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Peer-reviewedCC BYFrontiers in Pediatrics

Death by neurologic criteria and organ donation in German pediatric intensive care units—data from the PIA network

  • Nadine Mand1
  • Carolin Donath1
  • Franziska König1
  • Sebastian Brenner2
  • Nora Bruns3
  • Christian Dohna-Schwake3
  • Florian Hoffmann4
  • Martin Olivieri5
  • Michael Urschitz6
  • Diana Perera Cutiño6
  • Richard Biedermann7
7 affiliations
  1. 1Department of Pediatrics, Neonatology and Pediatric Intensive Care Medicine, Marburg University, Marburg, Germany
  2. 2Department of Pediatrics, Pediatric Intensive Care Medicine, University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
  3. 3Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
  4. 4Department of Pediatrics, Klinikum Dritter Orden Munich, Munich, Germany
  5. 5Pediatric Intensive Care Unit, Dr. von Hauner Children’s Hospital, LMU Munich, Munich, Germany
  6. 6Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
  7. 7Department of Child and Adolescent Medicine, Neonatal and Pediatric Intensive Care Section, University Hospital Jena, Jena, Germany
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Abstract

IntroductionEach year, between 250 and 300 children are listed for organ transplantation in Germany, while approximately 30 children donate organs. Despite identified barriers to pediatric organ donation, comprehensive data on characteristics and clinical management of pediatric deaths in German pediatric intensive care units (PICUs), especially among organ donors, remains limited. This study aims to analyze the epidemiology of in-PICU deaths and the characteristics of pediatric organ donors within a multicenter network of German PICUs.MethodsRetrospective analysis of data anonymously collected in 33 PICUs participating in the Pediatric Intensive Care Admission Network (PIA) between May 1, 2023 and July 31, 2025. Patients included were children older than 27 days and younger than 18 years who died during their PICU stay.ResultsOf 11,095 children recorded, 219 died (overall case-fatality rate:19.7/1,000). Median age at death was 6 years (IQR, 1– 13). Death occurred after withdrawal (30.1%) or limitation of life-sustaining treatment (20.5%), failed maximal therapy (26.5%) and failed cardiopulmonary resuscitation (12.8%). 21/219 (9.6%) children met neurologic criteria for death. Of these, 11 children became organ donors (52.4%). Median age of organ donors was 4 years (IQR 1–13).DiscussionThis first multicenter analysis from a nationwide German PICU network shows comparable mortality rates but substantially lower rates of death by neurologic criteria (DNC) in German PICUs than in international multicenter studies. This gap may indicate missed opportunities for organ donation. More structured donor identification, enhanced training for DNC diagnosis, and development of evidence-based guidelines for pediatric donor management may enhance quality of care and increase pediatric organ donation in Germany.

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Cite

BibTeXRIS
BibTeX
@article{mand2026death,
  title = {{Death by neurologic criteria and organ donation in German pediatric intensive care units—data from the PIA network}},
  author = {Nadine Mand and Carolin Donath and Franziska König and Sebastian Brenner and Nora Bruns and Christian Dohna-Schwake and Florian Hoffmann and Martin Olivieri and Michael Urschitz and Diana Perera Cutiño and Richard Biedermann},
  journal = {Frontiers in Pediatrics},
  year = {2026},
  month = oct,
  doi = {10.3389/fped.2026.1890906},
  url = {https://doi.org/10.3389/fped.2026.1890906},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Death by neurologic criteria and organ donation in German pediatric intensive care units—data from the PIA network
AU  - Nadine Mand
AU  - Carolin Donath
AU  - Franziska König
AU  - Sebastian Brenner
AU  - Nora Bruns
AU  - Christian Dohna-Schwake
AU  - Florian Hoffmann
AU  - Martin Olivieri
AU  - Michael Urschitz
AU  - Diana Perera Cutiño
AU  - Richard Biedermann
PY  - 2026
DA  - 2026/10/23
JO  - Frontiers in Pediatrics
DO  - 10.3389/fped.2026.1890906
UR  - https://doi.org/10.3389/fped.2026.1890906
AB  - IntroductionEach year, between 250 and 300 children are listed for organ transplantation in Germany, while approximately 30 children donate organs. Despite identified barriers to pediatric organ donation, comprehensive data on characteristics and clinical management of pediatric deaths in German pediatric intensive care units (PICUs), especially among organ donors, remains limited. This study aims to analyze the epidemiology of in-PICU deaths and the characteristics of pediatric organ donors within a multicenter network of German PICUs.MethodsRetrospective analysis of data anonymously collected in 33 PICUs participating in the Pediatric Intensive Care Admission Network (PIA) between May 1, 2023 and July 31, 2025. Patients included were children older than 27 days and younger than 18 years who died during their PICU stay.ResultsOf 11,095 children recorded, 219 died (overall case-fatality rate:19.7/1,000). Median age at death was 6 years (IQR, 1– 13). Death occurred after withdrawal (30.1%) or limitation of life-sustaining treatment (20.5%), failed maximal therapy (26.5%) and failed cardiopulmonary resuscitation (12.8%). 21/219 (9.6%) children met neurologic criteria for death. Of these, 11 children became organ donors (52.4%). Median age of organ donors was 4 years (IQR 1–13).DiscussionThis first multicenter analysis from a nationwide German PICU network shows comparable mortality rates but substantially lower rates of death by neurologic criteria (DNC) in German PICUs than in international multicenter studies. This gap may indicate missed opportunities for organ donation. More structured donor identification, enhanced training for DNC diagnosis, and development of evidence-based guidelines for pediatric donor management may enhance quality of care and increase pediatric organ donation in Germany.
SN  - 2296-2360
ER  -