Access to organ donation in paediatric intensive care is shaped by end-of-life trajectories

Paediatric organ donation remains limited despite persistent needs for transplantation, partly due to the small number of potential donors and the complexity of end-of-life decision-making in children. In paediatric intensive care units (PICUs), most deaths occur following withholding or withdrawal of life-sustaining treatments (WWLST), whereas organ donation predominantly relies on death by neurologic criteria (DNC). This discrepancy suggests that end-of-life trajectories may play a central role in shaping access to organ donation. However, the extent to which these trajectories translate into actual or potential donation opportunities remains insufficiently quantified. We aimed to describe end-of-life trajectories in a tertiary PICU and assess their relationship with organ donation pathways.1–4