Introduction: The Australian organ donation national reform was a successful initiative that saw an increase over ten years of actual deceased donors by 122% and an associated increase in transplantation rate of 81%. Disappointingly, this donation growth was not seen in the paediatric donor population. An important feature of the reform was to embed in hospitals a collaborative approach to family donation conversations, involving a Donation Specialist Nurse along with the treating intensive care specialist. Repeated audits and observations have demonstrated that this approach results in improved consent outcomes compared to when conversations are conducted by treating specialists alone. However, whether this approach is equally effective in paediatric cases has not previously been independently studied.
Method: Data on all paediatric deaths (age 0-15) from 1 January 2016 to 31 December 2021 was obtained from the Australian DonateLife Death Audit. The audit is conducted by DonateLife staff in 90 hospitals in Australia and reports demographics of all hospital deaths and detailed information on all donation conversations and outcomes.
Results: During the study period, 474 paediatric family donation conversations resulted in a verbal consent decision. Organ donation was first raised by hospital staff in 314 cases and by the family in 160 cases. Of the 314 staff-raised conversations, 136 were collaborative (43%), and 178 were non-collaborative (57%). There were no statistical differences in the demographic characteristics between the collaborative and non-collaborative conversations. In staff-raised conversations, when collaborative the consent rate was 81/136 (60%, 95% CI 51% - 68%) compared with 44/178 (25%, 95% CI 19% - 32%) when non-collaborative (p < 0.001, Fisher’s Exact Test). The consent rate in family-raised conversations was 130/160 (81%, 95% CI 74% - 87%).
Conclusion: We found that in cases where hospital staff first raised the issue of organ donation a collaborative approach to the donation conversation was associated with a significantly greater rate of family consent than a non-collaborative approach.  Consent rates were greatest, however, when families themselves first raised the question of donation. These findings suggest that organ donation services and the paediatric intensive care community should engage to ensure that all family donation conversations are conducted using a collaborative approach.