Brain Death

Brain death is the irreversible cessation of all brain activity, including the brain and brain stem. The brain dies from lack of blood/oxygenation. Most organ donation occurs after brain death declaration. A hospital physician, in accordance with accepted medical standards and following the hospital policy, must make the diagnosis of brain death.

Note: Donor Network of Arizona does not determine brain death.

The time of brain death determination is the legal time of death. The physician who determines brain death cannot be the physician who recovers the donated organs.

The following links will take you to the American Academy of Neurology’s guidelines for determining brain death in adults.

• AAN Clinician Guideline Supplement
• Evidence-based Guideline Update: Determining brain death in adults

Circulatory Death

Donation after Circulatory death (DCD) is the irreversible cessation of all circulatory and respiratory function. Patients who die through circulatory death can, in some cases, donate organs, tissues and eyes.

When a patient has a nonsurvivable neurological injury or illness, families or patients may elect to withdraw life support. In some of these cases, it may be possible to recover organs for transplantation after support is withdrawn and after circulatory determination of death.

In order for donation after circulatory death (DCD) to occur, the following circumstances must exist:

• Non-survivable ventilator dependence stemming from:
  • Permanent and irreversible neurological injury (e.g. upper spinal cord injury)
  • Permanent and irreversible disease (e.g. end-stage musculoskeletal or pulmonary disease)
  • Critical heart and or lung injury
• Planned withdrawal of life-sustaining medical treatment/ventilator support

The initial referral and collaboration between the hospital and Donor Network of Arizona is the same. However, if proceeding down the donation after circulatory death (DCD) pathway, there are some things that are different.