Each year, more than 7,000 deceased donors make more than 20,000 organ transplants possible [17]. Organs such as the heart, lung, liver, kidneys, pancreas, and small bowel are potentially life-saving. Even tissues such bone, tendons, ligaments, corneas, skin, and heart valves from cadaveric donors can be procured and used to replace such tissues damaged by trauma or disease. However, the need for organs still surpasses availability. As of 2013, more than 110,000 patients of all ages currently await life-saving organ transplants. An average of 18 people die daily because of the lack of organs. Neurosurgical patients who suffer catastrophic intracranial events are a major source of organ donation [5]. This chapter aims to inform families of loved ones who have sustained irreversible brain injuries of the process of organ donation, and also to encourage individuals to help alleviate the organ shortage by signing up to be a donor with their state’s donor registry.

In 1984, the National Organ Transplant Act was passed by the US Congress [4]. The act called for a national Organ Procurement and Transplantation Network (OPTN) to be created. The aim of the OPTN is to manage the country’s organ procurement, donation, and transplantation system and to increase the availability of and access to donor organs for patients with end stage organ failure [8, 9]. OPTN members include all US transplant centers, organ procurement organizations (OPO), histocompatibility laboratories, voluntary health care organizations, medical and scientific organizations, and members of the general public. UNOS (United Network for Organ Sharing) currently based in Virginia was awarded the OPTN contract in 1986 by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). UNOS has operated the OPTN continually since that time under contract with HRSA. The Organ Procurement Organization (OPO) is the local agency responsible for the recovery, preservation and transportation of organs for transplantation. Currently there are 58 OPOs in the US. One of the aims of the OPO is to educate the public about the critical need for organ donation. An OPO’s service area can include a portion of a state, an entire state, or more than one state. The OPO will be notified when a patient in a hospital is a potential organ donor. Coordinators from the OPO will then approach the family of the potential donor with the aim of building a rapport with the family during this trying and stressful time and to explain the process of organ donation. When a donor is identified and organs become available for transplantation, an electronic list of potential recipients is generated from the OPO’s local service area. If no suitable match is made, a wider regional list of potential recipients is generated, followed by a national list.

Typical neurosurgical patients who are potential organ donors include those who have sustained unrecoverable intracranial cerebrovascular accidents and traumatic brain injuries. Even brain dead patients who have brain tumors may be able to donate organs and tissues provided that their tumors have no malignant potential or have not metastasized. As medical science evolves, donation opportunities change and may widen. A patient’s medical condition at the time of death determines which organs and tissues can be donated. Donation does not interfere with medical care. Consent for donation is confirmed by verifying the person’s enrollment on a state registry (and typically will be noted on one’s drivers license) or by obtaining written consent from the family. The organ procurement procedure is a surgical operation which can take up to 3–4 h, during which the body is treated with the utmost of respect and care. Organ donation will not change or delay funeral arrangements and will not interfere with open casket funeral viewing. It is illegal to buy and sell organs and tissues in the United States, and there is no cost to the deceased donor’s family for organ and tissue donation.

Organ and tissue donation can only occur after all life-saving efforts have been made and death has been declared [2, 7, 15]. During the earliest years of transplantation through the 1960s, determination of death required the heart to stop. The first deceased donor kidney, liver and heart transplants in 1958, 1963, and 1967 respectively were all performed using organs recovered from donors who had irreversible cessation of cardiac and circulatory function (hence the term cardiac death or non-heart beating donors). In the 1960’s, the concept of brain death came into being with the report of the Ad Hoc Committee of the Harvard Medical School in 1968 [1] establishing the criteria for the determination of brain death. Brain death has since been endorsed by all the major medical and legal professional associations in the United States and Europe [13]. Organs procured from brain dead individuals seem to function better than those procured from cardiac death donors, as the latter organs are more exposed to the effects of low blood flow with resulting poor oxygenation of the tissues and consequent poor graft function. For the next quarter of a century, virtually all organ donation was from brain dead individuals. In 2004, only 4 % of deceased donors in the United States were cardiac death donors [16]. Cardiac and pulmonary functions in brain dead individuals are usually intact or maintained with respirators or medications. For this reason, brain death can be emotionally very distressing and puzzling to family and friends, because their loved ones appear warm, alive and viable, but these patients are, in fact, dead. Another source of confusion for family members can be the distinction between brain death and the persistent vegetative state. The latter is defined as a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. These patients are not brain dead, and organ procurement from such patients is illegal [7].