Seeking global agreement on controlled donation after circulatory determination of death: methodology and definitions of the Bucharest international European Society for Organ Transplantation (ESOT) consensus

Controlled donation after circulatory determination of death (cDCDD) is now a major contributor to transplant activity worldwide. However, its expansion has been complicated by inconsistent terminology, diverse clinical protocols, and ethical uncertainties. To address these challenges, the European Society for Organ Transplantation (ESOT) convened a global consensus forum involving multidisciplinary experts from various geographic regions. Four steering committees were established to address adult and pediatric donation pathways, normothermic regional perfusion, and the determination of death. Using a structured methodology, expert panels participated in two waves of surveys, complemented by an in-person consensus meeting to develop recommendations on key clinical and ethical aspects of cDCDD. This article presents the project methodology and consensus results regarding standardized terminology and definitions that are essential for successfully harmonizing international practice. Consensus was achieved on fundamental terms, including the recommended nomenclature of "donation after circulatory determination of death," definitions of clinical categories such as possible and potential donors, and key time points in donation protocols. The establishment of shared terminology provides a foundation for comparing outcomes across programs, facilitating international research collaboration, and supporting evidence-based improvements in clinical practice. This consensus represents an important step toward global convergence of donation practices while maintaining core ethical values and supporting continued technological and societal progress in the field.