Every ICU clinician has a professional and ethical responsibility to identify potential organ donors and refer them to the SNOD. There is clear evidence that the availability of specialist nurse support, and the manner in which families are approached, are the most significant determinants of consent rates — but this process cannot begin unless the clinical team identifies the potential donor and makes the referral.

A potential DBD donor is any patient who meets or is approaching brain stem death criteria while being maintained on a ventilator. A potential DCD donor is any patient in whom a decision to withdraw life-sustaining treatment has been made or is under consideration, and who does not meet brain stem death criteria. Both populations should be referred to the SNOD early — ideally before brain stem death is confirmed in the DBD pathway, and at the point of the withdrawal decision in the DCD pathway.

The SNOD (Specialist Nurse for Organ Donation) is an NHSBT employee, not a member of the clinical team caring for the patient, and has no involvement in the management decisions leading to brain stem death diagnosis or withdrawal of treatment. The SNOD brings specialist expertise in donor suitability assessment, family communication, logistics coordination, and donor management. NHSBT data consistently shows that SNOD-facilitated family conversations result in significantly higher consent/authorisation rates than those conducted by clinical staff alone.

Absolute Contraindications to Organ Donation

Absolute contraindications are rare and far fewer than commonly assumed. They include confirmed or suspected Creutzfeldt-Jakob disease (CJD) and other prion diseases, and active malignancy with metastatic spread outside the CNS at the time of death. Most other conditions — including HIV, hepatitis B and C, age, hypertension, diabetes, and even some malignancies — are not absolute contraindications. The SNOD should be involved to assess suitability rather than individual clinicians making that determination in isolation.