Fewer German Children Meet Neurologic Criteria for Death, PICU Network Data Show

Only 9.6 percent of children who died in German pediatric intensive care units met neurologic criteria for death, according to a retrospective analysis of data from 33 PICUs in the Pediatric Intensive Care Admission Network (PIA) between May 1, 2023 and July 31, 2025. The researchers report that this rate is substantially lower than in international multicenter studies, and they suggest the gap may indicate missed opportunities for pediatric organ donation in Germany.

The study team, drawn from institutions including Philipps-Universität Marburg, TU Dresden, University Hospital Essen, LMU Munich and University Hospital Jena, examined deaths among children older than 27 days and younger than 18 years who died during their PICU stay. Of 11,095 children recorded in the network during the study window, 219 died, yielding an overall case-fatality rate of 19.7 per 1,000. The median age at death was 6 years, with an interquartile range of 1 to 13 years.

The circumstances of death varied across the cohort. Withdrawal of life-sustaining treatment preceded 30.1 percent of deaths and limitation of life-sustaining treatment preceded 20.5 percent, while failed maximal therapy accounted for 26.5 percent and failed cardiopulmonary resuscitation for 12.8 percent.

Among the 219 deaths, 21 children, or 9.6 percent, met neurologic criteria for death. Of these 21 children, 11 became organ donors, a conversion rate of 52.4 percent. The median age of the organ donors was 4 years, with an interquartile range of 1 to 13 years.

The authors note that comprehensive data on the characteristics and clinical management of pediatric deaths in German PICUs, especially among organ donors, had been limited until now. Their analysis is presented as the first multicenter analysis from a nationwide German PICU network.

The context for the work is a persistent imbalance in German pediatric transplantation: each year, between 250 and 300 children are listed for organ transplantation in Germany, while approximately 30 children donate organs.

The researchers propose that more structured donor identification, enhanced training for the diagnosis of death by neurologic criteria, and the development of evidence-based guidelines for pediatric donor management may enhance quality of care and increase pediatric organ donation in Germany.

As a retrospective analysis of anonymously collected registry data, the study describes patterns of care rather than testing an intervention, and it cannot establish why German rates of death by neurologic criteria fall below those reported internationally. The authors present the findings as a baseline for future work on pediatric donor identification and management.

Subject of Research: Epidemiology of death by neurologic criteria and organ donation among children dying in German pediatric intensive care units

Article Title: Death by neurologic criteria and organ donation in German pediatric intensive care units—data from the PIA network

Article References: Mand, N., Donath, C., König, F., Brenner, S., Bruns, N., Dohna-Schwake, C., Hoffmann, F., Olivieri, M., Urschitz, M., Perera Cutiño, D., & Biedermann, R. (2026). Death by neurologic criteria and organ donation in German pediatric intensive care units—data from the PIA network. Frontiers in Pediatrics, 14, Article 1890906. https://doi.org/10.3389/fped.2026.1890906

Image Credits: AI Generated

DOI: 10.3389/fped.2026.1890906

Keywords: death by neurologic criteria, brain death, organ donation, pediatric intensive care, PICU, Germany, PIA network, pediatric transplantation, life-sustaining treatment, case-fatality rate, retrospective study, Death