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This process utilized a Delphi consensus methodology involving 30 international experts to develop recommendations to guide the development and operation of pcDCDD programs. Two survey rounds evaluated agreement on system requirements, donor identification, medical suitability, communication, end-of-life care, and ante-mortem interventions. Consensus recommendations emphasized the need for robust administrative and legal frameworks that explicitly support pcDCDD, multidisciplinary approaches for donor suitability assessment, and normalization of integrating donation into paediatric end-of-life care. The particularities of obtaining consent for both donation and antemortem interventions necessary for pcDCDD for patients that have never expressed a valid intent to donate were addressed. While our findings demonstrated international variability, strong consensus was obtained for multiple recommendations, suggesting the possibility of developing pcDCDD in varied international settings. 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