From Determination of Death by Neurological Criteria to Early Graft Function: A 7‐Year Single‐Center Retrospective Study of 155 Consecutive Cases

BACKGROUND: Organ 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. METHODS: We 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). RESULTS: 155 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. CONCLUSIONS: Family 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.