DCD vs DBD · Overview

The World Organ Donation Collaborative

Two pathways to organ donation after death

Most organs come from one of two pathways: donation after brain death (DBD), the more common path, and donation after circulatory death (DCD), the fastest-growing share worldwide. Different starts. Same finish.

~72%
DBD share
~28%
DCD share
5 min
DCD wait
173,727
Transplants · 2024

Both pathways are legally death. Both lead to donation.

The two pathways differ in how death is declared. In donation after brain death (DBD), neurological criteria confirm that the brain has stopped permanently while the heart, supported by a ventilator, is still beating. In donation after circulatory death (DCD), the heart and breathing stop, and the team waits five minutes to confirm the stop is permanent. Both pathways are recognized as death under international consensus criteria, and both lead to organ donation.

The cards below describe each pathway in plain language. The Key insight panel that follows shows how rapidly DCD is reshaping deceased donation in several leading countries. Three visual abstracts at the bottom of the page summarize the same story in different formats — pick whichever works best for your context.

The two pathways
DBD Brain stops first

Donation after brain death

Default · Heart still beating on a ventilator

Catastrophic brain injury — stroke, severe trauma, or cardiac arrest with delay — has caused the brain to stop permanently. A clinical exam and apnea test confirm this. The heart is supported by a ventilator until procurement begins. The more common pathway worldwide.

Worldwide share ~72 % · the dominant pathway
Germany 100 % of deceased donation · no operating DCD program

DCD Heart stops first

Donation after circulatory death

Default · Five-minute wait after the heart stops

A decision to withdraw life support is made independently of donation, with the family. After withdrawal, the heart and breathing stop. The team waits five minutes — long enough to confirm the stop is permanent — before procurement begins. Driving the recent rise in deceased donation worldwide.

Worldwide share ~28 % and rising
Netherlands ~66 % of deceased donation · the highest DCD share globally

Key insight

DCD is reshaping deceased donation in leading countries.

Highest DCD share % of deceased donation
Netherlands ~66
United Kingdom ~52
Belgium ~50

Two-thirds of Dutch deceased donors are now DCD — and the UK has crossed the parity line.

DBD-dominant systems % of deceased donation
Germany 100
Italy ~90
Portugal ~90

Other high-rate systems remain DBD-dominant — and a few report no DCD activity at all. The pathway mix varies far more than the overall rate.

DCD share  =  donation after circulatory death as a percentage of all deceased donors (2023–2024). Figures rounded; exact values in the dashboard.

What happens, step by step

Two parallel journeys to organ donation

Brain death (DBD)

  1. Catastrophic brain injuryStroke, trauma, or cardiac arrest with delay.
  2. Clinical exam + apnea testConfirms the brain has stopped permanently.
  3. Death declaredOn neurological criteria.
  4. Heart still beating on ventilatorFamily consents to donation.
  5. Organ procurementHeart, lungs, liver, kidneys, pancreas.

Circulatory death (DCD)

  1. Decision to withdraw life supportMade independently of donation, with the family.
  2. Withdrawal in the OR or nearbyHeart and breathing stop within minutes to hours.
  3. Five-minute waitNo heart restart = death is permanent.
  4. Death declaredOn circulatory criteria.
  5. Organ procurementKidneys, liver, lungs; heart with new perfusion.
FINDING

Different starts. Same final step.

Steps 1–4 differ. Step 5 — donation — is the same.

Two ways to be declared dead

Both lead to donation.

Brain death (DBD)

~72%

Brain icon

The brain stops permanently; the heart can still beat on a ventilator. The more common pathway worldwide.

Germany 100% of deceased donation — no operating DCD program.

Circulatory death (DCD)

~28%

Heart icon

The heart and breathing stop. The team waits five minutes to confirm; then procurement begins.

Netherlands ~66% of deceased donation — the highest DCD share globally.

FINDING

Different starts, same finish.

Both pathways are legally death. Both lead to donation.

Types of DCD

Maastricht classification

  1. IDead on arrivalUncontrolled — unexpected cardiac arrest outside hospital, no resuscitation possible.
  2. IIUnsuccessful resuscitationUncontrolled — cardiac arrest with attempted but failed resuscitation.
  3. IIIAwaiting cardiac arrestControlled — planned withdrawal of life support after a decision made with the family. most common
  4. IVCardiac arrest in a brain-dead donorControlled — unexpected arrest during DBD workup or procurement.
  5. VCardiac arrest in an inpatientControlled — added in the modified Maastricht classification (Thuong et al., 2016).
FINDING

Most DCD worldwide is Type III.

Controlled, planned withdrawal — the only type most systems support.

After the heart stops, the team waits

The pause that proves death is permanent

12 3 6 9 WAIT 5 MINUTES

Some countries (notably Italy) extend the observation period up to 20 minutes.

FINDING

Five minutes proves the stop is permanent.

The 5-minute period is the observation period.

Go deeper
The WOD Collaborative
Interactive · 17 countries
Country dashboard
 The WOD Collaborative
Read the full article
Donation after Brain Death, Donation after Circulatory Death
 The WOD Collaborative — For Everyone
Plain language
Donation after Brain Death, Donation after Circulatory Death For everyone
 The WOD Collaborative
References · primary sources
Bibliography