What you need to know about organ donation

Hospitals are required to contact their local organ procurement organization (OPO), a non-profit that helps coordinate organ donation, when a patient is on a ventilator, meets certain medical criteria, and may be an eligible organ donor. Donation after Circulatory Death (DCD) is one way that organ donation can happen, when a person becomes a donor after their heart and breathing have permanently stopped. 

DCD is different from donation after brain death. In brain death cases, a patient has suffered brain damage, and tests confirm that all brain function has irreversibly stopped. These patients are legally dead, even while ventilator machines may continue to support their heartbeat and breathing to allow for organ donation. 

In DCD cases, the patient does not meet brain death criteria, but has a severe injury or illness and is not likely to survive. The patient may not show traditional clinical triggers for donation, and in many cases, the only clear indication is the family’s decision to stop life-sustaining treatment with the expectation that death will follow. Organ donation can only happen after the patient’s heart and breathing permanently stop and death is declared by the hospital team. 

The DCD process is carefully coordinated to ensure it is ethical and respectful of the patients, their family, and the hospital team. The decision to withdraw ventilator support is made solely by the family and hospital team. Only then is the OPO able to offer DCD donation to the family and confirm authorization to donate. While the patient is still alive, they are cared for entirely by the hospital team. The OPO will work with the hospital to review the patient’s medical history and coordinate testing to see which organs are healthy enough for transplant. However, the OPO does not provide medical treatment to patients, participate in end-of-life decisions, or declare death. They are trained to never interfere with the patient’s care or the hospital team’s decisions. 

Once ventilator support is withdrawn, hospital teams monitor the patient closely while the OPO remains on standby. If the patient’s heart and breathing stop permanently, and this continues for a short, required period (usually 2-5 minutes), the hospital team – independent from the OPO – will officially declare death. Only after death is declared and donation is authorized does the OPO proceed with organ recovery. If the patient does not pass away within a specific timeframe (usually 60-120 minutes) 

 Death is not a single moment, it’s a process. The decisions at the end-of-life are deeply personal and complex, and are made between patients, their families, and their doctors. If the patient is a registered donor, or if a family chooses to pursue donation, the OPO is there to answer questions and walk them through each step. OPOs provide compassionate support to families during one of the most tragic times of their lives. They follow strict DCD protocols that honor the donation decision, respect the donor’s gift, and help save as many lives as possible. 

• Determines prognosis and end-of-life care: The hospital medical team decides when further treatment is no longer beneficial. 
• Initiates conversation with the family: Discusses withdrawal of life-sustaining treatment with the patient’s family. 
• Manages ventilator withdrawal: Withdraws ventilator support under clinical supervision. 
• Maintains clinical care until death: Provides comfort and supportive care up to the point of death. Comfort care medications are administered by the hospital to ease the pain of passing, not to hasten death. Families can and do seek comfort care on behalf of their loved ones.
• Declares death: Independently confirms death based on circulatory criteria (no heartbeat or breathing) after the observation period. 

• Receives referral: Is notified of a potential donor once the patient meets clinical criteria. 
• Evaluates donor eligibility: Conducts medical and social history review and clinical testing in coordination with the hospital. 
• Obtains donation authorization: If the patient is not registered, works with the family to obtain legal authorization. 
• Coordinates with transplant centers: Matches and allocates organs using the national waitlist. 
• Coordinates recovery logistics: Prepares surgical teams and coordinates the organ recovery process following death declaration. 

• Receives organ offers: Is notified by the OPO when a suitable organ becomes available. 
• Evaluates organ suitability: Assesses compatibility with potential recipients on their waitlist. 
• Accepts or declines the offer: Makes clinical decisions based on recipient need, organ condition, and readiness. 
• Prepares recipient for surgery: Mobilizes surgical and care teams once an organ is accepted. 
• Performs the transplant: Conducts the transplant surgery and provides immediate post-operative care Receives referral: Is notified of a potential donor once the patient meets clinical criteria. 
• Evaluates donor eligibility: Conducts medical and social history review and clinical testing in coordination with the hospital. 
• Obtains donation authorization: If the patient is not registered, works with the family to obtain legal authorization. 
• Coordinates with transplant centers: Matches and allocates organs using the national waitlist. 
• Coordinates recovery logistics: Prepares surgical teams and coordinates the organ recovery process following death declaration.