Objectives Shortage of size-matched organs and of tissues is the key factor limiting transplantation in children. Empirical data on the procurement process in children is sparse. This study aimed to gain insight into the recognition of potential pediatric donors in the Netherlands and the procurement process.

Methods A national retrospective cohort study in the Dutch pediatric intensive care units. The records of 683 deceased children were analyzed by two independent donation experts and procurement process data were compared with the national protocol.

Results From 2003 thru 2006, 74 (11%) of the deceased children were found to have been suitable for organ donation and 132 (19%) for tissue donation. Sixty-two (84%) potential organ donors had been correctly identified; parental consent had been obtained and donation effectuated in 26/62 children (42%). Sixty-three potential tissue donors (53%) had been correctly identified; parental consent had been obtained and donation effectuated in 17/63 children (27%).

Conclusion Recognition of pediatric organ donors by medical professionals is acceptable; recognition of tissue donors may be improved. Efforts to address the shortage of organs and tissues for transplantation in children should focus on the gap between recognition of donors and parental consent. We suggest such studies should not only assess the process itself, i.e. the competencies of the professional staff (micro-level) but also the influence of legislation, societal views on donation by children, and the potential relevance of children’s views on donation (macro-level).