Kidneys for transplantation could come from babies who die at birth

Kidneys from babies who die during or soon after birth are being overlooked for transplantation into children and adults, as it is a difficult topic to broach with bereaved parents, according to doctors.

Such transplants are performed in some nations, including the UK and the US, but only a few times a year per country. There were calls for hospitals to make wider use of the practice at the European Society for Organ Transplantation Congress in Greece last week. “We have to recognise that this very rare and valuable resource could be used to save lives,” says Dai Nghiem at Allegheny General Hospital in Pittsburgh, Pennsylvania.

Although newborn babies’ kidneys are smaller than those of an adult, they grow quickly when put into a child or adult. Due to their small size, their kidneys are removed as a pair and transplanted into a recipient next to each other on one side of their body. With adult donors, normally only one kidney is transplanted, which is usually sufficient.

A pair of kidneys from a newborn baby usually grow big enough to do the work of one adult kidney within three months.

Kidneys are one of the most commonly transplanted organs and can save the lives of people with kidney failure, but there aren’t enough donor organs available for everyone who needs them, with thousands of people worldwide dying each year while on a waiting list.

This is because organ donation is only possible in a small subset of deaths, such as after a sudden stroke or severe physical injury that leaves someone in intensive care and when it becomes apparent that their injuries are unsurvivable.

Babies who die because they were deprived of oxygen during childbirth could fit into this category, as well as fetuses that are diagnosed during pregnancy with severe congenital conditions that mean they won’t survive for long after birth, says Nghiem.

Staff at most hospitals don’t approach parents in these circumstances to ask if they would consider organ donation because they think it would be too upsetting. While a family’s decision on organ donation can be difficult in any situation, it is “especially tough” if the donor is so young, says Nghiem.

In the UK, some hospitals do consider asking parents for permission in these circumstances, but it still happens only rarely, says Gavin Pettigrew at the University of Cambridge.

Pettigrew was a member of the surgical team involved in one such kidney transplant a few years ago, when a fetus was diagnosed before birth with anencephaly, where all or most of the brain is missing – a condition that is always fatal.

Another concern around neonatal kidney donation is whether the success rate is as good as receiving organs from adult donors.

Kidneys from babies tend to be more vulnerable to developing blood clots soon after the transplant, which can lead to such damage that the organs have to be removed, says Pettigrew. On the other hand, after that initial hurdle, the kidneys tend to perform well in the longer term because the baby’s organs are in such good condition, says Nghiem.

A small 2018 study found that transplants of pairs of kidneys taken either from babies or older children had about the same long-term success rate, with around 90 per cent functioning after 12 months. The equivalent figure for kidneys taken from adult donors is about 95 per cent.

Angie Scales at NHS Blood and Transplant, which manages UK organ transplant services says: “We have done a lot of work on neonatal donation in the UK and continue to work closely with neonatal units to offer the chance of organ donation whenever the situation arises.”