Downloaded from http://fn.bmj.com/ on November 17, 2015 - Published by group.bmj.com
PostScript REFERENCES 1
2
3
4
El-Khuffash AF, McNamara PJ. Neonatologistperformed functional echocardiography in the neonatal intensive care unit. Semin Fetal Neonatal Med 2011;16:50–60. American Academy of P, Committee on F, Newborn, Canadian Paediatric S, Fetus, Newborn C. Prevention and management of pain in the neonate: An update. Adv Neonatal Care J 2007;7:151–60. Holsti L, Grunau RE, Oberlander TF, et al. Is it painful or not? Discriminant validity of the Behavioral Indicators of Infant Pain (BIIP) scale. Clin J Pain 2008;24:83–8. Slater R, Cornelissen L, Fabrizi L, et al. Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial. Lancet 2010;376:1225–32.
CORRESPONDENCE
Fetal and neonatal organ transplantation I was delighted to read the letter from Atreja and Godambe,1 leading on from the review by Wright and Barlow.2 While there are undoubted ethical considerations,3 this reported development provides hope in the UK to parents in two invidious positions. In the first, fetologists regularly counsel couples where an isolated prenatally diagnosed anomaly indicates that their baby would not be expected to survive. An example, at the severe end of this spectrum, would be isolated anencephaly, where the pregnancy may continue to term unless intervention is chosen. While
Arch Dis Child Fetal Neonatal Ed July 2015 Vol 100 No 4
many couples elect to terminate the pregnancy without delay in these situations, a certain number, for personal or faith reasons, will continue the pregnancy. It is not uncommon in my personal experience of the latter scenario, for parents to ask whether they could offer organs for donation, should the baby be born alive, but eventually succumb to the anomaly. Until now, this option did not appear to be available in the UK. Given that the usual timing of these diagnoses is around 4 months before delivery, there is the potential opportunity to allow appropriate counselling and the logistics of recipient selection before possible transplantation. In the second situation, an isolated single solid organ anomaly may be either diagnosed prenatally by imaging or anticipated by other prenatal diagnostic means —for example, a genetic defect affecting a single organ. This scenario is less common. An example would be isolated renal insufficiency. Where there is a high risk of a single organ insufficiency, parents may choose to terminate the pregnancy, rather than risk subjecting a baby to prolonged invasive treatment and the uncertainty of delayed transplantation from an adult donor. The option of neonatal transplantation could transform this prenatal conversation. Until now, this has been a theoretical discussion,4 5 but the team at the Hammersmith Hospital has changed that.
Alastair McKelvey Correspondence to Dr Alastair McKelvey, Department of Fetal Medicine, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY, UK; [email protected] Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
To cite McKelvey A. Arch Dis Child Fetal Neonatal Ed 2015;100:F375. Accepted 10 February 2015 Published Online First 19 March 2015 Arch Dis Child Fetal Neonatal Ed 2015;100:F375. doi:10.1136/archdischild-2015-308287
REFERENCES 1
2
3
4
5
Atreja G, Godambe S. First neonatal organ donation in the UK. Arch Dis Child Fetal Neonatal Ed 2015; 100:F276–7. Wright JCE, Barlow AD. The current status of neonatal organ donation in the UK. Arch Dis Child Fetal Neonatal Ed 2015;100:F6–7. Critical care decisions in fetal and neonatal medicine: ethical issues. The Nuffield Council on Bioethics, 2006. Brierley J. Current status of potential organ donation in cases of lethal fetal anomaly. Obstet Gynaecol 2013;15:184–8. McKelvey A. Current status of potential organ donation in cases of lethal fetal anomaly. Obstet Gynaecol 2014;16:68.
F375
Downloaded from http://fn.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Fetal and neonatal organ transplantation Alastair McKelvey Arch Dis Child Fetal Neonatal Ed 2015 100: F375 originally published online March 19, 2015
doi: 10.1136/archdischild-2015-308287 Updated information and services can be found at: http://fn.bmj.com/content/100/4/F375
These include:
References Email alerting service
This article cites 4 articles, 2 of which you can access for free at: http://fn.bmj.com/content/100/4/F375#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
PostScript REFERENCES 1
2
3
4
El-Khuffash AF, McNamara PJ. Neonatologistperformed functional echocardiography in the neonatal intensive care unit. Semin Fetal Neonatal Med 2011;16:50–60. American Academy of P, Committee on F, Newborn, Canadian Paediatric S, Fetus, Newborn C. Prevention and management of pain in the neonate: An update. Adv Neonatal Care J 2007;7:151–60. Holsti L, Grunau RE, Oberlander TF, et al. Is it painful or not? Discriminant validity of the Behavioral Indicators of Infant Pain (BIIP) scale. Clin J Pain 2008;24:83–8. Slater R, Cornelissen L, Fabrizi L, et al. Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial. Lancet 2010;376:1225–32.
CORRESPONDENCE
Fetal and neonatal organ transplantation I was delighted to read the letter from Atreja and Godambe,1 leading on from the review by Wright and Barlow.2 While there are undoubted ethical considerations,3 this reported development provides hope in the UK to parents in two invidious positions. In the first, fetologists regularly counsel couples where an isolated prenatally diagnosed anomaly indicates that their baby would not be expected to survive. An example, at the severe end of this spectrum, would be isolated anencephaly, where the pregnancy may continue to term unless intervention is chosen. While
Arch Dis Child Fetal Neonatal Ed July 2015 Vol 100 No 4
many couples elect to terminate the pregnancy without delay in these situations, a certain number, for personal or faith reasons, will continue the pregnancy. It is not uncommon in my personal experience of the latter scenario, for parents to ask whether they could offer organs for donation, should the baby be born alive, but eventually succumb to the anomaly. Until now, this option did not appear to be available in the UK. Given that the usual timing of these diagnoses is around 4 months before delivery, there is the potential opportunity to allow appropriate counselling and the logistics of recipient selection before possible transplantation. In the second situation, an isolated single solid organ anomaly may be either diagnosed prenatally by imaging or anticipated by other prenatal diagnostic means —for example, a genetic defect affecting a single organ. This scenario is less common. An example would be isolated renal insufficiency. Where there is a high risk of a single organ insufficiency, parents may choose to terminate the pregnancy, rather than risk subjecting a baby to prolonged invasive treatment and the uncertainty of delayed transplantation from an adult donor. The option of neonatal transplantation could transform this prenatal conversation. Until now, this has been a theoretical discussion,4 5 but the team at the Hammersmith Hospital has changed that.
Alastair McKelvey Correspondence to Dr Alastair McKelvey, Department of Fetal Medicine, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY, UK; [email protected] Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
To cite McKelvey A. Arch Dis Child Fetal Neonatal Ed 2015;100:F375. Accepted 10 February 2015 Published Online First 19 March 2015 Arch Dis Child Fetal Neonatal Ed 2015;100:F375. doi:10.1136/archdischild-2015-308287
REFERENCES 1
2
3
4
5
Atreja G, Godambe S. First neonatal organ donation in the UK. Arch Dis Child Fetal Neonatal Ed 2015; 100:F276–7. Wright JCE, Barlow AD. The current status of neonatal organ donation in the UK. Arch Dis Child Fetal Neonatal Ed 2015;100:F6–7. Critical care decisions in fetal and neonatal medicine: ethical issues. The Nuffield Council on Bioethics, 2006. Brierley J. Current status of potential organ donation in cases of lethal fetal anomaly. Obstet Gynaecol 2013;15:184–8. McKelvey A. Current status of potential organ donation in cases of lethal fetal anomaly. Obstet Gynaecol 2014;16:68.
F375
Downloaded from http://fn.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Fetal and neonatal organ transplantation Alastair McKelvey Arch Dis Child Fetal Neonatal Ed 2015 100: F375 originally published online March 19, 2015
doi: 10.1136/archdischild-2015-308287 Updated information and services can be found at: http://fn.bmj.com/content/100/4/F375
These include:
References Email alerting service
This article cites 4 articles, 2 of which you can access for free at: http://fn.bmj.com/content/100/4/F375#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
