Potential for donation after circulatory death in Germany: a multicenter retrospective study at seven university hospitals.

Many countries have established donation after circulatory death (DCD) in addition to donation after brain death (DBD). In Germany, DCD is not permitted, and its potential to increase organ donation rates has not yet been quantified. We retrospectively identified all deceased with brain injury between 2023-2024 at seven German university hospitals. Eligible DCD donors were defined as patients with preserved brainstem reflexes precluding DBD donation, documented consent or an unknown donation preference, and death occurring within 120 min after withdrawal of life-sustaining measures. For patients with unknown preference, a consent rate of 40% was assumed. Among 4,587 deceased, 1,509 had preserved brainstem reflexes as the main reason against DBD. Of these, 58 patients with documented consent and 212 patients with an unknown donation preference died within 120 min after treatment withdrawal. Compared with 128 utilized DBD donors, this corresponds to an additional theoretical DCD potential of 45% based solely on documented consent. When applying the assumed consent rate to patients with an unknown preference, the hypothetical increase reaches 112%. The introduction of a DCD program could substantially increase organ donation rates at German university hospitals. However, its actual impact would depend on establishing appropriate legal, organizational, and ethical frameworks.