**3. Deceased donation: Donations after brain death versus Donations after cardiac death**

Organ donation has traditionally been possible only after brain death. It now includes donations after cardiac death (DCD), which is increasing in European countries, North America, and Australia. However, the majority of deceased donor organs continue to be from donations after brain death (DBD). DCD are from donors who do not meet the criterion for brain death, and whose cardiac function stopped before the organs were procured. The cessation of cardiac function could have occurred spontaneously or initiated deliberately. There are two types of DCDs, controlled and uncontrolled. In controlled DCD, the donor is withdrawn from life support and his or her family has given written consent for organ donation in a controlled environment. The clinical steps for controlled DCD are shown in **Figure 2**. In uncontrolled DCD, the donor died in the emergency department or elsewhere in the hospital before consent for organ donation was obtained. Catheters are placed in the femoral vessels to cool organs and infuse perfusate until consent can be obtained.

DCD now accounts for 17% of the 31,812 donors reported to the Global Observatory on Organ Donation and Transplantation in 2015 [1]. DCD is used in a limited number of countries, because of legislative and ethical obstacles, lack of technical expertise, and/or insufficient organizational capabilities [2, 8]. There are also differences in DCD practices, including differences in legislative and ethical frameworks, patterns of end-of-life care, and approaches for the treatment of patients with cardiovascular arrest outside of the hospital [9]. Although transplant outcomes from organs obtained from DCD donors are appropriate overall, they need improvement [9]. It is generally accepted that DCD can substantially increase the availability of deceased donor organs with optimal results.

**Figure 2.** Clinical steps for controlled DCD.
