Organ donation network to let procurement teams approach families before life-support decision

The Organ Procurement and Transplantation Network rules, described in an opinion piece by a neurointensivist at Oregon Health & Science University, will allow organ procurement organizations to initiate donation conversations with families before clinicians and families decide whether to continue or withdraw life-sustaining treatment. The change is scheduled to begin Nov. 18. Its stated aim is to increase viable organ availability for more than 100,000 people on the U.S. transplant waiting list.

The piece cites a 2025 Department of Health and Human Services report of 73 cases in which organ donation was authorized but not completed after donors showed neurological signs incompatible with donation. It also notes New York Times reporting that some patients may not have been dead when procurement began, especially in rural or small hospitals. The author contrasts donation after circulatory death, which relies on prognostic judgment, with brain death determination, which uses standardized criteria.

Under the Uniform Determination of Death Act, most states recognize death by irreversible cessation of circulation and breathing or irreversible loss of entire brain function. For families, a brain-dead patient can still appear alive on a ventilator, with a beating heart and warm skin. The author argues early procurement contact may blur roles between doctors trying to save a patient and teams seeking organs, potentially weakening trust. The evidence is policy description and expert observation, not a clinical trial or outcome study.

The rules affect families facing catastrophic brain injury, ICU clinicians, organ procurement organizations and transplant candidates. The author recalls a 22-year-old donor whose organs saved four people. Families may be asked about donation before they have accepted a diagnosis or decided on withdrawal, while procurement teams seek organs that can save people waiting for transplants. The source does not provide outcome data showing whether early approaches will increase donations or reduce trust; it describes a regulatory change and a concern about role separation.