Comprehensive Review of Pediatric Organ Transplantation Allocation Practices

Pediatric Transplantation Overview

1. General Information

  • Journal Reference: Pediatric Transplantation, 2023; 27(S1): e14317.

  • Publication Date: Accepted on April 29, 2022.

2. Authors and Affiliations

  • Stefany Hernández Benabe (AdventHealth, Orlando, Florida, USA)

  • Irini Batsis (Mount Sinai School of Medicine, New York, USA)

  • Anne I. Dipchand (The Hospital for Sick Children, Toronto, Ontario, Canada)

  • Stephen D. Marks (NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK)

  • Mignon I. McCulloch (Red Cross War Memorial Children's Hospital, Rondebosch, South Africa)

  • Evelyn K. Hsu (University of Washington School of Medicine, Seattle, Washington, USA)

3. Abbreviations

  • IPTA: International Pediatric Transplant Association

  • LMR: Low- or Medium-Resourced

  • MELD: Model for End-stage Liver Disease

  • PELD: Pediatric End-Stage Liver Disease

  • UNOS: United Network for Organ Sharing

4. Abstract Summary

Background

  • Lack of global surveys on pediatric deceased donor organ allocation practices since late 20th century.

  • Aim: Summarize pediatric organ transplantation practices and allocation methods worldwide.

Methods

  • Utilized IRODAT for identifying countries performing pediatric transplantations.

  • Review literature, allocation policies, country-specific references.

  • Communicated with international pediatric centers to confirm practices and gather information.

Results

  • Most countries have policies focusing on reducing organ allocation disparity.

Conclusion

  • Emphasis on the importance of pediatric organ donation due to the long-term life potential of children.

5. Introduction

  • Introduction of deceased donor transplantation at the end of the 20th century.

  • No comprehensive global surveys have been conducted on deceased donor allocation for pediatric patients.

  • Historical perspective on childhood definitions and protections.

    • 16th Century: Children viewed as miniature adults.

    • 1924: Legal acknowledgment of children's rights.

    • 1946: Establishment of UNICEF, focusing on children’s rights for development and wellbeing.

    • 1989: Adoption of the Convention on the Rights of the Child by the United Nations.

  • Ethical considerations surrounding organ allocation for children under 18, its variability globally, and implications for transplantation outcomes.

6. Methods

  • Utilization of IRODAT:

    • List of countries performing transplantation sorted by continent.

    • Compilation of publicly available policies and database references.

  • Survey Methodology:

    • Conducted via REDCAP, gaining responses from 29 countries.

    • Information summarized for pediatric allocation practices by organ.

7. Results

7.1 Overall Data

  • Total countries performing pediatric transplants: 69.

    • 42% of these classified as LMR by OECD.

    • Africa: All countries performing pediatric transplants are LMR; no lung transplants available.

    • North America: 12 centers, with 75% being LMR.

    • South America: 8 centers, 6 classified as LMR.

7.2 Country-Specific Allocation Practices

  • Pediatric Kidney Allocation:

    • Children with ESKD benefit significantly from dialysis options.

    • Various strategies for prioritizing children noted (e.g., pre-emptive transplantation, donor matching).

7.3 Organ Allocation Tables

  • Table 1: Outline of pediatric-deceased donor transplant availability by organ.

  • Examples of countries providing pediatric priority allocation for organs:

    • France: Offers left lobe priority for children under 35 years.

    • Italy: Generally prioritizes pediatric organ recipients.

    • United States: National priority given to pediatric patients, geographic allocation principles apply.

8. Additional Strategies in Pediatric Transplantation

  • Kidney Transplantation Strategies:

    1. Pre-emptive transplantation before dialysis is required.

    2. Early identification of potential living donors.

    3. Scoring systems favoring younger candidates.

    4. Regional vs national allocation impact.

  • Liver Transplantation Strategies:

    1. Prioritizing pediatric liver donations from pediatric donors.

    2. Mandating split liver transplants for smaller children.

  • Heart and Lung Allocation:

    • Emphasis on pediatric priority in cases of equal medical status.

    • Variability in policies across jurisdictions especially concerning heart transplants.

9. Challenges in Pediatric Allocation

  • Significant disparities in pediatric prioritization between well-resourced and less-resourced regions.

  • Lack of standardized national policies in many regions impacting effective allocation.

10. Discussion

  • The importance of expanding pediatric organ allocation practices.

  • Call for international cooperation and policy translation to improve pediatric waitlist outcomes.

  • Acknowledgment of authors and contributors to the study: Evelyn K. Hsu, Stefany Hernández Benabe, and collaborators.

11. Limitations

  • Gaps in data collection highlighted, especially in low-resourced regions.

12. Citation and Reference Notes

  • Specific references were cited throughout the text providing evidence and supporting data for the discussions.

13. Call to Action

  • Encouragement for transparency and uniformity in pediatric organ allocation policies.

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