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Paeds Casespain-palliative-and-end-of-life-care

Paeds Cases · pain-palliative-and-end-of-life-care

Hold the goals-of-care conversation for organ and tissue donation in children — OSCE

OSCE communication station for organ and tissue donation in children: open the conversation, explore understanding, make a clear recommendation, address fear of abandonment, and agree a documented plan.

osce communication and shared decision-making
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Target exams

MRCPCH ClinicalRACP DCERCPSC Pediatrics

Target exams

MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
A five-year-old sustains catastrophic traumatic brain injury. After optimisation, clinical examination suggests neurological death. The parents ask whether their child can help other children.

Candidate brief

You have eight minutes to open a goals-of-care conversation with the family in this scenario. Explore their understanding, hopes and worries; explain the clinical recommendation in plain language; address fear of abandonment; and agree next steps including documentation and support. [1][2]

Key teaching and communication objectives

Start with listening. Ask what the family already understands and what they are most afraid of. Name the clinical situation honestly without jargon. Make a clear recommendation grounded in the child's best interests rather than asking the parents to choose from an unsupported menu. [1]

Explain that limiting non-beneficial life support is not the same as stopping care. Symptom control, presence and dignity intensify. Invite questions, allow silence, and check back for understanding. If disagreement remains, explain second opinion and ethics pathways without threatening abandonment. [1][2]

Close with a concrete plan: who will do what by when, which treatments continue, which are limited, how symptoms will be treated, how siblings will be supported, and when you will meet again. [2]

Marking domains

Suggested marking domains (formative)
  1. Rapport and exploration of understanding
  2. Clear best-interests recommendation
  3. Distinction between limiting life support and withdrawing care
  4. Shared plan and documentation
  5. Family and sibling support / escalation if disagreement
[1]

References

  1. [1]Moynihan KM et al. Epidemiology of childhood death in Australian and New Zealand intensive care units. Intensive Care Med, 2019.PMID 31270578
  2. [2]Dopson S et al. Exploring nurses' knowledge, attitudes and feelings towards organ and tissue donation after circulatory death within the paediatric intensive care setting in the United Kingdom: A qualitative content analysis study. Intensive Crit Care Nurs, 2019.PMID 31350064
  3. [3]Lee LA et al. Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021-2022. Pediatr Crit Care Med, 2024.PMID 37966310
  4. [4]Kramer AH et al. Missed Organ Donation Opportunities in Patients With Devastating Brain Injury: A Prospective Population-Based Cohort Study. Crit Care Med, 2026.PMID 41269058