Ancillary Testing in Pediatric Death by Neurologic Criteria and Associations With Organ Donation

Monday, March 23, 2026

2:30 PM - 3:30 PM Central Time

Location: Connections Central - RST 15

RO

Rob Ohman, MD, MPH

University of Washington

Disclosure(s): No relevant financial relationship(s) to disclose.
DK

Daniel Kim, MD, MA

PCCM/Palliative Care
Seattle Children's Hospital

Disclosure information not submitted.
Elizabeth Y. Killien, MD, MPH

Seattle Children's Hospital, Washington

Disclosure(s): No relevant financial relationship(s) to disclose.
IB

Ian Bost, BA

Analyst
LifeCenter Northwest

Disclosure information not submitted.
EB

Emily Berkman, MD, MA (she/her/hers)

Washington

Disclosure information not submitted.
AL

Abhijit Lele, MBBS, MD, MSCR, FNCS, CPHQ

Neurocritical Care Physician
University of Washington

Disclosure information not submitted.
JC

Jonna Clark, MD, MA

Associate Professor
University of Washington

Disclosure information not submitted.

Introduction: Death by neurologic criteria (DNC) guidelines for pediatric patients have evolved over time, and recommend ancillary tests when potential confounders limit clinical assessment. Ancillary testing is completed in 28% of adult DNC cases, with an additional 6% requested by the organ procurement organization (OPO). Because pediatric DNC is a rare occurrence, we hypothesized that ancillary testing would be more frequent than in adults and more prevalent in patients who become organ donors.

Methods: We conducted a retrospective study of pediatric referrals to a regional OPO from 2016-2022. Patient and hospital data, brain death exams, and case notes documenting communication between the OPO coordinator, medical advisors, and healthcare teams were reviewed to identify ancillary test utilization and indications. Chi-squared analyses and logistic regressions were generated using Stata.

Results: Among 215 DNC cases, 91 (42%) cases used ancillary testing, including 62/135 donors (46%) and 29/80 non-donors (36%) (p=0.17). The OPO medical advisor requested ancillary testing in 6%. Nuclear cerebral perfusion imaging was used as an ancillary test in 73%, EEG in 23%, and 8% had both studies. Indications for ancillary testing included limitations in meeting laboratory or clinical prerequisites (18%), incomplete clinical examinations (26%), incomplete apnea testing (41%), shortened testing interval (4%), or family requests (5%). Ancillary testing occurred more frequently in non-children’s hospitals with dedicated pediatric units (45%; OR 2.04, 95% CI 1.0-4.1) and without pediatric units (75%; OR 7.5, 95% CI 1.3-41.7) relative to children’s hospitals (29%). It was not significantly associated with other hospital factors (trauma level, number of pediatric beds, annual rate of DNC cases, presence of a PICU) or patient characteristics (age, sex, region, race and ethnicity, mechanism of injury, or time to testing).

Conclusions: Use of ancillary testing in pediatric DNC occurred more frequently than in an adult cohort from the same region, and frequency of testing varied based on facility characteristics. A higher percentage of organ donors underwent ancillary testing, but did not reach a threshold of significance in this cohort. Further exploration of the drivers of ancillary testing in pediatric DNC is warranted.