Clinical Triggers

Clinical triggers to call include a mechanically ventilated patient with a severe neurologic injury or insult and one of the following:
  • A patient whom a physician is evaluating for brain death, or
  • A patient with a Glasgow Coma Score (GCS) of five or less, or
  • A plan to discuss withdrawal of life-sustaining therapies

The concept of organ donation clinical triggers was developed during the first Organ Donation Breakthrough Collaborative session (October 2002-May 2005). The first collaborative specifically studied the donation practices of high-performing hospitals and organ procurement organizations. Identifying and utilizing clinical triggers was identified as a donation best practice based on the following.

Clinical Triggers

  • Define a standard point in care when the hospital is expected to call the OPO with a referral (imminent death)
  • Allow hospital and OPO staff time to support potential donor families
  • Allow the hospital and OPO time to collaborate regarding the referral
  • Allow hospital and OPO staff time to build a relationship of trust with potential donor families

According to the Centers for Medicare and Medicaid Services Conditions of Participation for organ donation as well as Joint Commission, all deaths and imminent deaths must be referred to the organ procurement organization (OPO) in a timely manner. Timely notification is defined as the referral being made to the OPO within (1) hour of the patient meeting clinical triggers as defined above.


In addition, the hospital must call the OPO prior to the withdrawal of life support as well as prior to approaching a family regarding donation.