Observational studyClinical transplantation2026
From Determination of Death by Neurological Criteria to Early Graft Function: A 7-Year Single-Center Retrospective Study of 155 Consecutive Cases.
Observational study in Clinical transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
backgroundOrgan donation after determination of death by neurological criteria (DBD) remains a cornerstone of deceased donation programs, yet the full pathway from donor identification to organ retrieval, transplantation, and early graft function remains insufficiently described. A better understanding of where falls occurs along this trajectory may help identify modifiable barriers and improve donation-system performance.
methodsWe performed a retrospective single-center observational study including all consecutive cases of patients who underwent determination of death by neurological criteria recorded between 2019-2025 in four intensive care units of a tertiary-care hospital in Northern Italy. Data were extracted from institutional clinical and donation records and included donor characteristics, recorded donation preference, family authorization, causes of non-retrieval, number and type of organs retrieved and transplanted, and early graft functional recovery (e.g., 24-48 h posttransplant).
results155 patients underwent determination of death by neurological criteria. Organ retrieval was performed in 111 cases (71.6%). Documented prior consent was present in 41 cases (26.4%), decline in 3 (1.9%), and no prior recorded donation preference in 106 cases (68.4%), requiring family authorization. In this subgroup, family decline occurred in 27 cases (25.5%) and represented the leading cause of non-retrieval. Medical contraindications accounted for 12 further exclusions. Overall, 365 organs were retrieved, corresponding to 65.8% of potentially available organs; 343 (94.0%) were transplanted, and 332 (96.8% of transplanted organs) showed functional recovery at 24-48 h. Mean number of retrieved organs was 3.28, with 2.99 functioning grafts per donor.
conclusionsFamily decline and non-retrieval of organs judged unsuitable at retrieval were the main points of loss along the donation pathway. Systematic whole-pathway data collection may help identify missed opportunities, guide quality-improvement strategies, and optimize assessment at the organ retrieval stage.
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