Landscape of Deceased Donor Pathways: A 4-Year Experience in the Tuscany Region

Donor pathways (donation after neurological death, ie, brain death; and donation after circulatory death ) are influenced, within each country, by several factors such as social trends and disease prevalence, which profoundly affect the mechanism and age of deaths in a population. An informed perspective on this process requires a rigorous analysis of donor efficiency (number of organs retrieved and transplanted, utilization rate, and organs per donor ) and procurement policies.

We assessed the procurement activity regarding deceased donors in the Tuscany region from the period 2022 -2025. We focused on trends in donation after brain death and donation after circulatory death (both controlled and uncontrolled donation after circulatory death ), and on deceased donor pathway efficiency as assessed by utilization rate and organs per donor.

In the Tuscany region, 1517 donors were assessed from the period 2022-2025. Most were donations after brain death (1260 /1517, 83 % ), and the remaining 257 (17 % ) were donations after circulatory death (162 uncontrolled, 63 %; and 95 controlled, 37 % ). The number of uncontrolled donations after circulatory death remained stable, whereas the number of controlled donations after circulatory death showed progressive growth. Utilization rate remained stable in donations after brain death and controlled donations after circulatory death, whereas the rate progressively increased in uncontrolled donations after circulatory death (from 56 % in 2022, to 73 % in 2025 ). During the study period, 1367 transplants were performed, and donations after brain death were the main source for transplants.

Among 1517 deceased donors, the high performance of the donation after brain death pathway, particularly regarding transplant volume and transplant type, underscores the critical need for the systematic identification and optimal management of all potential donations after brain death within the territory.