What is DCD? Understanding Donation after Circulatory Death
07/21/2025So, you’re familiar with organ donation and you’d like to know more specifics. This blog post explains the two pathways that allow deceased organ donation to happen.
PATHWAYS TO DONATION
Donation can only occur under certain circumstances. Among other details, the donor must:
- Be on a ventilator
- Pass away in a hospital setting, typically in the ICU
Donation is a possible outcome when all lifesaving measures haven’t worked for the patient. And it’s only possible after the donor passes away. The two pathways are brain death or circulatory death.
Note: Donor Network of Arizona cannot and does not declare death for any patient ever. The death declaration must be made by physicians who are not connected to the donation or transplantation process.
So, what exactly are the two pathways?
1. Brain Death
Brain death is death. Doctors declare brain death after testing shows the irreversible cessation of all brain activity, including the brain and brain stem. The brain dies from a lack of blood and oxygen.
A hospital physician, following accepted medical standards and hospital policy, must make the diagnosis of brain death by following specific steps and procedures to test for the presence of any brain activity.
A brain death diagnosis is a medical diagnosis, and it becomes the patient’s legal time of death. This can be confusing for some since the heart continues to beat and the lungs fill will air because of medications, a ventilator and other external factors.
Donation after circulatory death (DCD)
What is it?
Often referred to as DCD, donation may also take place after the irreversible cessation of all circulatory and respiratory functions. In other words, the heart isn’t pumping blood, and the lungs are not breathing. They have stopped.
Patients who die through circulatory death can, in some cases, donate organs and tissues.
How does it work?
It can only happen if the donor’s family decides to withdrawal all care because that patient has a nonsurvivable injury after doctors have tried everything to save their life. DNA is not in contact with any patient’s family until after they make this decision independent of DNA.
Donation then is only possible if that person dies naturally and within a certain timeframe—after all external care has ended. The final time of death is recorded after five minutes of no heart activity.
Organ donation is never possible until after the donor passes away. Sometimes, the patient doesn’t pass away in a time frame that supports donation. If that happens, it’s simple: Organ donation will not continue. No organs will be recovered.
If that’s the case—meaning the patient continues breathing and the heart doesn’t stop—they will continue receiving comfort care until they naturally pass away.
In Summary
We at Donor Network of Arizona (DNA) work closely with all hospitals in the state and with the families of donors who go on to save and heal others through their gifts.
DCD, as a pathway to donation, is one of many ways DNA honors its commitment to donors and their families to make the most of the gifts that they’ve trusted us with.
Through either pathway, with all requirements met, the recovery of donated organs can proceed to save the lives of the best matching patients on the national organ waiting list. It is done with the utmost respect and dignity for the donor throughout the entire process, even when donation is deemed not possible.
If you’d like to learn more about how donation works: Visit our About Donation page on our website.
HERE ARE SOME FREQUENTLY ASKED QUESTIONS ABOUT DCD
Is the patient still alive when donation starts?
No. All organ recovery happens after death. Organ recovery does not begin until after the patient has been declared dead by a hospital physician (not an employee at DNA), and only after the observation period passes.
What if the patient keeps breathing or their heart restarts on its own?
Donation after circulatory death depends on the donor’s heart stopping naturally. If the patient keeps breathing or their heart continues or restarts, organ donation does not move forward.
What happens after circulatory death?
Because the donor is no longer on a ventilator, recovery happens quickly – typically within minutes after death has been declared. This helps to protect the health of the organs, giving their recipients the best shot at a second chance at life.
What organs can be donated through DCD?
The same organs that a brain death donor may offer remain possible for recovery for transplantation based on many other factors in a DCD donation situation.
In addition to organs, life-healing gifts like tissues, corneas, bones and skin can also be donated after circulatory death.