While some countries – like Britain and America – carry out a few transplants each year using kidneys from babies who died during or soon after birth, increasing the practice is difficult, say doctors, because it’s such a difficult topic to broach with bereaved parents.
However, at the European Society for Organ Transplantation Congress in Greece last week, there was agreement that “this very rare and valuable resource could be used to save lives” according to Dai Nghiem from Allegheny General Hospital in Pennsylvania.
Although newborn babies’ kidneys are smaller than those of an adult, they grow quickly when put into a child or adult, reports New Scientist.
Due to their small size, the kidneys are removed as a pair and transplanted into a recipient – beside 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. Thousands of people worldwide die every 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 their injuries are unsurvivable.
Babies who die because they were deprived of oxygen during childbirth could fit into this category, as could foetuses diagnosed during pregnancy with severe congenital conditions, meaning they won’t survive for long after birth, Nghiem said.
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, and it’s “especially tough” if the donor is so young.
In the UK, some hospitals consider asking parents for permission in these circumstances, but it happens only rarely, said Gavin Pettigrew at the University of Cambridge.
Pettigrew was part of a surgical team involved in one such kidney transplant several years ago, when a foetus 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 must be removed, said 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.
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% functioning after 12 months. The equivalent figure for kidneys taken from adult donors is about 95%.
See more from MedicalBrief archives
First successful newborn transplant in UK
‘Dead’ heart transplant technique found suitable also for use with children
Less-than-perfect kidneys can be successfully used for transplants
Discarded kidneys more viable than thought