New rules change organ donation process
A neurointensivist at Oregon Health & Science University recently performed an apnea test on a 22-year-old college student, Hailey, who had suffered a catastrophic brain injury in a traffic accident. The test, which is the final step in determining whether a patient has died by neurological criteria, involves watching for any sign of life, such as a tiny intake of breath, as the patient is removed from a breathing machine.
The neurointensivist, who has experience with organ donation, recalls the case of Hailey, who was declared brain dead after the test. Her organs were donated, saving the lives of four people, including two grandparents who received her kidneys, a young woman who received her liver, and a young man who received her heart.
New Organ Donation Rules
Starting November 18, new rules from the Organ Procurement and Transplantation Network will change how the organ donation process works. The rules will allow organ procurement organizations to approach families about donation before they have decided whether to withdraw life-sustaining treatment. The goal is to increase the number of viable organs available for transplantation, but some medical professionals are concerned that this approach may blur the line between physicians fighting to save a patient’s life and teams responsible for organ procurement.
The neurointensivist believes that proposing potential organ donation early in the process can open the door to distrust in the ICU care provided to patients. They argue that the primary concern of physicians should be the well-being of the patient, and that discussing organ donation before the patient’s family has fully grasped the gravity of the situation can be confusing and cause conflicted emotions.
In 2025, the Department of Health and Human Services reported 73 cases in which organ donation had been authorized, but not completed, where donors showed “neurological signs incompatible with organ donation.” This fact highlights the need for careful assessment of the neurological condition of potential donors.
The Uniform Determination of Death Act establishes two definitions of death: irreversible cessation of circulatory and respiratory function, or irreversible loss of function of the entire brain, known as brain death. Determining brain death requires a rigorous assessment of three criteria: coma with a known cause, loss of brainstem reflexes, and loss of the ability to breathe spontaneously.
No one who has been correctly diagnosed with brain death under these criteria has ever recovered. The neurointensivist emphasizes the importance of a separate organ donation team working alongside physicians, remaining independent of the physicians treating the patient, to ensure that the primary focus remains on the patient’s care.
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As the new rules take effect, the neurointensivist is concerned about the potential impact on families and patients. They argue that a safer path to increasing organ donations would involve better education about what it means to be an organ donor, expanding access to neurological expertise in underserved areas, and focusing on patients who have been declared brain dead.
The new policy allows donation teams to approach families before they have fully grasped the gravity of the patient’s injury, which can subtly blur the distinction between caring for the patient and obtaining organs for someone else. The neurointensivist believes that the first priority must always be the patient before them, and ensuring that family members making decisions on their behalf understand and trust the care being provided.
According to the report, the number of people waiting for life-saving transplants in the U.S. exceeds 100,000, highlighting the need for an increase in organ donations.
Improving Organ Donation Processes
Video consultations with neurologists or intensive care physicians can facilitate this process, particularly in small and rural hospitals.
After brain death, families and healthcare teams have more time to obtain organs in an orderly fashion, facilitating the best outcome for both donors and recipients.
The organ donation team’s approach to families should be sensitive to their emotional state and the gravity of the patient’s injury. The team should ensure that families understand the process and trust the care being provided, avoiding any confusion or conflicted emotions.
