Timing and mode of death and impact of starting organ donation in a pediatric intensive care unit: 2016-2024 in Japan.

BACKGROUND

There are very few descriptions of end-of-life (EOL) practices from pediatric intensive care units in Japan. Our objective is to describe the mode and timing of death and EOL practices in a tertiary care PICU in Japan.

METHODS

This is a retrospective observational study using data from February 2016 to April 2024. Organ donation started locally in 2020. The patients who died in the PICU and were younger than 18 years were included. The mode of death was determined through independent chart review by 2 reviewers. Patient demographic data, care intensity within 24 h before death, length of ICU stay, and interval between consensus on EOL care and death were recorded. Comparisons between before and after starting organ donation were performed.

RESULTS

In total, 77 pediatric deaths were included, and their modes of death were as follows: 48 (62%) cases of limitation of life-sustaining therapy, 11 (14%) of withdrawal of life-sustaining therapy, 12 (16%) of maximal support, and 6 (8%) of DNC. Mechanical ventilation was withdrawn in 82% (9/11) of the withdrawal group. The median and IQR of the interval between EOL consensus and death in our cohort were 12 (4, 23) days. The proportion of patients who died within 2 weeks after the EOL consensus was reached increased after organ donation program initiation (69% vs. 90%, p < 0.05).

CONCLUSIONS

Seventy-seven percent of modes of death were either limitation or withdrawal of life-sustaining therapies. More patients died within 2 weeks after the EOL consensus increased after the organ donation program initiation.