La donación en asistolia controlada (tipo III de Maastricht) en pediatrÃa
Pediatric organ donation following controlled circulatory death (Maastrich category III)
1Unidad de Cuidados Intensivos Pediátricos. 2Unidad de NeonatologÃa. Hospital Universitario de Burgos. Fundación Nene. 3Unidad de NeonatologÃa. Hospital Universitario RÃo Hortega. Valladolid. Fundación Nene
Abstract
Children constitute a specific population who face a higher risk of mortality and morbidity while on a transplant waiting list and who encounter greater difficulty in finding suitable organ donors, since progression towards brain death is exceptional in this age group. Maastricht category III organ donation after circulatory determination of death is defined as that which occurs following confirmation of death using circulatory and respiratory criteria in patients who die as a result of the decision to limit therapy, which must have been made previously and independently. Results published in the current literature seem to indicate that survival of organs donated after circulatory death is not lower than that of organs donated after brain death. The establishment of controlled cardiac death organ donation protocols could significantly increase the number of donors and transplants, which would imply a great number of available organs, thus benefitting not only children but also the adult population. There is, however, a number of particular aspects pertaining pediatric and especially neonatal patients which are subject to debate, such as the identification of transplant candidates, the definition of death and the withdrawal of consent for organ donation. In this article, the ethical issues that can arise during the implementation of these protocols are reviewed, including those related to the decision to limit therapy, the way of conveying information and obtaining informed consent, medical management and palliative care, the process of life-support withdrawal, death certification and bereavement support.
Correo electrónico: ferdemedina@gmail.com
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