Organ Donation Authorization After Brain Death Among Patients Admitted to PICUs in the United States, 2009-2018

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.