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To determine the impact of a pediatric donation after cardiac death (DCD) program on organ donation.Retrospective case series.A free-standing children's hospital.All ventilated pediatric intensive care unit patients who died between September 1, 2005 and April 30, 2007.Institution of a DCD program.Data collected included clinical features, medical eligibility and consent for organ donation, as well as outcome for donation among eligible patients. One hundred ten patients who died in the pediatric intensive care unit and were treated with mechanical ventilation immediately before death were identified. Thirty-one patients met exclusion criteria, 26 patients were not referred, and 53 patients were evaluated for potential DCD by the organ procurement agency. The majority of patients had anoxia or trauma as their primary diagnosis. Family members initiated discussions regarding donation in 17% of evaluations. Sixty-eight percent of patients were deemed medically ineligible by the organ procurement agency. Of the 17 medically eligible patients, consent for donation was given in 9 cases (53%). Of these, 7 patients (41%) successfully donated; accounting for 37% of organ donors during the study period. Two families gave consent for donation which did not occur; one child did not die within the required time period and one could not be matched with any recipients.Although a small percentage of dying patients are eligible for and will undergo DCD, such a program can markedly increase the number of organ donors at a children's hospital.