Organ donation after circulatory death (DCD): What it means, how it happens and why it matters

At LifeSource, we work closely with hospitals, families, and transplant teams to honor each donor and make sure every step is done with care, compassion and respect. Organ donation is a highly regulated process, and we follow all the rules set by federal and state agencies, like the Centers for Medicare & Medicaid Services (CMS), Organ Procurement and Transplantation Network (OPTN) and the Health Resources and Services Administration (HRSA). 

A small percent of deaths in the United States — about 1% — will have this rare ability to save lives through organ donation. The entire organ donation process generally takes a couple of days. During this time, we’re using every minute to support families and their loved one to ensure they can help as many people as possible.  

Two ways someone is eligible to become an organ donor 

There are two legal and medical ways someone can donate organs after death:  

1. Brain Death 

This means the person has completely and permanently lost all brain activity, including the brain stem. They are declared dead by a doctor using neurological tests. Learn more about brain death.  

2. Circulatory Death (DCD) 

This is when a person is not brain dead, but their injuries or illness are so serious that they will not survive; meaning they are dependent on artificial, mechanical support (like a ventilator) to keep oxygen and blood flowing to their organs. The doctors and family agree when it’s time to remove the ventilated support and let the person pass peacefully. When this happens, their heart eventually stops beating, and they are declared dead by hospital staff. That’s when Donation after Circulatory Death (DCD) can happen.   

Let’s dive deeper into the second pathway: Organ Donation after Circulatory Death (DCD).  

How organ donation after circulatory death process works 

When a severe injury occurs and an individual is brought to the hospital, the care team will do everything possible to save the patient’s life. Once all life-saving treatments are exhausted and there is no chance for recovery, the medical team and the family decide — together — that it’s time to remove the ventilator. This decision is made completely separate from any conversations about organ donation. LifeSource, or the Organ Procurement Organization (OPO, i.e. organ donation team), does not take part in that decision. 

End-of-life care planning begins. Here is a look at the process when LifeSource is involved:  

Step 1: Referral to organ procurement organization 
By federal law, hospitals must notify their regional OPO — like LifeSource — when a patient meets potential donor criteria (on a ventilator and death is imminent). At this time, the organ procurement organization (OPO) – a team separate from the hospital staff – will begin to evaluate whether the patient may be eligible for organ donation.  

Step 2: Authorization for donation 
During end-of-life planning, LifeSource may talk to the family about the rare opportunity to save lives through organ donation:   

• If the patient is a registered donor, LifeSource walks the family through the donation path that will save the most lives and fulfill their loved one’s legal decision to donate.  

• If the patient is not registered, their legal decision maker (i.e. a family member or health care agent) is asked to make a decision on their behalf. The decision-making process is easier for families if the patient is already registered as a donor and/or if the family had previously discussed donation. 

Step 3: Preparing for donation, evaluation of medical suitability 
The hospital and LifeSource work closely together to plan the donation process. The hospital care team will continue to manage all patient care while specialized medical professionals from LifeSource will evaluate the patient’s medical suitability for organ donation in the hospital. This evaluation in collaboration with the hospital involves assessing the results from lab tests to determine any infectious diseases and health of the organs as well as potential imaging such as X-rays, etc. 

Neurological status is monitored throughout this process by the hospital’s physicians and the organ procurement team.  

Step 4: Controlled withdrawal of ventilated support 
The patient is moved to a surgical setting where a vigil is held; the ventilator is withdrawn in a planned and respectful manner, with their comfort care support as the top priority. The medical team waits until the heart stops naturally.  

In rare cases, after the ventilator is removed, the patient may keep breathing on their own beyond a mandatory observation period. If this happens and the heart doesn’t stop within a set amount of time, organ donation does not happen. The patient is returned to their hospital room, and the hospital team continues comfort care measures for them until natural death.

The comfort care transition process is the same up to this point even if organ donation is not going to happen – the difference is if the ventilator is removed in the specialized intensive care unit (ICU) compared to the operating room. 

Step 5: Death is declared by circulatory criteria 
Once the heart stops and the patient stops breathing, doctors wait at least five minutes to make sure death has truly happened. Only then is death officially declared—by the hospital team, not LifeSource. 

Step 6: Organ donation surgery begins 
The surgical team respectfully proceeds with organ donation. Organs that may be donated through DCD include kidneys, liver, lungs and pancreas. Heart donation is sometimes possible with new medical technology but is less common in DCD than in brain death donation. This process helps save the lives of people waiting for an organ transplant. 

At LifeSource, we believe organ donation is a final act of love and generosity. We are honored to work with families and hospital teams to make sure every step is done with care, respect and compassion.  

DCD is a powerful way to give life, and we are here to support families every step of the way. 

What others often want to know about DCD 

What if the patient keeps breathing after the ventilator is removed?

In almost all circumstances in DCD, a patient is expected to have their last breaths for a short period of time. This is a natural response to the decreased levels of oxygen and increased levels of carbon dioxide. Once the heart stops and breathing ceases, there is a mandatory waiting period (5 minutes) to ensure that the heart does not restart.

In rare cases, after the ventilator is removed, the patient may keep breathing on their own beyond a mandatory observation period. If this happens and the heart doesn’t stop within a set amount of time, organ donation does not happen. The patient is returned to their hospital room, and the hospital team continues comfort care measures for them until natural death.

This can be heartbreaking for families who had hoped their loved one could save lives. But LifeSource and hospital staff are there to support them through this. 

Can families still say goodbye? 

Yes. Families are always given time to say goodbye throughout the donation process. Many hospitals also offer special moments or rituals to honor the donor’s life, such as honor walks, moments of silence, flag raisings and other personalized tributes. 

Is the patient still alive when donation starts? 

No. Organ recovery does not begin until after the patient has been declared dead by the hospital, and only after a set observation period has passed. This ensures the donation process respects the patient and follows ethical and medical standards. 

How is death declared in a DCD case? 

After life-sustaining treatments like a ventilator or medications are withdrawn, the medical team monitors the patient closely. Once the heart stops and breathing ceases, there is a mandatory waiting period (5 minutes) to ensure that the heart does not restart. A physician —not affiliated with the transplant team — then officially declares death. 

Related:  

How long can an organ be outside the body before transplant?