The death of a child is an uncommon event but needs to be handled with professionalism and sensitivity, especially with regard to supporting the family involved. A multidisciplinary approach is required with early involvement of the paediatric medical and nursing teams.

Paediatric organ donation and transplantation can have a significant life extending benefit to their recipients. Increasing identification and referral of potential donors suggests that should a child be admitted to the ED with a catastrophic brain injury they should be considered for organ donation regardless of age. Therefore because of the specialist expertise required both in withdrawal of life support in children, progression to declaration of brain death and possible organ donation, best practice dictates that this should be carried out after transfer to the paediatric intensive care unit (PICU). In addition, the withdrawal of life support in a child involves extensive parental discussion and support often taking days. Early referral to the paediatric intensive care consultant via NCS is advised to facilitate admission. Referral and discussion with a specialist nurse for organ donation (SNOD) can then be initiated by the PICU team.

Practice does not differ from adult best practice and the family must be allowed time to understand and accept organ withdrawal of life support before organ donation can be discussed. The most appropriate environment for this is the PICU.

→ Section 6.j

End of life and organ donation