Neonatal organ donation has the potential to expand the deceased donor pool, but worldwide practices for referral and acceptance criteria are inconsistent. Determination of neurological death in neonates has traditionally been considered challenging. This national study aimed to quantify the proportion of neonates in Australia who would be eligible for donation via neurological or circulatory determination of death and to identify common reasons for ineligibility.
The investigators analyzed data from the Australian and New Zealand Neonatal Network (ANZNN). The dataset included neonates who died in one of 23 tertiary neonatal intensive care units across Australia between 2012 and 2022. Eligibility for donation through either neurological death pathways or donation after circulatory determination of death (DCD) was determined using International Classification of Diseases, Tenth Revision (ICD-10) codes together with ANZNN morbidity data. The study applied inclusion criteria to identify the subset of neonatal deaths suitable for assessment against established neurological and circulatory donation criteria.
From a source population of 1,760 infants who died in the participating tertiary neonatal units during the study period, 750 infants (43%) met the study inclusion criteria and were assessed for donation eligibility. The cohort was categorized by primary cause of death into neurological causes and non-neurological causes to allow pathway-specific eligibility determination.
Eligibility for donation was evaluated along two distinct pathways:
Neurological death pathway: infants who died from neurological causes were assessed against criteria relevant for neurological determination of death.
Circulatory death pathway (DCD): infants were assessed for suitability for donation after circulatory determination of death based on diagnostic codes and morbidity characteristics recorded in the ANZNN dataset.
The analysis relied on coded diagnoses (ICD-10) and recorded morbidities to apply the pathway-specific inclusion and exclusion criteria.
Of the 750 infants included for eligibility assessment, 307 deaths were classified as due to neurological causes and 443 as non-neurological.
Among the 307 neurological deaths, 65 infants (21%) were potentially eligible for donation via the neurological death pathway. The remaining 242 infants (79%) with neurological causes were assessed as potentially eligible for donation after circulatory determination of death (DCD).
Among the 443 infants with non-neurological causes of death, 257 infants (58%) met the criteria for donation after circulatory death.
These results indicate that a substantial proportion of neonatal deaths—particularly those from non-neurological causes—may be suitable for organ donation via the circulatory determination pathway.
The study identified several recurrent clinical reasons why neonates were considered ineligible for donation. Reasons reported in the dataset included:
These conditions were used to exclude infants from donation eligibility according to the applied criteria derived from coded diagnoses and morbidity records.
The authors conclude that neonates represent a potentially underused donor population in Australia. More than half of neonates dying of non-neurological causes met criteria for donation after circulatory determination of death. The analysis suggests that consistent referral criteria and streamlined clinical pathways are needed to maximize donation opportunities in this population.
The study underscores the importance of standardized processes—both for identifying eligible neonates and for facilitating referrals to organ donation services—to improve utilization of neonatal donors. Specific operational or policy recommendations beyond the need for consistency and streamlined pathways were not detailed in the abstract.