POLICY AND PRACTICE REVIEWS article
Front. Transplant.
Sec. Abdominal Transplantation
This article is part of the Research TopicOvercoming Barriers and Enhancing Strategies in Organ Transplantation SystemsView all articles
Variability in clinical triggers for organ donation referrals
Provisionally accepted
Kylie Casey1,2*
Elizabeth Thomas3,4- 1Baptist Health System, San Antonio, United States
- 2US Acute Care Solutions LLC, Canton, United States
- 3University Health, San Antonio, United States
- 4The University of Texas Health Science Center at San Antonio, San Antonio, United States
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In organ transplantation, regulatory efforts have mainly targeted Organ Procurement Organizations (OPOs) and transplant centers, while donor hospitals—crucial to the donation process—have remained under-examined. As the first point of contact for potential donors, these hospitals lack standardized criteria for when and how to refer patients to OPOs, creating variability that can delay referral and reduce organ availability. This viewpoint focuses on clinical triggers: the physiological criteria that prompt hospitals to notify OPOs of potential donors. While CMS requires donor hospitals to maintain written agreements with their designated OPOs and to inform the OPO of deaths and "imminent deaths," there is no national standard defining which bedside clinical criteria should prompt timely notifications; most hospitals defer to their local OPO for guidance. We analyzed clinical triggers from 55 of 56 U.S. OPOs and found marked inconsistency. Glasgow Coma Scale thresholds were used by 69.1%, and brainstem reflexes by 54.6%, with wide variation in both. Fewer than half addressed family discussions, and notification windows ranged from immediate to 240 minutes. These discrepancies reflect a critical bottleneck in the donor identification process. Standardizing clinical triggers and instituting a referral-based performance metric framework may improve metrics, thereby enhancing early donor identification, reducing missed referral opportunities, enhancing organ recovery, and reducing waitlist mortality. As scrutiny of OPOs and transplant centers increases, improving donor hospital practices is essential to optimizing the transplant system.
Keywords: Brainstem reflexes, Clinical Triggers, Donor referral, GCS, Healthcare quality, OPO, organ procurement, standardization
Received: 08 Sep 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 Casey and Thomas. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Kylie Casey
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