There are not many things in pediatrics more horrific than a child dying at the hands of a caregiver. Most physicians, let alone those in the legal or lay community, cannot fathom that such events occur. However we see fatal child abuse far too often. When the tragic does happen, organ donation is one way for families and medical professionals to make some sense out of a senseless event. Another child, or even children, are given new life with the donation of organs.
Unfortunately, this selfless act of organ donation can become a nightmare as a result of the actions of well-meaning, but misguided, investigators and prosecutors. I have witnessed the impact on a family, and even on the medical staff, as a county attorney refused to allow donation because he feared it would compromise his case. This month’s Ethics Rounds in Pediatrics(10.1542/peds.2020-0662), reports the death of an infant that ultimately required intervention from the state legislature to allow a parent’s wish for organ donation. The literature is clear that there have been no reports of organ donation affecting the prosecution of a child abuse case. Additionally, the National Association of Medical Examiners, an organization which is very conservative in its actions to preserve evidence for prosecution, clearly supports organ donation in fatal child abuse cases.
Fortunately, my community in Omaha has made significant changes over the past decade and other jurisdictions could learn from the collaboration that this and other jurisdictions have followed. Our local organ procurement organization (OPO), pathologist and coroner (who is the county attorney) came together to better work on cases of fatal child abuse. Currently, these entities are co-located at the same facility. In cases of fatal abuse, the pathologist can be present at the time of organ retrieval to attest that the organs were uninjured. In addition, the OPO is able to provide documentation that the transplanted organs are functioning well after transplant.
The case of the tragic death of John, as described in this article, highlights the need for continued proactive discussions surrounding organ donation in fatal child abuse cases. It is important to bring the medical team, investigators, prosecutors, and the medical examiner/coroner to the table ahead of time to discuss and have a plan in place and prevent further trauma to everyone involved. Now if we can only find a way to prevent these deaths from ever occurring…
