543 - Barriers and Enablers to Pediatric Donation after Cardiac Death (DCD): A Qualitative PICU Study

Publication Number: 1522.543

Olivia Gould, Children's National Health System, Alexandria, VA, United States; Christiane O. Corriveau, Children's National Hospital, Washington, DC, United States; Divya Gupta, Children's National Health System, Washington, DC, United States; Pamela S.. Hinds, Children's National Health System, Washington, DC, United States; Amy Wolfe, Childrens national Hospital, Washington, DC, United States

Background: The demand for pediatric organ donors exceeds the available supply. Donation after circulatory death (DCD) has been increasingly utilized to address this shortage; however, its adoption in pediatric settings remains limited. DCD accounts for under 30% of all pediatric deceased donors, though ~ 50% of children over the age of one withdrawn from life-sustaining therapy meet eligibility. No prior study has examined factors contributing to the underutilization of pediatric DCD (pDCD). This study explored barriers and enablers to pDCD among pediatric intensive care unit (PICU) staff at a large pediatric transplant center.

Objective: We aim to use semi-structured interviews to explore the perspectives of PICU providers on motivators and barriers to donation by circulatory death.

Design/Methods: We conducted a prospective qualitative study to explore barriers and enablers to pDCD as perceived by members of the PICU healthcare team. Semi-structured interviews were conducted with physicians, nurses, and social workers. Thematic content analysis was used to identify codes and emergent themes.

Results: Twenty PICU team members participated, including 13 physicians, 5 nurses, and 2 social workers. Thematic content analysis revealed 11 themes. Enablers identified by participants included: 1) professional fulfillment, 2) ethical commitment to patient and societal good, 3) alignment with personal beliefs, and 4) access to accurate and up-to-date resources. Reported barriers included: 1) the emotional weight of pediatric end-of-life care, 2) systemic limitations, 3) complex family dynamics, 4) communication challenges, 5) clinician moral distress, 6) limited access to credible resources, and 7) the challenge of addressing families’ pre-existing misconceptions about pDCD.

Conclusion(s): PICU team members described a combination of emotional strain, institutional limitations, communication challenges, and complex interpersonal dynamics as key barriers to pDCD implementation. Enabling factors included ethical principles, personal beliefs, as well as access to reliable resources. Participants proposed strategies to improve pDCD utilization, including enhanced clinician education, identification of internal pDCD advocates, and development of streamlined protocols for donor identification and coordination. Understanding the barriers and enablers to pDCD provides a foundation for targeted interventions to improve clinician and family support during this challenging process.