Ideally this should be discussed as early as is practicable and certainly before the terminal phase. Discussions at the time of, or after, death may reveal an important wish to donate but it will be very difficult to achieve this without planning ahead.

Many professionals feel uneasy about having this discussion, but choice is important, and many young people are keen to improve the lives of others.

Prior to approaching a child/young person/family, it is useful to know where things stand. Phone the local transplant co-coordinator (they can be contacted 24hrs a day through your hospital switchboard) and discuss your patient with them. They will be able to tell you whether donation is possible or not, and how to proceed.

Approach the family/ young person and establish and record their wishes. Make sure that the team around the child are aware of the decision and know what to do after death.