Every day in the United States, 17 people die waiting for an organ transplant, and organ donation remains one of the most powerful ways to save lives. A single deceased donor can save up to eight lives through heart transplant, lung transplant, kidney transplant, liver transplant, pancreas transplant, and intestinal transplant. In 2024 alone, over 48,000 Americans received life-saving organ transplants, according to the Organ Procurement and Transplantation Network (OPTN). Behind each story is the extraordinary generosity of nearly 17,000 organ donors and their loved ones whose decision brought hope and a second chance at life to other individuals in 2024.
A recent analysis of organ donation practices by the Health Resources and Services Administration (HRSA) identified significant concerns with the management of potential organ donors. While the concerns that were identified emphasize the need for improved policies and practices within the U.S. organ donation and transplant system, it is crucial that we address the questions raised by recent media reports and congressional inquiries. The cases described are rare. The U.S. organ donation and transplant system enables thousands of safe; lifesaving transplants each year. Yet, public misperceptions about the deceased donor process and organ donation safeguards may discourage individuals from choosing to register as organ donors, thus limiting organ availability when it is needed most. More than 100,000 Americans are waiting for an organ transplant, and we must ensure continued public support and trust for this life-saving mission.
To understand recent discussions about organ donation, it helps to know there are two main types of deceased donor organ donation.
What is donation after brain death (DBD)? In donation after brain death, doctors who are not part of the organ donation or transplant recovery teams determine that the patient’s brain has completely stopped working. The hospital providers perform multiple clinical exams and confirmatory tests to determine that the patient is brain dead, even though the heart is still beating and the lungs are still functioning with help from machines. The organ recovery team performs organ donation surgery only after the patient has been declared brain dead. Because the patient is dead, organs can be recovered while the heart continues pumping blood to keep them healthy for transplantation.
What is donation after circulatory death (DCD)? DCD donation works differently. Here, a patient is critically injured or ill but not brain dead. If the patient's prognosis is deemed poor by the treating physician who is not part of the organ donation or transplant team, and the patient or their family chooses to proceed with withdrawal of life support, the evaluation process for possible donation after circulatory death begins. If the evaluation testing reveals that the patient may be a suitable organ donor, the patient, while still alive, will transfer to the operating room for withdrawal of life support and comfort care measures, that may include the administration of pain medication. This comfort care is provided in the operating room by a hospital provider who is separate from the organ donation and transplant recovery team. Once the patient's heart stops beating naturally and an appropriate waiting period has occurred to make sure that the heart does not start beating again, the patient is declared dead by the hospital provider. At that point the transplant recovery team enters the operating room, and organ recovery proceeds. If the patient does not pass away in the time necessary for successful organ donation and transplantation, then the patient returns to the intensive care unit for ongoing comfort care measures.
The key difference between DBD and DCD is the process by which the patient is pronounced dead. In both instances, the declaration of death is made by hospital providers who are never part of the organ recovery surgical team.
Both types of organ donation save lives. DCD donation has been increasing in number, making up 45% of all deceased donations, a substantial increase from previous years. In 2024, 7,283 patients chose to help others by donating organs after circulatory death and facilitated 12,975 transplants, per OPTN data. This pathway has become critical for patients with end-stage organ disease, as our population ages and conditions like diabetes and heart disease increase the need for organ transplants. DCD donation benefits candidates awaiting kidney, heart, liver, pancreas, and lung transplants, and expands opportunities for patients with these life-threatening conditions.
Recent media coverage has raised important questions about DCD donation practices. The highlighted cases, while concerning, represent isolated incidents in a system that has safely facilitated thousands of life-saving organ donations each year. However, they illuminate important areas where we must strengthen our protocols and enhance patient protections. DCD donation has evolved over two decades into a critical pathway for addressing our country’s organ shortage. This success reflects careful protocol development, medical expertise, and the generosity of donors and families who choose to give the gift of life even in their darkest moments.
Preserving Public Trust Through Transparency
The organ donation system depends entirely on public trust. Potential organ donors registering for organ donation and families faced with the decision to donate a loved one’s organs must have confidence that their wishes will be honored ethically and safely and that the system will serve them with integrity.
This trust requires transparency about our successes and our challenges. The recent reports highlight concerning cases yet also demonstrate that oversight systems are working - problems are being identified, investigated, and addressed. This is exactly how a responsible medical system should function.
We must resist the temptation to dismiss legitimate concerns or to let those concerns paralyze or dismantle a system that saves so many lives. Instead, we should use this moment to strengthen our protocols, enhance our oversight, and reaffirm our commitment to the highest standards of medical ethics in organ donation.
The Bigger Picture
The United States faces a growing organ shortage that will only intensify as our population ages and diseases like diabetes, heart disease, and obesity become more prevalent. These demographic trends make every improvement in organ donation safety and efficiency critically important.
The solution is not to retreat from DCD donation or create barriers that reduce the number of available organs. Instead, we must improve our systems to ensure that donations proceed safely, ethically, and with complete family confidence.
Moving Forward Together
The American Society of Transplantation stands ready to work with regulators, hospitals, organ procurement organizations (OPOs), and oversight bodies to implement the improvements our system needs. We support the development of updated regulations and guidelines that align DCD practices across all institutions, with input from medical professionals, patients, donor families, and regulators.
Most importantly, we remain committed to honoring the extraordinary generosity of organ donors and their families. Their decision to give life in the midst of loss represents humanity at its most compassionate level. Our responsibility is to ensure that their gift is handled with the care, respect, and safety that it deserves. We will strive for continuous improvement to ensure the trust and protection of donors and their families.
To learn more about organ donation, click here.
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