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Pediatr Transplant. 2019 Feb 7:e13373. doi: 10.1111/petr.13373. [Epub ahead of print]

Communication about prognosis and end-of-life in pediatric organ failure and transplantation.

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Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan.
University of Michigan Transplant Center, Ann Arbor, Michigan.
Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.



Despite advancements in treatment and survival, pediatric organ failure and transplant populations continue to face significant risks of morbidity and mortality. Little scientific attention has been given to addressing the end-of-life care needs of this growing population of young people. This study characterized current practices, beliefs, and challenges specific to the disclosure of prognosis and end-of-life care topics among providers caring for pediatric organ failure and transplant populations.


This cross-sectional study included 144 healthcare providers actively caring for children, adolescents, and young adults with organ failure or solid organ transplant history. Participants completed an electronic survey measuring frequency and comfort in discussing the following topics with patients and parents: prognosis/survival statistics, re-transplantation, advance care planning (ACP), and death/dying. Descriptive statistics, two-sample t tests, and analysis of variance were used.


Fewer than half of respondents regularly discuss prognosis/survival statistics and potential need for re-transplantation with their pediatric and young adult patients. Less than 20% of providers engage their pediatric patients in ACP discussions, and approximately 30% facilitate such discussions with young adult patients. Pediatric organ failure and transplant providers endorse a number of barriers specific to discussing these topics.


Pediatric organ failure and transplant providers do not regularly discuss prognosis or end-of-life care topics with this patient population. Communication-focused intervention research is needed to improve honest and compassionate discussion of these topics that is aligned with both patients' and parents' needs and preferences.


advance care planning; communication; end-of-life; pediatric; solid organ transplant


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