National recommendations on paediatric organ donation

Spain is a global leader in organ donation and transplantation. In 2019 it reached a proportion of 48.9 donors per million inhabitants, with a target of 50 donors per million inhabitants for 2022. Among the measures taken to achieve this target are strategies to promote paediatric donation. However, the number of paediatric donors has been decreasing sharply since 2002, despite a historical reduction to the lowest levels of family refusal to donation.

The document presenting the “National recommendations on paediatric donation”1 discusses new alternatives to obtain organs, some of which may pose an ethical dilemma. This is the case of controlled donation after circulatory death, in which, beyond its conflict with the Dead Donor Rule,2 which is the foundation of any transplantation programme, antemortem interventions may be performed to facilitate the donation process, including the establishment of central vascular access and other measures taken solely to improve the viability of the organs. Handling prior to the death of the donor can be a form of instrumentalization that goes against the dignity of the patient, as it involves interventions that do not provide any direct benefit to the patient and are not justified by the clinical situation.3

CITATION  An Pediatr (Engl Ed). 2024 Apr 3:S2341-2879(24)00091-7.  doi: 10.1016/j.anpede.2024.03.036