(377) Factors Associated With Pediatric Organ Donation After Death by Neurologic Criteria

Introduction: Evaluation for death by neurologic criteria (DNC) may help inform family decisions around end of life care and organ donation in pediatric patients with severe neurologic injury. Knowledge is limited on which children who undergo DNC testing proceed to become organ donors. We aimed to characterize factors associated with organ donation in pediatric patients meeting criteria for DNC, hypothesizing that organ donation would be more common in older patients with a shorter interval from admission to DNC.

Methods: We conducted a retrospective cohort study of pediatric referrals to a regional organ procurement organization (OPO) who met DNC criteria from 2016-2022. Demographics, admission diagnoses, cause and circumstances of death, and donation outcomes were extracted from the OPO referral database. We performed chi-square and Wilcoxon rank-sum tests to estimate associations between exposures and organ donation after DNC and used backwards stepwise regression to develop a multivariable logistic regression model.

Results: Of 220 pediatric patients who met criteria for neurologic death, 61% proceeded to organ donation, donation was declined by family in 31%, 5% were medically ruled-out, and 3% were not approached by the OPO. Age was bimodally distributed with peaks at < 1 and 17 years, 58% were male, and 62% were of white non-Hispanic racial/ethnic background. The most common causes of death were anoxia (54%) and head trauma (34%). Older age, shorter duration from admission to testing, race/ethnicity, cause of death, and circumstances of death were associated with donation on bivariate analyses. On multivariable modeling, donation was less likely among Black (OR 0.07, 95% CI 0.02-0.28) and Native American (OR 0.06, 95% CI 0.01-0.27) patients compared to white, non-Hispanic patients. Donation was more likely in patients with head trauma (OR 4.1 vs anoxia, 95% CI 1.6-10.6) and patients who died by suicide (OR 13.9 vs natural causes, 95% CI 3.8-51.4).

Conclusions: Organ donation after DNC was less likely among Black and Native American patients relative to white non-Hispanic patients, and more common following traumatic injury and suicide. Further research is warranted to elucidate how these factors may influence family decisions to donate in pediatric patients who meet criteria for neurologic death.