AUTHOR=Opdam Helen , Pérez-Blanco Alicia , Gardiner Dale , Hasz Richard , Jansen Nichon Esther , Le Dorze Matthieu , Sandiumenge Alberto , Testa Giuliano , Then Shih-Ning , Zanierato Marinella , Domínguez-Gil Beatriz , Oniscu Gabriel C. , Cillo Umberto , Martin Dominique E. 
  
TITLE=Establishing standards for controlled donation after circulatory determination of death in adults: the Bucharest international European Society for Organ Transplantation consensus
  
JOURNAL=Transplant International
  
VOLUME=Volume 39 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2026.16284
  
DOI=10.3389/ti.2026.16284
  
ISSN=1432-2277
  
ABSTRACT=Controlled donation after circulatory determination of death (cDCDD) is increasingly vital to expanding deceased organ donation globally, yet variability exists in clinical, legal, and ethical practices. This study utilized a Delphi consensus process involving 37 international experts to develop recommendations to guide the development and operation of adult cDCDD programs. Two survey rounds evaluated agreement on system requirements, donor identification, medical suitability, communication, end-of-life care, and ante-mortem interventions. Consensus was achieved on numerous recommendations emphasizing the need for robust legal frameworks distinct from end-of-life care decisions, multidisciplinary approaches for donor suitability assessment, and clear, sensitive communication led by trained donation professionals. Ensuring patient comfort and dignity during withdrawal of life-sustaining measures, alongside optimizing donation outcomes, was prioritized. Use of ante-mortem interventions was deemed to require careful balancing of benefits and burdens in line with patient and family preferences. The findings highlight international variability and underscore the importance of tailored protocols, education, and further research to establish an evidence base for ante-mortem interventions and improve clinical prediction of donation feasibility. These consensus recommendations aim to advance ethical, effective, and sustainable adult cDCDD programs worldwide.