Organ & Tissue Donation

The nurse's role in organ donation isn't asking the family — it's preserving the option. One missed step and viable organs are lost forever.

When a patient progresses toward brain death, the nurse's primary obligation is to notify the organ procurement organization (OPO) at or near the time of death — this is federally mandated. The nurse does NOT make the donation request; that conversation belongs to trained OPO coordinators. Timing matters: organs require perfusion, so hemodynamic support continues after brain death is declared until the OPO coordinates recovery. Brain death criteria (two clinical exams demonstrating absent brainstem reflexes, no spontaneous respirations on apnea testing) must be met before organ procurement, but tissue donation (corneas, skin, bone, heart valves) can occur hours after cardiac death because these tissues tolerate ischemia longer. Consent hierarchy follows legal next of kin unless the patient is a registered donor or documented wishes in an advance directive. A signed donor card or registry enrollment is legal consent in most jurisdictions — family cannot override it, though OPOs work collaboratively with families. The nurse supports the family emotionally, maintains the donor's hemodynamic stability (fluids, vasopressors, ventilator settings as ordered), and documents meticulously. Cultural and religious beliefs must be assessed without assumption — most major religions permit donation, but the family's specific concerns guide the approach.

Key Distinctions

Don't confuse brain death with a persistent vegetative state — brain death is irreversible cessation of all brain function including the brainstem, and the patient is legally dead. Students often think nurses ask the family about donation; by law, the OPO must be notified and their coordinators lead the request. Organ donation requires maintained perfusion (ventilator stays on after brain death); tissue donation does not.

Clinical Pearl

Refer, don't request. Your job is to call the OPO — their trained coordinators have the conversation with the family.