Paeds · pain-palliative-and-end-of-life-care
Organ and tissue donation in children
Also known as Paediatric organ donation · Donation after brain death children · Donation after circulatory death children · Tissue donation paediatrics · Family approach to organ donation PICU
Fellowship guide to organ and tissue donation in children. Covers donation after neurological determination of death (DBD), donation after circulatory determination of death (DCD), paediatric brain-death testing including apnea testing, the family approach, tissue donation, contraindications, PICU logistics, ANZICS/TSANZ/AAP-aligned practice, and family support regardless of the decision. Built for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examination.
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Red flags
- Neurological determination of death must follow an accepted paediatric pathway with two examinations and an apnea test appropriate to age; informal pronouncement is unsafe and unlawful.
- The donation conversation is separated from the death conversation; collapsing them into one rushed discussion destroys trust.
- Families who decline donation still receive full end-of-life and bereavement care; donation is never a condition of good care.
- Missed donation opportunities after devastating brain injury are a system quality issue — early referral to the donation agency is part of intensive care.
- DCD requires a planned withdrawal of life-sustaining treatment already judged to be in the child's best interests; donation must not drive the decision to withdraw.
Life stages
Care settings
Clinical exam formats
Board mappings
- Clinical Sciences — Ethics and professionalism
- Clinical Practice — Communication
- Current 2026 PREP curriculum — Learning Objective 1.4.1: Communicate effectively and compassionately with children, young people and families including goals-of-care and end-of-life conversations
- Current 2026 PREP curriculum — Learning Objective 2.3.1: Recognise and manage the child with a life-limiting condition, including palliative care and end-of-life decisions
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Ethical practice and end-of-life care
- Clinical Applications
- Medical Sciences
- Professional Qualities
- Long Cases
- Short Cases
- Communication stations
- 1. Professional values and behaviours
- 4. Professional skills and knowledge: Patient management
- 5. Communication
- 9. Leadership and team working
- Applied Knowledge in Practice (AKP)
- Theory and Science (TAS)
- Clinical
- History
- Communication
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- General Pediatrics Content Outline — Universal Task 8: Ethics and Professionalism
- General Pediatrics Content Outline — Universal Task 5: Communication
- Patient Care 5: Patient Management
- Interpersonal and Communication Skills 1
- Professionalism 1: Professional Conduct and Ethical Principles
- Systems-Based Practice 2
- Medical Expert
- Communicator
- Collaborator
- Professional
- Pediatrics: Palliative and end-of-life care
Overview & Definition
A five-year-old sustains catastrophic traumatic brain injury. After optimisation, clinical examination suggests neurological death. The parents ask whether their child can help other children. The fellowship task is to move from this scene to a safe, ethical, documented plan that puts the child first while holding the family. [1] [2] [3]
Paediatric organ and tissue donation proceeds only after death is properly determined (neurological or circulatory), after a best-interests decision about life support that is independent of donation, and after a skilled, separated family approach that supports the family whether they accept or decline. [1] [2] [3]
This page is written so a candidate can answer examiner questions across definition, ethics, communication, documentation and escalation without reaching for another source. Regional frameworks differ in language, but the bedside sequence is stable: stabilise comfort, explore understanding, make a recommendation, share the decision, document, and escalate early when disagreement persists. [1] [2] [3] [4]
References8ShowHide
- [1]Moynihan KM et al. Epidemiology of childhood death in Australian and New Zealand intensive care units. Intensive Care Med, 2019.PMID 31270578
- [2]Dopson S et al. Exploring nurses' knowledge, attitudes and feelings towards organ and tissue donation after circulatory death within the paediatric intensive care setting in the United Kingdom: A qualitative content analysis study. Intensive Crit Care Nurs, 2019.PMID 31350064
- [3]Lee LA et al. Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021-2022. Pediatr Crit Care Med, 2024.PMID 37966310
- [4]Kramer AH et al. Missed Organ Donation Opportunities in Patients With Devastating Brain Injury: A Prospective Population-Based Cohort Study. Crit Care Med, 2026.PMID 41269058
- [5]Jarrah RJ et al. Developing a standard method for apnea testing in the determination of brain death for patients on venoarterial extracorporeal membrane oxygenation: a pediatric case series. Pediatr Crit Care Med, 2014.PMID 24201855
- [6]Weiss MJ et al. The Bucharest international European Society for Organ Transplantation consensus on paediatric controlled donation after circulatory determination of death. Transpl Int, 2026.PMID 42453307
- [7]Murphy NB et al. Advancing the Scientific Basis for Determining Death in Controlled Organ Donation After Circulatory Determination of Death. Transplantation, 2024.PMID 38637919
- [8]Himelstein BP et al. Pediatric palliative care. N Engl J Med, 2004.PMID 15103002