Deceased Donor Management

Deceased donor management is the identification, certification, and physiologic support of a person who has died and whose organs may be recovered for transplantation, together with the assessment of whether each organ is suitable for transplant. After death is certified by neurologic criteria, the donor's circulation and organ perfusion are maintained until procurement so that organs remain viable.

Definition

Deceased donor management is the process of identifying a potential deceased donor, certifying death, maintaining organ viability through physiologic support, and assessing organ suitability prior to procurement.

Scope

The topic covers donor identification and the determination of death by neurologic criteria, the physiologic support of the donor before organ recovery, the assessment of donor and organ quality including expanded-criteria and higher-risk donors, and donor risk scoring. It is a reference overview and does not provide critical-care protocols or individualized clinical management instructions.

Core questions

• How is death determined by neurologic criteria in a potential donor?
• How is organ perfusion and physiologic stability maintained until procurement?
• How is the quality and suitability of each donated organ assessed?
• How are higher-risk or expanded-criteria donor organs used while protecting recipient outcomes?

Key concepts

• Determination of death by neurologic criteria
• Donor physiologic support and stabilization
• Organ viability and preservation
• Expanded-criteria donors
• Donor risk index
• Cold ischemia time

Mechanisms

Once a potential donor is identified and death is certified by neurologic criteria, the loss of central regulation produces hemodynamic, hormonal, and metabolic instability that threatens organ perfusion; supportive measures aim to maintain circulation, oxygenation, and homeostasis so that organs remain transplantable until recovery. Each organ is then evaluated for suitability using donor history, laboratory and functional measures, and risk scores such as the donor risk index, which relate donor characteristics to expected graft outcome. Expanding the usable pool with older or higher-risk donors trades a degree of expected graft quality for greater organ availability.

Clinical relevance

Effective donor management increases the number and quality of organs that reach recipients, directly affecting how many candidates can be transplanted. This entry summarizes the framework of deceased donor management for educational reference and does not constitute critical-care or procurement guidance for individual cases.

Epidemiology

Most transplanted solid organs come from deceased donors, and the size and composition of this pool depend on donor identification, consent, and the willingness to use expanded-criteria organs. Donor risk scoring shows that graft outcomes vary systematically with donor age and other characteristics, which informs how organs are matched and counseled.

Evidence & guidelines

The determination of brain death follows guideline frameworks such as the American Academy of Neurology update (Wijdicks and colleagues, 2010), building on the historical Harvard criteria (1968). Strategies to expand and improve the deceased-donor supply are reviewed by Tullius and Rabb (2018), and the donor risk index concept (Feng and colleagues, 2006) links donor characteristics to graft outcome.

History

Organized deceased donation became possible once neurologic criteria for death were articulated, notably by the Harvard Ad Hoc Committee in 1968, which defined irreversible coma. Subsequent guidelines standardized the clinical determination of brain death, while the persistent organ shortage drove the use of expanded-criteria and higher-risk donors and the development of donor risk scoring to match organ quality to recipient need.

Debates

How should expanded-criteria and higher-risk donor organs be used?

Accepting organs from older or otherwise higher-risk donors increases supply and can shorten waiting time, but at some cost to expected graft quality, raising questions about how such organs should be allocated and to whom.

Key figures

• Eelco Wijdicks
• Sandy Feng
• Stefan Tullius

Seminal works

• harvard-1968
• feng-2006
• tullius-2018

Frequently asked questions

What does determination of death by neurologic criteria mean?

It is the clinical confirmation of the irreversible loss of all functions of the brain, including the brainstem, which constitutes death even while circulation is being supported, allowing organs to be recovered for transplantation.

What is an expanded-criteria donor?

It is a deceased donor whose age or medical characteristics carry a higher expected risk of reduced graft function; such organs broaden the available supply and are used selectively, balancing availability against expected outcome.