Organ Donation and End-of-Life Care
1
Nurse's Role
REFER to OPO only
60 mmHg
Apnea Test PaCO2
Threshold for brain death confirmation
2
Donation Types
DCD and DBD
Brain Death Criteria
Brain death is the irreversible cessation of all brain function, including the brainstem. Clinical examination tests for absent brainstem reflexes (pupillary, corneal, oculocephalic, oculovestibular, gag, cough) and absent respiratory drive (apnea test).
The nurse's role is to REFER to the OPO, NOT to approach the family about donation. Trained OPO requestors achieve significantly higher consent rates than untrained clinical staff.
Prerequisites for Brain Death Testing
Core temperature above 36°C (normothermia)
No sedating or paralytic medications on board
No severe electrolyte or metabolic derangement
Systolic BP adequate (no severe hypotension)
Two clinical examinations by qualified physicians (timing varies by state)
DCD vs DBD
DBD
Donation After Brain Death
Patient is declared brain dead. Organs are maintained on ventilator support until surgical recovery. More organs can typically be recovered. Formal brain death testing required.
DCD
Donation After Circulatory Death
Family chooses comfort care. After withdrawal and circulatory death, organs are recovered. Shorter warm ischemia time is critical. Typically kidneys, liver, and lungs.
Key Values to Memorize
Apnea test PaCO2 ≥60
Core temp >36°C for testing
Nurse refers, OPO requests
No sedation during testing
DBD = brain death first
DCD = circulatory death
end-of-life questions test professional practice, not just clinical knowledge
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Practice CCRN QuestionsExam Traps
The nurse REFERS to the OPO, does NOT approach the family about donation
This is one of the most commonly tested professional practice questions on the CCRN. The bedside nurse's role is to notify the Organ Procurement Organization (OPO) when a patient meets referral criteria. The OPO has specially trained requestors who approach the family. Nurses who approach families about donation have lower consent rates and may create ethical complications.
Brain death testing requires specific preconditions
Before brain death testing can proceed, the patient must be normothermic (core temp >36°C), have no sedating medications on board, have no severe metabolic derangements (electrolytes, glucose), and have no severe hypotension. If these conditions are not met, the exam results are unreliable.
Apnea test confirms absent respiratory drive when PaCO2 reaches 60 or more
The apnea test disconnects the patient from the ventilator while providing passive oxygen flow. If the PaCO2 rises to ≥60 mmHg (or ≥20 above baseline) and no respiratory effort is observed, the test is positive for brain death. Any respiratory movement at any point means the test is negative.
Refer, Do Not Request
You call the OPO. They approach the family. Trained requestors get higher consent rates. This is your lane. Stay in it.
Brain Death Prerequisites
Normothermia. No sedation. No metabolic derangement. Stable hemodynamics. Meet all four before testing. Document everything.
The nurse runs the first leg of the relay. You provide excellent end-of-life care, support the family through the dying process, and recognize when the patient meets OPO referral criteria. You then hand the baton.
Calling the OPO is the handoff. You give them clinical information. They assess donor eligibility. You do NOT discuss donation with the family because the timing and approach matter enormously for consent rates. The OPO has trained requestors who know exactly when and how to have this conversation.
Donation after brain death (DBD) occurs after formal brain death declaration. Donation after circulatory death (DCD) occurs after withdrawal of life-sustaining treatment in patients who do not meet brain death criteria but whose families have chosen comfort care. The processes are very different.
Once a patient is declared brain dead and consent is obtained, the nurse's role shifts to donor management. The goal becomes preserving organ function for the recipients. Hemodynamic support, hormone replacement therapy, and meticulous monitoring continue.
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