Donation Process
Donation after brain death (DBD): brain death declared, organs recovered while heart beating (optimal organ quality). Donation after circulatory death (DCD): cardiac death, organs recovered after cessation of circulation (warm ischemia time limits). Living donation: kidney, liver lobe (directed, non-directed, paired exchange). Tissue: corneas, bone, skin, heart valves, vessels. Eligibility: age, medical history, cause of death, organ function. Contraindications: cancer (some), active infection, HIV (relative). Organ Procurement Organization (OPO): coordinates donation.
Nurse Role
Recognize potential donors: severe brain injury, imminent death. Notify OPO early (before withdrawal of life support, per CMS). Maintain: hemodynamic stability, oxygenation, normothermia, electrolytes (for organ viability). Family approach: by OPO, not bedside nurse (avoid conflict of interest). Support: family decision, grief, cultural/religious considerations. Documentation: time of referral, family approach, decision. After death: care for body with dignity, facilitate recovery. Living donor: education, informed consent, support, follow-up.
Ethical Considerations
First-person consent: donor registration is legally binding (family cannot override in many states). Dead donor rule: patient must be dead before organ recovery. Conflicts: duty to care for patient vs. organ viability. Fairness: allocation by medical criteria, not wealth/status. Vulnerable: prisoners, mentally incapacitated (protections). Commercial: selling organs is illegal in most countries. Cultural: varies — some religions support, some oppose. Family: support regardless of decision. Grief: donation can help some families find meaning. Transparency: process, outcomes. Staff: support, debriefing.
Important Notes
- CMS requires hospitals to notify OPO of every death or imminent death — before withdrawing life support — for potential donor evaluation.
- First-person consent (donor registration) is legally binding — the family cannot override the patient decision in many states.
Clinical Tips
- The "dead donor rule" requires the patient to be declared dead before organ recovery — organ procurement cannot cause death.
- Notify OPO before withdrawal of life support to allow evaluation and family approach — timing affects organ viability.
Summary
Organ donation requires early OPO notification, maintaining organ viability, supporting family decisions, and respecting ethical principles (dead donor rule, first-person consent, fair allocation).
