Potential Neonatal Donors in Australia: A National Cohort Study

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BACKGROUND AND OBJECTIVE: Neonatal organ donation could significantly expand the deceased donor pool, but referral pathways and acceptance criteria remain highly variable worldwide and determination of neurological death in neonatal patients has traditionally been considered challenging. Our national study aimed to determine the potential proportion of neonates eligible for donation after neurological and circulatory determination of death in Australia and to identify reasons for ineligibility. METHODS: We analyzed the Australian and New Zealand Neonatal Network data for neonates who died in one of 23 tertiary neonatal intensive care units between 2012 and 2022. Donation eligibility via neurological or circulatory death pathways were determined using International Classification of Diseases, Tenth Revision codes and Australia and New Zealand Neonatal Network morbidity data. RESULTS: Of 1760 infants, 750 (43%) met the inclusion criteria. Neurological causes accounted for 307 deaths; 65 (21%) were potentially eligible for donation via the neurological death pathway and 242 (79%) for donation after circulatory death. Among 443 infants with non-neurological causes of death, 257 (58%) were eligible for donation after circulatory death. Reasons for ineligibility included multiorgan failure, active infection at time of death, underlying chromosomal or genetic disorders, birth with multiple or complex congenital anomalies, intra-abdominal pathologies inclusive of necrotizing enterocolitis, and underlying disorders of metabolic, hematological, or lymphatic origin. CONCLUSION: Neonates represent a potentially underused donor population, with more than half of those dying of non-neurological causes meeting criteria for donation after circulatory determination of death. Consistent referral criteria and streamlined clinical pathways are needed to maximize donation opportunities.

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