Brain-Dead Organ Donation in Neurosurgical Care: Roles of Neurosurgeons and Collaboration With the Korea Organ Donation Agency (KODA).

Organ transplantation is the ultimate treatment that extends and improves the quality of life for patients with end-stage organ failure, and among these, brain-dead organ donation enables life-sustaining heart and lung transplants. Since the first kidney transplantation from a brain-dead donor in Korea in 1979, the Organs Transplant Act was enacted in 1999 and comprehensively revised in 2010. This amendment marked a shift in the national framework from "Preventing Organ Trafficking and Ensuring Fair Allocation" toward "Establishing an Active Organ Procurement System" to promote donation. The number of brain-dead donors increased every year from 2010 to 2016 following the comprehensive amendment of the Organs Transplant Act. Since 2017, however, this trend has plateaued and subsequently declined, raising concerns about the widening gap between organ supply and demand, increasing reliance on living donation, and prolonged waiting times and mortality among transplant candidates. The major underlying causes of brain death, including traumatic brain injury, intracranial hemorrhage, and hypoxic brain injury, are frequently encountered in neurocritical care. Therefore, neurosurgeons play a crucial role in the brain-dead organ donation pathway. This review examines the institutional framework and current status of brain-dead organ donation in Korea. It also discusses the major clinical conditions leading to brain-dead organ donation and explores the role of neurosurgeons, as well as points of collaboration with the Korea Organ Donation Agency.