Editor,—A recent communication in theBMJ brought attention to the under utilisation of paediatric donors in the UK.1 At present, a potential organ donor is referred to the UK Transplant Service, and if under 18, is offered for transplant into a paediatric recipient at those centres with paediatric programmes. In the case of paediatric kidneys, if suitable paediatric recipients are not identified, then the kidneys are offered on to adult recipients. With small donors (under 4 years), the kidneys can be transplanted into adults, with best results obtained with en bloc transplants (two kidneys, aorta, and vena cava). The UK centres have been slow to develop the en bloc transplants and so far only 10 have been performed (six at our centre).

Perhaps, in consequence, the number of paediatric donors, particularly under the age of 2, whose organs are offered are considerably fewer than are seen in the United States, where 7% of donors are less than 5 years.2 This would suggest that the referral rate for paediatric donors in this country is below its full potential. As the results of transplanting organs from these small donors into adults is excellent,3 paediatricians should be encouraged to offer paediatric patients who are brain dead for donation. Parents often consider this as the only positive aspect of their child’s death.