A cadaveric donor, now commonly referred to as a deceased donor, provides materials for life-saving and life-enhancing medical procedures. This donation occurs after a patient has been medically declared dead, distinguishing it from living donation. The deceased donor process allows for the recovery of multiple materials that can address the significant global need for transplants. The structured process involves careful authorization, rigorous medical evaluation, and a highly synchronized logistical system. This coordination relies on clear legal statutes and specialized medical teams working in concert.
Defining Deceased Donation and Procured Materials
Materials recovered from a deceased donor are broadly categorized into organs and tissues, each having distinct requirements for viability. Organs, such as the heart, lungs, liver, kidneys, pancreas, and intestines, require immediate transplantation because they rapidly lose function without continuous blood flow. These solid organs must be preserved using specialized cooling solutions and transported quickly to the recipient’s surgical facility. This window of time, known as cold ischemia time, is relatively short, often measured in hours, making geographical proximity a significant factor in allocation.
Tissues are more resilient and can often be processed and stored for later use, or “banked,” which removes the immediate time pressure associated with organs. Donated tissues include corneas, skin, bone, tendons, cartilage, and heart valves. Corneas are the most frequently transplanted tissue, restoring sight to thousands annually. Most tissues can be recovered up to 24 hours after the cessation of circulation, provided the body is properly cared for.
The Authorization and Medical Criteria Process
The process begins with legal authorization, governed in the United States by the Uniform Anatomical Gift Act (UAGA). This legislation upholds “First-Person Authorization,” meaning an individual’s documented decision to donate (via a state registry or driver’s license designation) is legally binding. If no official designation was made, the decision falls to the legal next-of-kin or authorized representative. Organ Procurement Organizations (OPOs) coordinate this sensitive discussion with the family, ensuring the process honors the donor’s wishes or the family’s decision.
Simultaneously, a thorough medical evaluation determines the donor’s suitability, including a review of medical history, lab results, and imaging scans. Deceased donors are classified as Donation after Brain Death (DBD) or Donation after Circulatory Death (DCD). Brain death is the irreversible cessation of all functions of the entire brain, including the brainstem, confirmed by specific neurological tests performed by independent physicians. In DBD cases, circulation and breathing are maintained by mechanical ventilation, keeping organs perfused and viable until procurement surgery.
Donation after Circulatory Death (DCD) occurs when a patient does not meet brain death criteria, but life support is withdrawn following a decision to end life-sustaining treatment. Death is declared after a monitored period (typically two to five minutes) of irreversible cessation of heart and lung function. DCD organs are exposed to warm ischemia (lack of oxygenated blood), which affects viability and makes certain organs more challenging to transplant.
The medical suitability assessment includes specific exclusion criteria to prevent the transmission of disease to the recipient. Absolute contraindications for solid organ donation include active, widespread cancer (metastatic malignancy) and uncontrolled systemic infections, such as sepsis. Certain infectious diseases, including active HIV or rare neurological disorders like Creutzfeldt-Jakob Disease (CJD), also generally prevent donation. However, medical teams weigh the risk of disease transmission against the recipient’s risk of death while remaining on the waiting list, especially as the use of organs from donors with complex medical histories is an ongoing area of research.
Organ Allocation and Recipient Matching
Once a donor is medically cleared, the Organ Procurement Organization enters the clinical data into a centralized computer system managed by the United Network for Organ Sharing (UNOS) in the US. This system generates a list of potential recipients, known as a “match run,” based on standardized national allocation policies. The goal is to distribute organs equitably while maximizing transplant success.
Multiple medical and logistical factors determine the recipient’s rank on the match run. Medical urgency, reflecting the severity of the recipient’s condition and immediate need, is a primary consideration for organs like the heart and liver. Fundamental biological compatibility is also paramount, including blood type (ABO) matching and tissue typing (HLA). HLA typing assesses the immune system’s likelihood of rejecting the organ.
Size matching between the donor and recipient is important, especially for pediatric cases and thoracic organs. Geographical proximity is also a factor, particularly for organs with short viability times. The system prioritizes local candidates before widening the search to regional and national levels to minimize the time the organ spends outside the body, which directly influences transplant outcomes. The transplant center’s surgical team ultimately reviews the organ offer and makes the final decision on acceptance.