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| |
Received: 3 September 2021    Revised: 9 January 2023    Accepted: 17 January 2023

DOI: 10.1111/petr.14486

COMPREHENSIVE REVIEW

Potential of neonatal organ donation and outcome after

transplantation

Emil Bluhme1,2  | Ewa Henckel1,3 | Carl Jorns1,2

1
Department of Clinical Science,
Intervention and Technology, CLINTEC, Abstract
Karolinska Institutet, Stockholm, Sweden
Organ transplantation is limited by access to suitable organs. Infant recipient waitlist
2
Department of Transplantation,
Karolinska University Hospital, Stockholm,
mortality is increased due to the scarcity of size-­matched organs. Neonatal organ
Sweden donors have been proposed as an underutilized source of donor organs. However,
3
Department of Neonatology, Astrid the literature on the actual prevalence and outcome of neonatal organ donation and
Lindgren Children's Hospital, Karolinska
University Hospital, Karolinska Institutet, transplantation is fragmented and not well analyzed. This literature review aims to
Stockholm, Sweden summarize the available literature on the potential of neonatal organ donation and to
Correspondence analyze published cases of neonatal organ transplantation. A systematic search of the
Emil Bluhme and Carl Jorns, Department Medline and Cochrane databases yielded 2964 articles, which were screened for eli-
of Clinical Science, Intervention and
Technology, CLINTEC, Karolinska gibility. In total, 86 articles were considered eligible, of which 34 were included in the
Institutet, Karolinska University Hospital, literature review: 8 articles describing the potential of neonatal organ donation pro-
Stockholm, Sweden.
Email: carl.jorns@ki.se; emil.bluhme@ki.se grams, and 26 articles describing clinical transplantation. Current evidence suggests
there is a large pool of potential neonatal organ donors. In contrast, the literature on
Funding information
CIMED research grant; Region Stockholm/ neonatal organ donor utilization is sparse. However, case series of successful kidney,
Karolinska Institutet, forskar-­AT; Stiftelsen heart, liver, hepatocyte, and multivisceral transplantation using organs from neonatal
Tornspiran; Stockholm county council,
post doc/ALF donors are summarized. Although good posttransplant organ function was achieved,
the use of neonatal organs is associated with increased risk of thrombosis in both
kidney and liver transplantation. Neonatal organ donation is a promising alternative
for expanding the current donor pool. Experience is limited, but reported patient and
graft survival are acceptable and more research on the subject is warranted.

KEYWORDS
infant, neonate, newborn, organ donation, organ transplantation

1  |  I NTRO D U C TI O N
Liver, heart, and intestinal transplantation are lifesaving treatments
for end-­stage organ failure. Kidney transplantation is a life-­enhancing,
cost-­effective treatment for end-­stage renal disease and is associated
with lower mortality and morbidity in comparison with dialysis.1 The
need for organs for transplantation is increasing, and availability is in-
sufficient to meet the increasing demand. In comparison with adults,
pediatric patients are at a significantly increased risk of mortality when
waiting for an organ transplant. Mortality reaches over 31% and 10%
for pediatric patients awaiting heart and liver transplantation, respec-
tively.2,3 Increased mortality is largely attributed to the scarcity of

Abbreviations: DBD, Donation after brain death; DCD, Donation after circulatory death; DNC, Death according to neurological criteria; NICU, Neonatal intensive care unit; TPN, Total
parenteral nutrition.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction
in any medium, provided the original work is properly cited and is not used for commercial purposes.
© 2023 The Authors. Pediatric Transplantation published by Wiley Periodicals LLC.

Pediatric Transplantation. 2023;00:e14486.  |

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https://doi.org/10.1111/petr.14486
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size-­matched organs.4 Pediatric mortality is highest in the neonatal
period, ranging between 3 and 30.2 deaths per 1000 live births.5,6
Consequently, neonatal organ donation is a possibility that has been ex-
plored in certain countries to increase the availability of donor organs.
During 1970–­1990, selected transplantation centers utilized
organs procured from neonatal anencephalic donors as they were
thought to meet death according to neurologic criteria (DNC).
Anencephalic organ donation was discontinued in the early 1990
due to ethical and practical issues.7 Neonatal organ donation was
abandoned in most centers following the introduction of donation
after brain death (DBD) in 19688,9 and the fact that neonates were
excluded from pediatric DNC guidelines.10 However, neonatal organ
donation was still practiced to a limited extent within certain dona-
tion after circulatory death (DCD) programs. In 2011, an American
task force was assembled to re-­evaluate pediatric DNC guidelines
10,11
published in 1987 that introduced DNC in neonates born at term.
Issues relating to neonatal organ donation are multifaceted,
with concerns regarding anatomical size, organ maturity, and ethics.
Although transplantation using neonatal organs from both DCD and
DBD donors is possible in some countries, practices and legislation
vary internationally and literature on the subject is scarce. This re-
view aims to summarize the current literature on the donation and
use of organs procured from neonatal donors and to describe pub-
lished information on the potential for neonatal organ donation.
1.1  |  Search strategy
To acquire relevant literature, searches were done in the Cochrane
Library and Medline databases using PubMed through June 2021.
The search term used was “(infant, newborn [MeSH] OR neona*)
AND (hepatocyte transplantation OR Organ Transplantation [MeSH]
OR Tissue and Organ Procurement [MeSH])”. For PubMed, the fol-
lowing filters were used (Species; Humans. Age; Infant: newborn-
­23 months. Available abstract or full article).
All studies pertaining to neonatal organ donation were consid-
ered eligible and assessed further for inclusion. Inclusion criteria
were (1) articles that described clinical use of organs obtained from
neonatal donors, and (2) articles that explored the potential contri-
bution of neonatal organ donation. Articles merely describing do-
nors on a group level (i.e., under a certain weight or age) from which
results for neonatal donors could not be extracted were excluded.
Initial eligibility assessment was done by screening article titles.
In ambiguous or unclear cases, abstracts and/or entire articles were
read. The screening process was done by one individual. The neona-
tal period was defined as the first 28-­days following birth.
1.2  |  Review of the literature
The Medline search generated 2964 articles; 2746 articles were ex-
cluded based on the title, and 130 were excluded after they were
read. In total, 86 articles pertaining to neonatal organ donation were
deemed eligible (Figure 1). The Cochrane Library search generated
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2964 Articles found
2746
Excluded by title
218
Articles read
132
Excluded after reading
86
Eligible articles
52
Articles not included
34
Articles included
F I G U R E 1  Flowchart describing inclusion process of articles
included in literature review.
126 articles on Cochrane reviews and 36 articles on trials. Of these,
no reviews were related to the field and one trial was relevant and
also included in the PubMed search. The 86 articles were sorted into
nine different categories (Figure 2).
Of the 86 eligible articles, 34 met the inclusion criteria. Eight ar-
ticles met the inclusion criteria for articles investigating the potential
of neonatal organ donation (summarized in Table 1), and 26 articles
concerned the use of neonatal organs: heart n = 4, kidney n = 11,
liver n  = 4, multivisceral n  = 2, and hepatocyte n  =  5. Four of the
articles describing kidney transplantation were from an earlier era
(1978–­1987), using grafts procured from anencephalic donors, and
are not detailed in the synopsis.12–­15
Of the remaining 52 eligible articles not included, the majority
(n = 26) discussed anencephalic neonatal organ donation as either
case reports or discussions of ethical aspects.7,16–­40 Utilization of
neonatal anencephalic DBD donors ceased in the early 1990s after
a study at Loma Linda University Children's Hospital found that an-
encephalic patients seldom, if ever, met DNC criteria.7 Other areas
were represented by articles discussing the theoretical advantage of
possible neonatal tolerance or the possibility of ABO-­incompatible
transplants (n = 8).41–­47 There were articles discussing ethical aspects
of neonatal organ donation (n = 3),48–­50 and there were discussions
of difficulties in DNC in neonates (n = 3).51–­53 Others concerned the
donation of neonatal organs for research purposes (n  =  3)54–­56 or
protocols relating to neonatal organ donation (n  =  4).57–­60 Of the
reviews found (n = 5), 2 discussed hepatocyte transplantation,61,62
2 reviewed neonatal heart transplantation,63,64 and 1 discussed
pediatric donation after circulatory death.65 None of the reviews
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BLUHME et al.       3 of 9

F I G U R E 2  Eligible articles found

through systematic search86 sorted
into 9 categories. ABOi, blood group
incompatible.

TA B L E 1  Total result of potential neonatal donor in respective study, divided by organ if applicable. Rates are provided in relation to
deceased neonates within the study period.

DCD
Time period Total
Author Country (year) deaths Heart Kidney Liver Hepatoc-­y tes Heart valves DBD
70
Labrecque et al. U.S. 3 192 5.2% (10) 9.4% (18) 7.3% (14) –­ –­ –­
71
Mathur et al. U.S. 5 266 1.9% (5) –­ –­ –­ –­ –­
Hanley et al.72 U.S. 10 609 –­ 9.4% (57) –­ –­ –­ –­
73
Stiers et al. U.S. 2.5 136 –­ 33.1% (45) –­ 33.1% (45) 41.9% (57) –­
Bennett et al.66 U.S. 2 72 9.7% (7)a –­
Saha et al.67 ASTL 9 117 6% (7)a –­
68
Pregernig et al. SWTZ 10 –­ –­ % (7)b –­
69 a
Charles et al. U.K. 5 84 40% (34) 13% (11)a
a
Overall donation, specific organ not investigated/specified.
b
Total deceased neonatal patients not specified; 14 patients passed away following withdrawal of life-­sustaining treatment.

primarily detailed neonatal organ donation or the transplantation of
procured organs from neonatal donors.
1.3  |  The potential for neonatal organ donation
All studies included were retrospective, from four different coun-
tries (Australia, Switzerland, the United Kingdom, and the United
States). All evaluated potential neonatal DCD donation to some ex-
tent, and one study evaluated potential neonatal DBD. The evalu-
ated period was 2–­10 years. In total, 1526 deceased neonates were
evaluated across 8 studies (Table 1). Four studies evaluated poten-
tial DCD eligibility without considering organ-­specific criteria and
found a potential donation rate ranging from 6% to 86% of neonatal
patients who died in an NICU.66–­69 Only one study evaluated the po-
tential for neonatal DBD donation and reported a potential donation
rate of 13% of deceased neonates.69
Four studies included organ-­specific criteria in their methodol-
ogy.70–­73 When assessing potential DCD heart donation, Labrecque
et al reported that 5% of decedents were potential donors, and
Mathur et al reported 1.9% of total deaths as eligible.70,71 Similarly,
three studies applied criteria for potential DCD kidney donation.
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4 of 9       BLUHME et al.
Labrecque et al reported that 9.4% of deceased patients met criteria,
Henley et al reported a potential donation rate of 9.4% of deceased
patients, and Stiers et al found that 33.1% of deceased neonates
met criteria.70,72,73 Only Labrecque et al. applied specific criteria for
potential DCD liver donation, and they reported that 7.2% of de-
70
ceased neonates met criteria. Additionally, Stiers et al. evaluated
potential DCD donation of heart valves and hepatocytes and found
rates of potential donation of 41.9% and 33.1% of total deaths,
respectively.73
Two studies concurrently reported on the time elapsed from the
end of life-­sustaining treatment until the declaration of death.66,67
In the cohort presented by Saha and Kent, the median time from
extubation until confirmed cardiorespiratory death was 30 (1–­2880)
67
min. Bennett et al reported that following withdrawal of life-­
sustaining treatment, 26% of patients expired within 20 min and
57% within 60 min, with a median time of 57 min.66
Two studies evaluated the referral protocols at their respective
units. 66,73 Stiers et al showed that 11 out of 136 (8.7%) patients
were adequately referred for organ donation and therefore eval-
uated, of which 3 resulted in organ donation, allowing procure-
73
ment of kidneys as well as tissue. Bennett et al investigated a
cohort of 72 deceased neonates and reported that 42 (65%) po-
tential donors were adequately referred for assessment, of which
seven met criteria and four underwent successful DCD dona-
tion. 66 Comparatively, in older age groups at the respective insti-
tutions, proper referral rates ranged from 80% to 95% of deceased
patients.
1.4  |  Transplantation using organs from
neonatal donors
1.4.1  |  Heart
Two studies were identified describing heart transplantation from
anencephalic neonatal donors. An article from 1990 by Boucek et al.
described a cohort of infants who underwent cardiac transplanta-
tion at Loma Linda Hospital where one of the donors was described
as an anencephalic neonatal donor.74 However, the outcome follow-
ing transplantation was not further described nor assessed. Another
article by Parisi et al describes a neonate with hypoplastic left heart
syndrome who received a heart transplant on his first day of life.75
Despite initially doing well, the patient died after 10 days, and au-
topsy revealed thrombosis of the inferior vena cava and diffuse
necrotizing enterocolitis. Both donors were anencephalic neonates
who were described as meeting DNC criteria. This practice was dis-
continued in the early 1990s due to ethical and practical issues sur-
rounding anencephalic organ donation, as anencephalic neonates
seldom if ever fulfilled DNC criteria.7
In an article published in 2017, Blitzer et al. describe a unique
occurrence from 1991. Two dizygotic twins were delivered using
emergency caesarean section due to fetal distress.76 One twin was
born with a previously undiagnosed hypoplastic left heart syndrome
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requiring a heart transplant. The other twin died following peri-
natal asphyxia and subsequently met DNC criteria. The twin with
hypoplastic left heart syndrome received a transplant utilizing the
heart from the deceased sibling. The article describes the 25-­year
follow-­up of the recipient, who is clinically doing well with no rejec-
tion episodes.
In 2008, Boucek et al. published a series of three infants who
received heart transplants from neonatal DCD donors.77 Cause of
death was birth asphyxia, mean donor weight was 3.2 kg, and mean
age was 3.7 days. During the study period, 17 infants received heart
transplants from size-­matched DBD donors. On echocardiographic
follow-­up, no significant difference was observed between DBD and
DCD recipients.
1.4.2  |  Kidneys
An article from 2018 compared outcomes after en bloc kidney trans-
plantation from donors weighing <10 kg, comparing DCD and DBD
donors in a matched-­pair analysis.78 Although their numbers were
not specified, the compared groups both included neonatal donors.
No difference could be observed in primary nonfunction or graft
thrombosis. At long-­term follow-­up, no difference in graft survival or
function could be observed when comparing DBD with DCD recipi-
ents. Two other studies performed by the same group likely included
the same patient population.79,80
Another study analyzed a series of 30 en block kidney trans-
plantations, comparing outcomes of recipients receiving organs
from donors weighing either <5 or >5 kg. 81 The <5-­k g group con-
stituted of 8 donors, 7 of whom were in the neonatal period. In
this group, two cases of thrombosis and one case of primary non-
function occurred. In comparison, in the >5-­k g group, one case
of thrombosis was reported. No statistical difference in graft sur-
vival or kidney function could be shown at one-­year follow-­up.
The same authors also published a case report describing bilateral
adrenal hemorrhage in a neonatal donor. 82 Kidneys were procured
en bloc and transplanted into a 20-­year-­old recipient, with a func-
tioning graft at 1-­year follow-­up.
A study from 2017 analyzed a series of 8 en bloc kidney trans-
plantations from donors with low body weight, 5 of whom were
neonatal donors.83 An alternative surgical technique was used to
reduce the risk of thrombosis. The thoracic aorta was used as an
inflow tract and, instead of leaving the distal aorta closed blindly,
an outflow tract was established, anastomosing the common iliac
or the external iliac to the recipient's external iliac artery. At 1-­year
follow-­up, no vessel thrombosis had been reported, with patients
showing normal serum creatinine.
Renal function and kidney growth were assessed in pediatric pa-
tients receiving en bloc renal transplants between 2001 and 2017.84
The study compared recipients receiving allografts from 11 infant
and neonatal donors weighing <10  kg to 17 patients receiving al-
lografts from donors weighing >10 kg. The study does not specify
how many of the donors weighing <10 kg were in the neonatal period.

BLUHME et al.
Mean kidney size as assessed by ultrasound was significantly different
at transplantation. From 3-­weeks posttransplantation, no significant
difference was observed. After 1 year, the size of allografts from do-
nors weighing under 10 kg had on average increased 3.1 times com-
pared with 2.1 times in the larger group. Thrombosis occurred in one
graft procured from a smaller (4 kg) donor. Neither posttransplanta-
tion creatinine nor graft survival differed significantly between the
groups.
1.4.3  |  Liver
A study from 1991 described liver allografts from neonatal donors
transplanted into pediatric recipients (n = 16) compared with donors
85
aged >32 days (n = 114). A significant increase in the incidence of
artery thrombosis in the group receiving neonatal allografts was ob-
served: 31.3% compared with 8.8%. Biochemical liver function tests
were slower to stabilize in recipients receiving neonatal allografts,
reaching normal levels within 8–­30 days.
In 2019, a series of 48 pediatric liver transplantations was as-
sessed, comparing outcomes after transplantation using allografts
from infant donors.86 Outcome was compared among three groups
stratified according to donor age: <1 month (n  =  8), 1–­3 months
(n = 18), and 3–­12 months (n = 22). The study included both DCD
and DBD donors. The authors reported high incidences of hepatic
artery thrombosis—­50.5%, 33.3%, and 26.1%, respectively—­in the
three age groups. In the neonatal group, thrombosis led to graft loss
in 2 patients, of which one was retransplanted, and the other patient
died. No significant difference in survival between the groups could
be observed at 2-­year follow-­up. Our search strategy yielded two
additional articles published by the same group, likely including the
same neonatal donors.87,88
1.4.4  |  Hepatocytes
Three studies described clinical transplantation using neonatal
hepatocytes. In 2009, 4 pediatric patients suffering from urea cycle
disorders received neonatal hepatocytes; they achieved transient
metabolic stabilization and were ultimately listed for solid organ
transplantation. 89 In 2012, an infant suffering from infantile oxa-
90
losis received infusions with neonatal hepatocytes, after which
a significant decrease in plasma oxalate was seen; however, no en-
grafted cells could be shown in liver biopsies. The patient received
a combined liver and kidney transplant 1 year later. In 2018, a study
describing 3 cases of hepatocyte transplantation using neonatal
donors was published.91 Two patients suffering from acute liver
failure received intraperitoneal injections of hepatocytes imbed-
ded in alginate microbeads. Biochemical stabilization was achieved,
and the patients were successfully bridged to liver transplantation.
The third child had a metabolic disease, with an inability to me-
tabolize sulfites. The patient received portal infusion of neonatal
hepatocytes and was reported to be biochemically stable.
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      5 of 9
Two studies analyzed hepatocytes isolated from neonatal do-
nors and compared them with hepatocytes isolated from adult do-
nors.91,92 In both studies, hepatocytes could be isolated in high yield
and viability from neonatal donors, and they tended to show greater
resilience to cryopreservation than did adult hepatocytes. Although
phase 1 and 2 metabolism were present, neonatal hepatocytes dis-
played lower enzyme maturity.
1.4.5  |  Multivisceral transplantation
Two articles described multivisceral transplantation from neona-
tal donors. In 1999, an article describing a series of combined liver
and intestine grafts including the pancreas was published.93 Of
the 8 patients included in the series, one patient received a graft
from a 7-­day-­old neonate. Unfortunately, the patient died follow-
ing an episode of sepsis after 47 days. The authors do not explicitly
discuss details or conclusions concerning the use of the neonatal
graft. In 2012, a case report was published describing a multivis-
ceral transplant in a 3-­month-­old baby diagnosed with gastroschi-
sis who suffered midgut volvulus at the second day of life.94 The
patient underwent extensive bowel resection, ultimately developing
total parentral nutrition–­induced liver disease. Due to the small size
(3.2 kg) of the patient, the transplant team opted to use a multivis-
ceral graft (stomach, duodenum, liver, pancreas, and spleen). Organs
were procured from a neonatal donor weighing 2.9 kg at 10 days of
life. At the time of publication, 6-­years posttransplantation, the pa-
tient was doing well.
2  |  D I S C U S S I O N
In this literature review, we identified studies from four different
countries describing a relatively large potential for neonatal organ
donation. Cases of successful heart, kidney, liver, hepatocyte, and
multivisceral transplantation have been identified.
Although studies have shown the potential for neonatal DCD
organ donation, this potential has yet to be realized, likely for mul-
tiple reasons. Primarily, although excellent organ function can be
achieved, the use of neonatal grafts is challenging and associated
with an increased risk of thrombosis. Second, successful DCD re-
quires that donors are identified and referred to organ procurement
organizations in a proper and timely manner. Stiers et al. and Bennett
et al. both found a low rate of proper referrals of potential neonatal
donors to local organ procurement organizations.66,73 This is likely
a reflection of limited knowledge and organization concerning neo-
natal organ donation. Education and awareness are essential for a
functional organ procurement program, primarily so that clinicians
successfully identify potential donors, but also within the public.
Studies have previously shown that major factors limiting organ do-
nation are the knowledge and attitudes of healthcare professionals,
and that proper education on the subject will aid in promoting organ
donation and increasing donation rates.95
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Only one of the studies we found addressed the potential for
69
neonatal DBD donation. Although determining DNC in neonatal
patients is possible, it is a rare occurrence. Due to the spatial ana-
tomical relationship, with patent cranial sutures accommodating in-
creased intracranial pressure, neonates seldom fulfill DNC. Although
an important source that should not be overlooked, neonatal DBD
is unlikely to significantly increase donation rates, and a more likely
donation route for neonatal donors is DCD.
In the transplantation of solid organs from neonatal donors, liv-
ers and hearts differ from kidneys. Liver and heart transplantations
in small recipients are often, if not always, lifesaving procedures and
require the organs to be size matched between donor and recipient.
Fortunately, pediatric heart transplantation is a rare occurrence.
However, patients <1 year of age listed for heart transplantation are
at a significantly increased risk of mortality compared with older
children. The increased mortality rate is largely due to the scarcity of
size-­matched donor hearts.96 Although advances in technical alter-
natives such as the Berlin heart can delay the need for transplanta-
tion, results indicate that it is advantageous to receive a transplant at
an earlier age, as this increases long-­term survival.97 Consequently,
there is an unmet need for heart allografts from small donors.
Boucek et al. showed neonatal heart donation to be feasible, even
in a DCD setting.77 However, an important limitation reported by
the authors was the availability of suitable recipients. Most neonatal
patients who underwent withdrawal of life-­sustaining treatment at
their institution could not be considered for DCD as there was no
available recipient locally, highlighting the importance of organ shar-
ing programs within a wider network.
Likewise, liver transplantation requires size matching between
donor and recipient. It is thus often difficult to locate a suitable
donor in time for smaller recipients. Our search strategy identi-
fied only two individual series of neonatal liver transplantations,
both reporting high incidences of hepatic artery thrombosis of
31%–­5 0%. 85,86 Artery thrombosis is associated with a marked
decrease in patient and graft survival.98 Although there are only
limited data from using livers procured from neonatal donors, the
literature on livers procured from small pediatric donors (infants)
shows similar results, with an inverse relationship between body
weight and the risk of hepatic artery thrombosis.99 Considering
solid organ transplantation with livers from neonatal donors, cau-
tion is warranted; however, when successful, the long-­term out-
come is excellent.
A potential alternative is hepatocyte transplantation. Although
only transient stabilization has been achieved, successful cases
using hepatocyte transplantation as a bridging therapy to liver
transplantation have been reported. Neonatal livers seem to carry
an increased risk of thrombosis when used for solid organ transplan-
tation. Additionally, one of the main hurdles facing the advancement
of hepatocyte transplantation is the lack of good-­quality adult liv-
ers, as these are primarily used for solid organ transplantation. This
may motivate further exploration of the use of neonatal livers for
hepatocyte transplantation, as neonatal hepatocytes show greater
tolerance to cryopreservation injury.100
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Unlike heart and liver, kidney transplantation is considered life
enhancing, prolongs survival in patients suffering from CKD, and
does not require organs to be size matched. Hence, the risk–­benefit
consideration differs, and a more conservative reasoning regarding
complications such as primary nonfunction and graft thrombosis is
therefore prudent. Moreover, neonatal kidneys can be used for adult
recipients and therefore do not directly benefit pediatric patients.
However, there is a growing discrepancy between the availability of
and demand for kidney allografts that is motivating consideration
of potential sources of additional allografts. Although the literature
concerning transplantation of neonatal kidneys is scarce, the stud-
ies reviewed here show this to be a feasible alternative. Excellent
kidney function can be achieved using neonatal kidney allografts.
Additionally, grafts from small donors seem to grow rapidly to ac-
commodate the recipient's physiology.84 Despite this, there seems
to be an increased rate of thrombosis associated with smaller donors
that needs to be considered. Determining whether this increased
risk can be mitigated with alternative surgical techniques or more
aggressive anticoagulation therapy will require additional studies.
A limitation of this literature review is that many of the studies
found concerned neonatal or infant recipients of organ transplants
and were often registry-­based studies where donors are grouped
in weight classes or below a certain age. Undoubtedly, there may
be neonatal donors included in these groups, although this is not
possible to determine. Hence, such articles were not included in this
review, which covers only articles explicitly describing cases of neo-
natal organ donation or transplantation using organs procured from
neonatal donors.
An important consideration is that many of the difficulties in
transplanting neonatal organs are associated with the weight of the
donor, not the mere classification of the donor as a neonatal patient.
However, there is a logical rationale for this division in organ trans-
plantation. Neonates and infants are often treated in different units,
the NICU and pediatric ICU, respectively. Traditionally, there has
been a difference in awareness of organ donation between these
different units, as reflected by the findings on proper referral rates.
A proposed strategy moving forward is to improve age stratification
in registry reporting. Registries commonly report donors as aged
younger than 1 year or as pediatric donors. More detailed age strat-
ification could affect donation on multiple levels. It would primarily
increase awareness of the possibility of neonatal organ donation. It
would also enable the pooling of data for studies exploring poten-
tial benefits or risks. Acknowledging the difficulties associated with
neonatal grafts, their use ought to be restricted to selected high-­
volume centers.
In summary, kidneys and hearts from neonatal donors can be a
valuable contribution to the current donor pool. Transplantation of
livers procured from neonates seems to be associated with a marked
increase in hepatic artery thrombosis, but excellent function can be
achieved. Advancements in surgical techniques and alternative an-
tithrombotic regimens are possible avenues that should be further
explored. Alternatively, neonatal livers are a valuable source of he-
patocytes for transplantation.

BLUHME et al.
AU T H O R C O N T R I B U T I O N S
EB, CJ, EH -­ Participated in research design, participated in the
writing of the paper, participated in the performance of the
research.
F U N D I N G I N FO R M AT I O N
Stockholm county council, post doc/ALF. Tornspiran. CIMED re-
search grant. Region Stockholm/Karolinska Institutet, forskar-­AT.
C O N FL I C T O F I N T E R E S T S TAT E M E N T
The authors declare no conflicts of interest.
DATA AVA I L A B I L I T Y S TAT E M E N T
Data sharing is not applicable to this article as no new data were cre-
ated or analyzed in this study.
ORCID
Emil Bluhme  https://orcid.org/0000-0003-0473-2893
REFERENCES
1. Tonelli M, Wiebe N, Knoll G, et al. Systematic review: kidney trans-
plantation compared with dialysis in clinically relevant outcomes.
Am J Transplant. 2011;11(10):2093-­2109.
2. Irving C, Parry G, Cassidy J, Hasan A, Griselli M, Kirk R. Outcomes
following infant listing for cardiac transplantation: the impact of
strategies introduced to counteract limited donor availability. Arch
Dis Child. 2010;95(11):883-­887.
3. Horslen S, Barr ML, Christensen LL, Ettenger R, Magee JC.
Pediatric transplantation in the United States, 1996–­2005. Am J
Transplant. 2007;7(5 Pt 2):1339-­1358.
4. John MM, Razzouk AJ, Chinnock RE, et al. Primary transplantation
for congenital heart disease in the neonatal period: long-­term out-
comes. Ann Thorac Surg. 2019;108(6):1857-­1864.
5. Wang H, Liddell CA, Coates MM, et al. Global, regional, and na-
tional levels of neonatal, infant, and under-­ 5 mortality during
1990–­2013: a systematic analysis for the global burden of disease
study 2013. Lancet. 2014;384(9947):957-­979.
6. Hug L, Alexander M, You D, Alkema L. National, regional, and
global levels and trends in neonatal mortality between 1990 and
2017, with scenario-­based projections to 2030: a systematic anal-
ysis. Lancet Glob Health. 2019;7(6):e710-­e720.
7. Peabody JL, Emery JR, Ashwal S. Experience with anen-
cephalic infants as prospective organ donors. N Engl J Med.
1989;321(6):344-­350.
8. Manara AR, Murphy PG, O'Callaghan G. Donation after circulatory
death. Br J Anaesth. 2012;108(Suppl 1):108-­121.
9. A definition of irreversible coma. Report of the ad hoc Committee
of the Harvard Medical School to examine the definition of brain
death. JAMA. 1968;205(6):337-­3 40.
10. Report of special Task Force. Guidelines for the determination of
brain death in children. American academy of pediatrics task force
on brain death in children. Pediatrics. 1987;80(2):298-­3 00.
11. Nakagawa TA, Ashwal S, Mathur M, Mysore M, Society of Critical
Care Medicine SoCCaSoNoAAoP, Child Neurology S. Clinical
report-­guidelines for the determination of brain death in infants
and children: an update of the 1987 task force recommendations.
Pediatrics. 2011;128(3):e720-­e740.
12. Iitaka K, Martin LW, Cox JA, McEnery PT, West CD. Transplantation
of cadaver kidneys from anencephalic donors. J Pediatr.
1978;93(2):216-­220.
|
13993046, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/petr.14486 by Pablo Lobos - CochraneArgentina , Wiley Online Library on [06/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
      7 of 9
13. Ohshima S, Ono Y, Kinukawa T, Matsuura O, Tsuzuki K, Itoh S.
Kidney transplantation from an anencephalic baby: a case report.
J Urol. 1984;132(3):546-­547.
14. Shapira Z, Yussim A, Savir A, et al. The use of the portal system for
the transplantation of a neonate kidney graft in a child with Wilms'
tumor. J Pediatr Surg. 1985;20(5):549-­551.
15. Gutierrez Calzada JL, Martinez JL, Baena V, et al. En bloc kidney
and bladder transplantation from an anencephalic donor into an
adult recipient. J Urol. 1987;138(1):125-­126.
16. Zaner RM. Anencephalics as organ donors. J Med Philos.
1989;14(1):61-­78.
17. Van Assche FA. Anencephalics as organ donors. Am J Obstet
Gynecol. 1990;163(2):599-­600.
18. Botkin JR. Anencephalic infants as organ donors. Pediatrics.
1988;82(2):250-­256.
19. Walters JW. Anencephalic infants as organ sources. Bioethics.
1991;5(4):326-­3 41.
20. Caplan AL. Should foetuses or infants be utilized as organ donors?
Bioethics. 1987;1(2):119-­140.
21. Walters JW, Ashwal S. Organ prolongation in anencephalic infants:
ethical & medical issues. Hastings Cent Rep. 1988;18(5):19-­27.
22. Cefalo RC, Engelhardt HT Jr. The use of fetal and anencephalic
tissue for transplantation. J Med Philos. 1989;14(1):25-­4 3.
23. Cutter MA. Moral pluralism and the use of anencephalic tissue and
organs. J Med Philos. 1989;14(1):89-­95.
24. Shewmon DA, Capron AM, Peacock WJ, Schulman BL. The
use of anencephalic infants as organ sources. A critique. JAMA.
1989;261(12):1773-­1781.
25. Beller FK, Reeve J. Brain life and brain death-­-­the anencephalic as
an explanatory example. A contribution to transplantation. J Med
Philos. 1989;14(1):5-­23.
26. Diaz JH. The anencephalic organ donor: a challenge to existing
moral and statutory laws. Crit Care Med. 1993;21(11):1781-­1786.
27. Truog RD, Fletcher JC. Brain death and the anencephalic newborn.
Bioethics. 1990;4(3):199-­215.
28. Kimura R. Anencephalic organ donation: a Japanese case. J Med
Philos. 1989;14(1):97-­102.
29. Arras JD, Shinnar S. Anencephalic newborns as organ donors: a
critique. JAMA. 1988;259(15):2284-­2285.
30. Fost N. Organs from anencephalic infants: an idea whose time has
not yet come. Hastings Cent Rep. 1988;18(5):5-­10.
31. Walters JW, Ashwal S. Anencephalic infants as organ donors and
the brain death standard. J Med Philos. 1989;14(1):79-­87.
32. Annas GJ. From Canada with love: anencephalic newborns as
organ donors? Hastings Cent Rep. 1987;17(6):36-­38.
33. Erlen JA. Anencephalic infants as sources of organs. Issues
and implications for nurses. J Obstet Gynecol Neonatal Nurs.
1990;19(3):249-­254.
34. Anencephalic infants as sources of transplantable organs by the
Ethics and Social Impact Committee, Transplant Policy Center,
Ann Arbor, MI. Hastings Cent Rep. 1988;18(5):28-­3 0.
35. Davis A. The status of anencephalic babies: should their bodies be
used as donor banks? J Med Ethics. 1988;14(3):150-­153.
36. Snyder RD, Fakadej AF, Riggs JE. Anencephaly in the United
States, 1968–­1987: the declining incidence among white infants.
J Child Neurol. 1991;6(4):304-­3 05.
37. Walters J, Ashwal S, Masek T. Anencephaly: where do we now
stand? Semin Neurol. 1997;17(3):249-­255.
38. Shewmon DA. Anencephaly: selected medical aspects. Hastings
Cent Rep. 1988;18(5):11-­19.
39. McAbee G, Sherman J, Canas JA, Boxer H. Prolonged survival of
two anencephalic infants. Am J Perinatol. 1993;10(2):175-­177.
40. Stuart AG, Wren C, Sharples PM, Hunter S, Hey EN. Hypoplastic
left heart syndrome: more potential transplant recipients than
suitable donors. Lancet. 1991;337(8747):957-­959.
 |
8 of 9       BLUHME et al.
41. West LJ. Neonatal tolerance: applicability to solid organ transplan-
tation. Curr Opin Organ Transplant. 2016;21(1):66-­73.
42. West LJ, Karamlou T, Dipchand AI, Pollock-­BarZiv SM, Coles JG,
McCrindle BW. Impact on outcomes after listing and transplan-
tation, of a strategy to accept ABO blood group-­incompatible
donor hearts for neonates and infants. J Thorac Cardiovasc Surg.
2006;131(2):455-­461.
43. West LJ, Pollock-­Barziv SM, Dipchand AI, et al. ABO-­incompatible
heart transplantation in infants. N Engl J Med. 2001;344(11):793-­800.
44. Urschel S, Campbell PM, Meyer SR, et al. Absence of donor-­
specific anti-­HLA antibodies after ABO-­incompatible heart trans-
plantation in infancy: altered immunity or age? Am J Transplant.
2010;10(1):149-­156.
45. Gambino A, Torregrossa G, Cozzi E, et al. ABO-­incompatible heart
transplantation: crossing the immunological barrier. J Cardiovasc
Med. 2008;9(8):854-­857.
46. Roche SL, Burch M, O'Sullivan J, et al. Multicenter experience
of ABO-­incompatible pediatric cardiac transplantation. Am J
Transplant. 2008;8(1):208-­215.
47. Saczkowski R, Dacey C, Bernier PL. Does ABO-­incompatible and
ABO-­compatible neonatal heart transplant have equivalent sur-
vival? Interact Cardiovasc Thorac Surg. 2010;10(6):1026-­1033.
48. Ahmad MU, Farrell RM, Weise KL. Neonatal organ donation:
ethical insights and policy implications. J Neonatal Perinatal Med.
2019;12(4):369-­377.
49. Darlington AS, Long-­Sutehall T, Randall D, Wakefield C, Robinson
V, Brierley J. Parents' experiences of requests for organ and tissue
donation: the value of asking. Arch Dis Child. 2019;104(9):837-­8 43.
50. Mendes J, Wool J, Wool C. Ethical considerations in perinatal pal-
liative care. J Obstet Gynecol Neonatal Nurs. 2017;46(3):367-­377.
51. Masuhr F, Dame C, Gratopp A, Hoffmann O. New challenges: di-
agnosis of brain death in newborn, children and adolescents. Klin
Padiatr. 2018;230(2):88-­96.
52. Mata-­Zubillaga D, Oulego-­Erroz I. Persistent cerebral blood flow
by transcranial Doppler ultrasonography in an asphyxiated new-
born meeting brain death diagnosis: case report and review of the
literature. J Perinatol. 2012;32(6):473-­475.
53. Bokisa AE, Bonachea EM, Jadcherla SR. Death by neurologic
criteria in a neonate: implications for organ donation. J Neonatal
Perinatal Med. 2015;8(3):263-­267.
54. Anderson M, Youngner S, Smith RD, et al. Neonatal organ and
tissue donation for research: options following death by natural
causes. Cell Tissue Bank. 2020;21(2):289-­3 02.
55. Sturner WQ. Can baby organs be donated in all forensic cases?
Proposed guidelines for organ donation from infants under
medical examiner jurisdiction. Am J Forensic Med Pathol.
1995;16(3):215-­218.
56. Khong TY, Tanner AR. Foetal and neonatal autopsy rates and
use of tissue for research: the influence of 'organ retention'
controversy and new consent process. J Paediatr Child Health.
2006;42(6):366-­369.
57. Weiss MJ, Hornby L, Rochwerg B, et al. Canadian guidelines for con-
trolled pediatric donation after circulatory determination of death-­
summary report. Pediatr Crit Care Med. 2017;18(11):1035-­1046.
58. Catlin A, Carter B. Creation of a neonatal end-­of-­life palliative care
protocol. J Perinatol. 2002;22(3):184-­195.
59. Vileito A, Siebelink MJ, Vermeulen KM, Verhagen AAE. Lack of
knowledge and experience highlights the need for a clear paedi-
atric organ and tissue donation protocol in The Netherlands. Acta
Paediatr. 2020;109(11):2402-­2408.
60. Martin DE, Nakagawa TA, Siebelink MJ, et al. Pediatric deceased
donation-­ a report of the transplantation society meeting in
Geneva. Transplantation. 2015;99(7):1403-­1409.
61. Ibars EP, Cortes M, Tolosa L, et al. Hepatocyte transplantation pro-
gram: lessons learned and future strategies. World J Gastroenterol.
2016;22(2):874-­886.
13993046, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/petr.14486 by Pablo Lobos - CochraneArgentina , Wiley Online Library on [06/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
62. Pareja E, Gómez-­Lechón MJ, Tolosa L. Alternative cell sources
to adult hepatocytes for hepatic cell therapy. Methods Mol Biol.
2017;1506:17-­42.
63. Bailey LL. Origins of neonatal heart transplantation: an historical
perspective. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu.
2011;14(1):98-­100.
64. Zales VR, Stapleton PL. Neonatal and infant heart transplantation.
Pediatr Clin North Am. 1993;40(5):1023-­1046.
65. Weiss MJ, Hornby L, Witteman W, Shemie SD. Pediatric donation
after circulatory determination of death: a scoping review. Pediatr
Crit Care Med. 2016;17(3):e87-­e108.
66. Bennett EE, Sweney J, Aguayo C, Myrick C, Antommaria AH,
Bratton SL. Pediatric organ donation potential at a Children's hos-
pital. Pediatr Crit Care Med. 2015;16(9):814-­820.
67. Saha S, Kent AL. Length of time from extubation to cardiorespi-
ratory death in neonatal intensive care patients and assessment
of suitability for organ donation. Arch Dis Child Fetal Neonatal Ed.
2014;99(1):F59-­F63.
68. Pregernig A, Karam O. Potential pediatric organ donors after car-
diac death. Transplant Proc. 2016;48(8):2588-­2591.
69. Charles E, Scales A, Brierley J. The potential for neonatal organ
donation in a children's hospital. Arch Dis Child Fetal Neonatal Ed.
2014;99(3):F225-­F229.
70. Labrecque M, Parad R, Gupta M, Hansen A. Donation after cardiac
death: the potential contribution of an infant organ donor popula-
tion. J Pediatr. 2011;158(1):31-­36.
71. Mathur M, Castleberry D, Job L. Identifying potential heart donors
among newborns undergoing circulatory determination of death. J
Heart Lung Transplant. 2011;30(4):389-­394.
72. Hanley H, Kim S, Willey E, Castleberry D, Mathur M. Identifying
potential kidney donors among newborns undergoing circulatory
determination of death. Pediatrics. 2014;133(1):e82-­e87.
73. Stiers J, Aguayo C, Siatta A, Presson AP, Perez R, DiGeronimo
R. Potential and actual neonatal organ and tissue dona-
tion after circulatory determination of death. JAMA Pediatr.
2015;169(7):639-­6 45.
74. Boucek MM, Kanakriyeh MS, Mathis CM, Trimm RF III, Bailey
LL. Cardiac transplantation in infancy: donors and recipients.
Loma Linda University pediatric heart transplant group. J Pediatr.
1990;116(2):171-­176.
75. Parisi F, Squitieri C, Carotti A, Di Carlo D, Gagliardi MG. Heart
transplantation on the first day of life from an anencephalic donor.
Pediatr Transplant. 1999;3(2):150-­151.
76. Blitzer D, Yedlicka G, Manghelli J, Dentel J, Caldwell R, Brown JW.
Twin-­to-­t win heart transplantation: a unique event with a 25-­year
follow-­up. Ann Thorac Surg. 2017;103(4):e341-­e342.
77. Boucek MM, Mashburn C, Dunn SM, et al. Pediatric heart trans-
plantation after declaration of cardiocirculatory death. N Engl J
Med. 2008;359(7):709-­714.
78. Troppmann C, Santhanakrishnan C, Fananapazir G, Troppmann K,
Perez R. Pediatric en bloc kidney transplantation from very small
(≤10 kg) donation after circulatory death (versus brain death) do-
nors: single-­center matched-­pair analysis of 130 transplants. Am J
Transplant. 2018;18(11):2811-­2817.
79. Fananapazir G, Tse G, Corwin MT, et al. Pediatric En bloc
kidney transplants: clinical and immediate postoperative
US factors associated with vascular thrombosis. Radiology.
2016;279(3):935-­942.
80. Troppmann C, Santhanakrishnan C, Fananapazir G, Sageshima
J, Troppmann KM, Perez RV. Short-­ and Long-­term outcomes of
kidney transplants from very small (≤15 kg) pediatric donors with
acute kidney injury. Transplantation. 2021;105(2):430-­435.
81. Wijetunga I, Ecuyer C, Martinez-­Lopez S, et al. Renal transplant
from infant and neonatal donors is a feasible option for the treat-
ment of end-­stage renal disease but is associated with increased
early graft loss. Am J Transplant. 2018;18(11):2679-­2688.

BLUHME et al.
82. Martinez-­Lopez S, Wijetunga I, Ecuyer C, Ahmad N. Bilateral ad-
renal hemorrhage in a neonatal kidney donor. Pediatr Transplant.
2018;22(4):e13173.
83. Dai H, Peng L, Peng F, et al. A novel technique for en bloc kid-
ney transplantation from infant donors with extremely low body
weight by using the distal abdominal aorta as an outflow tract. Am
J Transplant. 2018;18(9):2200-­2207.
84. Mitrou N, Aquil S, Dion M, McAlister V, Sener A, Luke PP.
Transplantation of pediatric renal allografts from donors less than
10 kg. Am J Transplant. 2018;18:2689-­2694.
85. Yokoyama I, Tzakis AG, Imventarza O, et al. Pediatric liver trans-
plantation from neonatal donors. Transpl Int. 1992;5(4):205-­208.
86. Gao W, Song Z, Ma N, et al. Utility of neonatal donors in pedi-
atric liver transplantation: a single-­ center experience. Pediatr
Transplant. 2019;23(5):e13396.
87. Song Z, Ma N, Dong C, et al. Feasibility and safety of using low-­
body-­weight donors in pediatric liver transplantation. J Pediatr
Surg. 2019;54(11):2382-­2386.
88. Ma N, Song Z, Dong C, et al. Risk factors of hepatic artery throm-
bosis in pediatric deceased donor liver transplantation. Pediatr
Surg Int. 2019;35(8):853-­859.
89. Meyburg J, Das AM, Hoerster F, et al. One liver for four children:
first clinical series of liver cell transplantation for severe neonatal
urea cycle defects. Transplantation. 2009;87(5):636-­6 41.
90. Beck BB, Habbig S, Dittrich K, et al. Liver cell transplanta-
tion in severe infantile oxalosis-­ a potential bridging procedure
to orthotopic liver transplantation? Nephrol Dialysis Transpl.
2012;27(7):2984-­2989.
91. Lee CA, Sinha S, Fitzpatrick E, Dhawan A. Hepatocyte transplan-
tation and advancements in alternative cell sources for liver-­based
regenerative medicine. J Mol Med. 2018;96(6):469-­481.
92. Tolosa L, Pareja-­Ibars E, Donato MT, et al. Neonatal livers: a source
for the isolation of good-­performing hepatocytes for cell trans-
plantation. Cell Transplant. 2014;23(10):1229-­1242.
|
13993046, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/petr.14486 by Pablo Lobos - CochraneArgentina , Wiley Online Library on [06/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
      9 of 9
93. Kato T, Romero R, Verzaro R, et al. Inclusion of entire pancreas in
the composite liver and intestinal graft in pediatric intestinal trans-
plantation. Pediatr Transp. 1999;3(3):210-­214.
94. Cauley RP, Suh MY, Kamin DS, et al. Multivisceral transplantation
using a 2.9 kg neonatal donor. Pediatr Transplant. 2012;16(8):E379
-­E382.
95. Jawoniyi O, Gormley K, McGleenan E, Noble HR. Organ do-
nation and transplantation: awareness and roles of health-
care professionals-­ a systematic literature review. J Clin Nurs.
2018;27(5–­6):e726-­e738.
96. Smits JM, Thul J, De Pauw M, et al. Pediatric heart allocation and
transplantation in eurotransplant. Transpl Int. 2014;27(9):917-­925.
97. D'Addese L, Joong A, Burch M, Pahl E. Pediatric heart transplanta-
tion in the current era. Curr Opin Pediatr. 2019;31(5):583-­591.
98. Bekker J, Ploem S, de Jong KP. Early hepatic artery thrombosis
after liver transplantation: a systematic review of the incidence,
outcome and risk factors. Am J Transplant. 2009;9(4):746-­757.
99. Nguyen NT, Harring TR, Liu H, Goss JA, O'Mahony CA.
Transplanting whole livers from donors less than 6 kilograms–­is it
prudent? J Surg Res. 2012;177(2):348-­358.
100. Bluhme E, Henckel E, Gramignoli R, et al. Procurement and evalua-
tion of hepatocytes for transplantation from neonatal donors after
circulatory death. Cell Transplant. 2022;31:9636897211069900.
How to cite this article: Bluhme E, Henckel E, Jorns C.
Potential of neonatal organ donation and outcome after
transplantation. Pediatric Transplantation. 2023;00:e14486.
doi:10.1111/petr.14486