Types of Donation

Deceased organ donation is a heavily regulated and nuanced process that is only possible in less than 1% of deaths. These potential circumstances are detailed below. In all circumstances, organ recipients are matched using the national transplant waiting list and robust grief support is offered to the donor’s family.

Donation After Brain Death (DBD)

Donation after brain death refers to the process where organs and tissues are recovered from a deceased individual after they have been declared brain dead by a physician. Brain death is declared after extensive testing by physicians who are independent of the organ recovery and transplant team.

Brain death is a clinical and legal determination of death based on the irreversible loss of all brain function, including the brainstem. It’s not a “coma” or “vegetative state;” it is legally recognized death. Patients cannot recover from brain death in any circumstance.

A person who has been declared brain dead and remains on a ventilator may be eligible for organ donation. Because the ventilator continues to provide oxygen and blood flow, their organs can stay healthy long enough to help others through donation.

Donation After Circulatory Death (DCD)

Circulatory or cardiovascular death means a person has died because their heart has stopped beating and blood is no longer circulating through the body. Donation after circulatory death happens when a person has a serious injury or illness and their family decides, together with doctors who are independent of the recovery and transplant team, that continuing mechanical life support is no longer desired.

When the ventilator is removed and the person’s heart eventually stops beating, a doctor who is independent of the organ recovery and transplant team confirms death. At this point, organ donation may be possible.

When mechanical support is removed from the patient, the patient is monitored closely by their hospital care team.

• If the patient maintains circulatory and respiratory functions without medical intervention, the hospital care team will continue patient care and organ recovery would not take place.
• If circulatory and respiratory functions cease and do not restart on their own, a physician unaffiliated with the organ recovery organization will declare death. Doctors confirm death by checking that the heart has stopped, there is no breathing, and these functions do not return after an observation period.
  
  

In a DCD case, the process of removing the ventilator, waiting for the heart to stop beating, observing to ensure cardiovascular function does not return, and death declaration, almost always takes place in an operating room. This is because, for donation of healthy organs to occur, operating quickly after death is a necessity.

Organ and tissue recovery never takes place until after the person’s heart stops beating under their own power, and they are declared deceased by a physician who is unaffiliated with the recovery and transplant team.