior donation experience. Conclusion Paediatric intensive care units and NICU professionals lack specialised knowledge and experience on organ and tissue donation. A comprehensive and clear paediatric donation protocol is clearly needed.
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Affiliation(s)
- Alicija Vileito
- Department of Paediatrics Beatrix Children's Hospital University Medical Centre Groningen University of Groningen Groningen the Netherlands
| | - Marion J. Siebelink
- Transplant Centre University Medical Centre Groningen University of Groningen Groningen the Netherlands
| | - Karin M. Vermeulen
- Department of Epidemiology University Medical Centre Groningen University of Groningen Groningen the Netherlands
| | - A. A. Eduard Verhagen
- Department of Paediatrics Beatrix Children's Hospital University Medical Centre Groningen University of Groningen Groningen the Netherlands
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18
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Rady MY. Integration of Routine Parental Request of Organ Donation in End-of-Life Care of Children with Neurologic Disorders in the UK: Unresolved Medical, Legal, Cultural, and Religious Challenges. Neurocrit Care 2020; 33:630-635. [PMID: 32445107 DOI: 10.1007/s12028-020-00997-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The UK adopted the opt-out system (deemed or presumed consent) in end-of-life organ donation enforceable in May 2020. Presumed consent applies to adults but not children. Transplant advocates have recommended that all children on end-of-life care should be referred for potential organ donation to increase the supply of transplantable organs in the UK. To buttress this objective, a UK survey of parents of deceased children mostly with neurologic disorders secondary to severe brain injuries recommended the integration of routine parental discussion of donation regardless of donation eligibility in end-of-life care. Donation discussions emphasize the utility and suitability of organs in dying children for transplantation to maximize consent rate. To ensure that this recommendation does not harm children and parents, contemporary medical, legal, cultural, and religious challenges to end-of-life organ donation should be disclosed in parental discussion of donation and resolved appropriately. To that effect, it is urged that: (1) practice guidelines for the diagnosis and treatment of neurologic disorders secondary to severe brain injuries in children are updated and aligned with recent advances in neuroscience to eliminate potential errors from premature treatment discontinuation and/or incorrect diagnosis of death by brain(stem) criteria, (2) transparent and non-biased disclosure of all empiric information when discussing donation to ensure informed parental decision-making, and (3) a societal dialogue is conducted on the legal, cultural, and religious consequences of integration of routine donation discussion and referral in end-of-life care of children in the UK.
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Affiliation(s)
- Mohamed Y Rady
- Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA.
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19
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Bratton SL, Zollinger CM. Bereaved ICU parental end-of-life care goals: including organ donation regardless of eligibility. Arch Dis Child 2019; 104:823-824. [PMID: 31129563 DOI: 10.1136/archdischild-2019-317214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Susan L Bratton
- Department of Critical Care, University of Utah, Salt Lake City, Utah, USA
| | - Charles M Zollinger
- Department of Clinical Services, Intermountain Donor Services, Salt Lake City, Utah, USA
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