Organ & Tissue Donation

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.