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Updated: Sep 11, 2026
Promotion of Survival and Differentiation of Neural Stem Cells with Fibrin and Growth Factor Cocktails after Severe Spinal Cord Injury
Published on: July 27, 2014
From Determination of Death by Neurological Criteria to Early Graft Function: A 7-Year Single-Center Retrospective
Alessandra Agnese Grossi1,2, Baiardo Redaelli Martina3,4, Federica De Min4,5
1Research Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy.
Background:
Organ donation after determination of death by neurological criteria (DBD) remains a cornerstone of deceased donation programs, yet the full pathway from donor identification to organ retrieval, transplantation, and early graft function remains insufficiently described. A better understanding of where falls occurs along this trajectory may help identify modifiable barriers and improve donation-system performance.
Methods:
We performed a retrospective single-center observational study including all consecutive cases of patients who underwent determination of death by neurological criteria recorded between 2019-2025 in four intensive care units of a tertiary-care hospital in Northern Italy. Data were extracted from institutional clinical and donation records and included donor characteristics, recorded donation preference, family authorization, causes of non-retrieval, number and type of organs retrieved and transplanted, and early graft functional recovery (e.g., 24-48 h posttransplant).
Results:
155 patients underwent determination of death by neurological criteria. Organ retrieval was performed in 111 cases (71.6%). Documented prior consent was present in 41 cases (26.4%), decline in 3 (1.9%), and no prior recorded donation preference in 106 cases (68.4%), requiring family authorization. In this subgroup, family decline occurred in 27 cases (25.5%) and represented the leading cause of non-retrieval. Medical contraindications accounted for 12 further exclusions. Overall, 365 organs were retrieved, corresponding to 65.8% of potentially available organs; 343 (94.0%) were transplanted, and 332 (96.8% of transplanted organs) showed functional recovery at 24-48 h. Mean number of retrieved organs was 3.28, with 2.99 functioning grafts per donor.
Conclusions:
Family decline and non-retrieval of organs judged unsuitable at retrieval were the main points of loss along the donation pathway. Systematic whole-pathway data collection may help identify missed opportunities, guide quality-improvement strategies, and optimize assessment at the organ retrieval stage.