As a pediatrician, I am lucky not to have to consider death as frequently and closely as some of our adult medicine counterparts. As a cardiac intensive care doctor, I reflect every day on how far our field has come, with some conditions that used to be universally fatal now having excellent survival for many years, if not decades. I also have the privilege, a sad one but a privilege nonetheless, to care for patients and families for whom even the most advanced medications or procedures are not successful in saving their lives or getting them home. Finally, as a physician for children with advanced heart failure who need a life-saving heart transplant, I have the incredible honor to care for patients receiving the ultimate gift of life from a selfless family who chose to think about someone else during their darkest days.
So it is no surprise that as I read this article on pediatric organ donation and transplantation (10.1542/pir.2023-006307) in Pediatrics in Review, published in the first month of the new year 2025, I was overcome by many feelings and thoughts. Needless to say, the authors had my attention at the title. Reading on, I was impressed with the call for partnership to the general pediatric community, inviting every pediatrician to join this discussion about new life from the times of death, encouraging and empowering every pediatrician to be an advocate for organ transplantation as well as a support for their patient who might be at either end of that process.
To be perfectly honest, my first emotion was one of surprise—as a pediatric resident I did not remember ever being engaged or involved in a family discussion about transplant or organ donation. And in my current role, I often catch myself thinking, “Well, that’s the transplant team’s job,” or “That’s the organ procurement organization’s job.” But this article didn’t just educate and inform me, it also encouraged me to consider lowering some of those walls that silos of subspecialization have created. Who better to encourage a family toward organ donation than their trusted pediatrician of years? But then, enabling those conversations need not just education but also training and practice. Perhaps this could be a new avenue for simulation, practicing these types of uniquely difficult conversations. Similarly, who could be in a better position to have a compassionate discussion about end-of-life care than a provider the family has known for such a long time? Once again, I will be the first one to admit that is not an angle I have often thought of in the intensive care unit. I remember calling pediatricians from the emergency room when we would admit their patient to the pediatric hospital medicine service. Perhaps there is a role for similar engagement in the times of crisis when we have a critically ill child in the intensive care unit who we are concerned will not survive this admission. But again, as intensive care physicians, we get training to carry out these conversations, sometime needed in families we have known for a matter of hours. But perhaps there is a role for partnership with a more friendly and familiar face? Finally, a child who undergoes a heart transplant is the recipient of a wondrous gift, but one with many strings attached and an uncertain expiry date. The pediatric providers for that child can be invaluable partners, not just in monitoring for clinical symptoms but also for supporting the mental health challenges that come with the process, as well as the end of life care that might be the next phase of palliation when the transplant graft starts to fail.
Truly, beyond the pearls of knowledge discussed in the paper, the possibilities of communication, collaboration, and community engagement that were proposed are incredible food for thought for all of us. As we embark on the new year, perhaps there is no better time to build bigger tables with more communication and further leverage the strengths of our healthcare teams.
