Donation after circulatory death (DCD) is a pathway to organ donation that may occur when a person has a severe, irreversible illness or injury and recovery is not possible, but they have not been declared brain dead.
After the decision to withdraw life-sustaining treatment has been made based solely on the patient’s medical condition and wishes, the person’s heart may stop. If death is declared, organ donation may then proceed according to the individual’s wishes and applicable safeguards.
DCD gives families the opportunity to honor their loved one’s wishes while offering hope to people waiting for a transplant.
What are the ways you can be an organ donor?
1. Brain Death Donation
Brain death occurs when a person has permanently lost all brain activity, including the brain stem. A physician determines death through a series of neurological tests following strict medical standards.
2. Donation After Circulatory Death (DCD)
DCD occurs when a person is not brain dead, but their injury or illness is so severe that recovery is not possible. The person requires medical support, such as a ventilator, to maintain breathing and circulation.
After conversations between the medical team and the family, a decision is made to withdraw life-sustaining treatment. This decision is based solely on the patient’s medical condition and wishes — never on the possibility of donation.
If the person’s heart stops after support is withdrawn, death is declared by the hospital medical team. Only then can organ donation proceed.
How does Donation After Circulatory Death (DCD) work?
Step 1: Referral
Hospitals are required by federal regulations to notify their local organ procurement organization (OPO), such as LifeShare Oklahoma, when a patient may meet potential donation criteria.
LifeShare’s role is separate from the patient’s medical care team. Our organ recovery coordinators evaluate whether donation may be possible and our family service coordinators provide support and education to the family.
Step 2: Patient Evaluation
The hospital continues managing the patient’s care while LifeShare evaluates whether organs are suitable for transplant.
This includes reviewing medical history, laboratory results, imaging and other information to determine what organs may be safely donated.
Throughout this process, the hospital’s physicians continue monitoring the patient’s condition.
Step 3: Family Discussion
During end-of-life conversations, LifeShare may speak with the family about the opportunity to honor their loved one’s wishes through donation.
- If someone is a registered donor, LifeShare helps the family understand the donation process and supports their loved one’s documented decision.
- If someone is not registered, the legal next of kin may be asked to make a donation decision on their behalf.
Families often find these conversations easier when donation has been discussed before a crisis occurs.
Step 4: Withdrawal of life-sustaining treatment
If donation is planned, the patient is moved to an appropriate location where loved ones can be present and meaningful moments can take place.
The focus remains on comfort, dignity and honoring the individual. The medical team withdraws life-sustaining treatment, and the patient is closely monitored.
In some cases, the heart may not stop within the expected timeframe needed for donation. If that happens, donation does not proceed, and the hospital team continues providing compassionate end-of-life care.
Step 5: Death is declared
When the heart stops and breathing ceases, the hospital medical team confirms death according to established medical standards.
There is a required observation period of 5 minutes to ensure the heart does not restart. A physician who is not part of the transplant team declares death.
Step 6: Organ donation takes place
Only after death has been declared does organ recovery begin.
Organs that may be donated through DCD include the kidneys, liver, lungs and pancreas. Advances in medicine have also made some heart donations possible in certain DCD cases.
Through donation, one person can help save multiple lives and provide hope to those waiting for a transplant.
Frequently asked questions about DCD
What happens if the patient continues breathing after the ventilator is removed?
In most DCD cases, after life-sustaining treatment is withdrawn, a patient’s breathing slows and eventually stops as the body naturally responds to changes in oxygen and carbon dioxide levels. Once the heart stops and breathing has ceased, a required five-minute observation period takes place to confirm that the heart does not restart before death is declared.
In rare situations, a patient may continue breathing longer than expected and the donation criteria may not be met within the required timeframe. When this occurs, organ donation does not proceed. The family is supported throughout the process, and the hospital team continues providing compassionate, comfort-focused care.
Can families still say goodbye?
Yes. Families are encouraged to spend time with their loved one throughout the donation process. Many hospitals offer special ways to honor donors, including honor walks, moments of reflection and personalized tributes.
Is the patient alive when organ recovery begins?
No. Organ recovery does not begin until after the patient has been declared dead by the hospital medical team and all required safeguards have been completed.
How is death declared in a DCD case?
After life-sustaining treatments like a ventilator or medications are withdrawn, the medical team monitors the patient closely. Once the heart stops and breathing ceases, there is a mandatory waiting period of 5 minutes to ensure that the heart does not restart. A physician — not affiliated with the transplant team — then officially declares death.
