Background: As of December 31, 2022, there were a total of 1,770 transplant recipients under the age of 10 years in Korea. However, between 2018 and 2022, only 38 deceased donors were recorded in this age group, with an annual average of 7.6. This indicates a significant shortage of donated organs for children under the age of 10 years. Therefore, we analyzed the average number of donated organs from donors aged ≤10 years between 2018 and 2022 to determine the need for increased organ donation efforts.

Method: A retrospective analysis was conducted on cases of potential brain death donor that were reported to the Korea Organ Donation Agency (KODA) between 2018 and 2022. Cases of potential brain death donor were divided into two groups: those aged ≤10 years (group A) and those aged ≥11 years(group B).

Result: Between 2018 and 2022, 179 individuals were potential brain death donor in group A(≤10) and 11,210 were identified in group B(≥11). Of these individuals, 38 from group A(≤10) and 2,186 from group B(≥11) eventually became deceased donors. The average number of transplanted organs per deceased donor was 2.61 for group A(≤10) and 3.41 for group B(≥11), with a higher average in group B(≥11).  A comparison of transplanted organ rates revealed that kidney (51.5%) was the most and which was followed by liver (24.6%), heart (11.4%), and lung (8.2%) in order for group B(≥11) and kidney (35.3%), heart (26.2%), liver (22.2%), and lung (16.1%) in order for group A(≤10). Although kidney donation was the most common in both groups, group A(≤10) had higher rates of heart and lung donations. During the same period, guardian rejection rates were 29.4% (4,484 individuals) for group B(≥11) and 71.7% (104 individuals) for group A(≤10), indicating a higher rate of rejection among guardians in group A(≤10).

Conclusion: The number of individuals under the age of 10 years awaiting transplantation significantly exceeds the number of deceased donors in this age group. Hence, there is a mismatch between the demand and availability of donated organs, leading to prolonged waiting times for transplant recipients and their guardians. To address this issue, it is crucial to reduce the number of guardian refusals for organ donation. This can be achieved by improving public awareness and enhancing the interviewing skills of organ procurement nurses to ensure parents are better informed about organ donation. Furthermore, efforts are needed by Organ Procurement Organization, the government, and related academic societies to address the issue of organ shortage for children under 10 years old in Korea.