The lifesaving processes of organ donation and transplantation in neonatology and pediatrics carry important ethical considerations. The medical community must balance the principles of autonomy, non-maleficence, beneficence, and justice to ensure the best interest of the potential donor and to provide equitable benefit to society. Accordingly, the US Organ Procurement and Transplantation Network (OPTN) has established procedures for the ethical allocation of organs depending on several donor-specific and recipient-specific factors. To maximize the availability of transplantable organs and opportunities for dying patients and families to donate, the US government has mandated that hospitals refer potential donors in a timely manner. Expedient investigation and diagnosis of brain death where applicable are also crucial, especially in neonates. Empowering trained individuals from organ procurement organizations to discuss organ donation with families has also increased rates of consent. Other efforts to increase organ supply include recovery from donors who die by circulatory criteria (DCDD) in addition to donation after brain death (DBD), and from neonates born with immediately lethal conditions such as anencephaly. Ethical offer no direct benefit to the donor, for example the consent process, procedures to preserve organ viability, and in some cases the timing and setting of withdrawal of support. Beneficence is the principle that people should do good. The medical community should give the potential donors and families the opportunity to donate because it may provide them comfort in knowing there is meaning or worth behind the death. Also, providing a potentially lifesaving organ for a recipient with end-stage organ failure is an act of beneficence. Justice is the fair and equitable allocation of resources in light of what is due to persons. One must consider whether persons dying on an organ transplant waiting list have the right to access organs of dying patients who will no longer use them.
These are prima facie principles in that each is binding unless it conflicts with another. For example, euthanasia and organ recovery has been performed on patients in whom the decision to withdraw support has been made (2). While we may maximize justice by providing organs to recipients who will benefit from them more than the dying patient, most in the medical community would believe that the maleficence inherent in killing a person would override that consideration. To consider the right course, practitioners must weigh all four principles of biomedical ethics, especially in pediatric and neonatal organ donation and transplantation