A New Frontier in Pediatric Palliative Care: Organ Donation at the End of Life

Background: Organ donation represents an underexplored field in pediatric palliative care (PPC). Although it may offer life-saving opportunities for recipients, it remains uncommon and particularly complex within PPC settings, where care is primarily focused on comfort, quality of life, and de-escalation of invasive interventions. Objective: To explore the main ethical and operational challenges and opportunities of integrating organ donation within PPC pathways. Methods: We present two clinical cases of patients requiring PPC in which organ donation after death was pursued. A qualitative approach was used, focusing on decision-making processes, communication with families, coordination between PPC and transplant teams, and organizational and ethical issues. Results: In both cases, the possibility of organ donation emerged during end-of-life care discussions, rather than as part of a pre-established pathway. While it was positively received and supported by parents, this had to be balanced with several practical and organizational constraints, including the alignment of PPC principles with transplant feasibility, particularly in relation to the lack of physiological monitoring and the need to prioritize comfort-focused care alongside organ preservation requirements. On-the-spot coordination between PPC and transplant teams was required, with varying degrees of timeliness and system readiness. Collaboration between teams allowed for adaptation of processes and improved communication with families. Conclusion: These experiences open new perspectives on the implementation of organ donation within PPC, highlighting the need for a more structured, multidisciplinary, and anticipatory approach. Early communication, shared decision-making, and integrated care pathways are essential to support families, preserve the child’s dignity, and optimize donation opportunities without compromising end-of-life care goals and PPC principles. Funding: This study received no specific funding.