JOURNAL CLUB · ARTICLE OF THE WEEK
Potential neonatal organ donors in Australia: a national cohort study
Barzegar R, Cavazzoni E, Popat H, Wong G. Pediatrics. 2026;158(4):e2025075110. doi:10.1542/peds.2025-075110. A retrospective national registry cohort study.
POTENTIAL
DONORS
About 1 in 3 were potential donors
564 of 1760 (32%) met the criteria: 499 (28%) via circulatory death and 65 (3.7%) via neurological death.
Circulatory death is the main pathway
Of 443 eligible babies dying of non-neurological causes, 257 (58%) could donate after circulatory death.
HIE is central
HIE was the leading cause of death (over 1 in 5). All 65 potential neurological-death donors had severe HIE; most potential donors were term babies who died in the first 2 weeks.
Referral is not routine
Neonatal donation is not in the Australian neonatal training curriculum, and only 5 of 374 child donors in 20 years weighed under 5 kg.
The verdict
Neonates are an under-recognised group of potential donors. The authors call for consistent referral criteria and clear pathways.
WHY THIS MATTERS
- Organ demand far exceeds supply; neonatal kidneys can be transplanted en bloc into adults with good medium-term function
- Overseas, fewer than 10% of eligible NICU deaths are referred for donation
- Families may value the option, but staff are often unsure how or when to raise it
- Brain death cannot be declared under 37 weeks in Australia (ANZICS), so most neonatal donation is after circulatory death
- The first national estimate of neonatal donor potential in Australia
STRENGTHS
- National: every Australian tertiary NICU over 11 years
- Uses a mature, validated registry (ANZNN)
- Conservative eligibility criteria, set with transplant and donation specialists
- Second reviewer (a NSW Donate Life medical director) confirmed classifications
- Findings match UK and Canadian estimates (27-35%)
LIMITATIONS
- Registry data only; no review of individual records
- Could not confirm whether brain death testing was done
- Ventilation status missing 2012-2015, likely underestimating eligibility
- No data on haemodynamic stability, organ function or actual referrals
- Family perspectives and consent were not studied
Practice implications
Most of these babies die in a NICU after transfer, but a third were born in hospitals like ours, and we are often the first team to care for a baby with severe HIE. Donation conversations are challenging and should be led by a consultant paediatrician, neonatologist or NETS consultant. Juniors should know the option exists (mostly after circulatory death, in term babies of 3 kg or more, most often after severe HIE) and pass on the family’s questions. Senior staff can call the NSW Organ and Tissue Donation Service for advice.
Would you feel able to respond if a family asked about organ donation for their baby?
When, and by whom, should donation be raised in redirection of care?
Why is neurological determination of death so difficult in newborns?
Should referral to the donation service be a routine trigger in end-of-life care?
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Take-home message: About 1 in 3 babies who died in Australian NICUs over a decade could potentially have been organ donors, mostly after circulatory death and often after severe HIE. Referral is not routine. Knowing the option exists is the first step to offering it to families.
For educational purposes only. Journal club appraisal - figures paraphrased from the published study; read the full article for complete data. Always align practice to your local guidelines.