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Pediatric donation after circulatory death (pDCD) is an established pathway for organ donation. It remains, however, a relatively rare event worldwide, and most clinicians outside of the pediatric intensive care unit (PICU) are unfamiliar with it. The goal of this review is to introduce the processes and concepts of pDCD. While most children die in circumstances that would not allow pDCD, many children that die after withdrawal of life sustaining therapy (WLST) may be eligible for donation of some organs. The potential benefits of this practice to patients on the wait list are well known, but donation can also be an opportunity to honor a patient's or family's desire to altruistically improve the lives of others. Offering the possibility of donation requires careful attention to ethical principles to ensure that conflicts of interest are avoided and that the family is free to make an independent, fully informed decision. Doing so allows families and decision makers the autonomy to decide if donation is something they wish to incorporate into end-of-life care.

The decision to donate organs and tissues has the potential to save and improve the quality of life of the transplant recipient. Previous studies suggest lack of information, fears, and prejudices have prevented some cultural minorities from participating in organ and tissue donation (OTD). There is scarce information about the views of those who might be approached for potential donation in the Haitian community. In fact, Haitians are the largest Black ethno-cultural community in Montreal and are at higher risk for needing a kidney transplant (DesiletsSodjinou, 2006).To learn what Haitians know and believe about OTD in order to enable registered nurses to develop culturally appropriate approaches and interventions.A qualitative descriptive design was used to explore the knowledge, beliefs, and attitudes toward OTD among the adult Haitian population in the Montreal area. Focus groups were held with 24 members of the Haitian community and moderated by Haitian registered nurses who spoke French and Creole.Group interviews were transcribed verbatim and analyzed for themes. Adult participants represented younger and older members of the community. They were from different socioeconomic backgrounds.Knowledge about donation was influenced by the media, personal beliefs and experience, and level of trust in the health care system. Participants' recommendations on how to address OTD issues within the Haitian community were shaped by beliefs about wholeness, perceived need for donation and key persons who could influence decision-making behaviour.The level of distrust with the health care system and the study consent process used with participants might have affected the degree of participation and disclosure in discussions.

In Canada, there is a growing gap between the number of organs donated each year and the number of organs needed for transplant. This gap is forcing health care professionals to re-examine end-of-life care and donation practices. In 2005, a national forum created recommendations for the development and implementation of donation after cardio-circulatory death programs. In this article, the authors outline the multifaceted approach needed for change in interdisciplinary clinical practice. Clinical nurse specialist leadership, ethics consultation, partnerships with key physician colleagues and administrators, as well as comprehensive workshops are described as essential for success. Lessons learned throughout are shared.