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Advocacy & Resources

Surgical Standards for Surgeons Performing Deceased Donor Organ Procurements for Transplantation

ASTS Standards & Quality Committee

Approved by the ASTS Executive Committee: April 2023

Because it is the first stage of the organ transplantation process, high quality organ procurement is essential to successful transplantation, and good stewardship of donor family wishes necessitates comprehensive professional training and application of the highest standards to those who procure organs, particularly in view of the increasing technical complexities of the procedure. 

The intent of the following standards for the procurement of organs is to establish criteria by which transplant centers and organ procurement organizations (OPOs) can ensure that, in addition to meeting any applicable licensure or third-party payer requirements, individuals who procure deceased donor organs are appropriately trained to provide the highest quality organs possible from every deceased donor with consistency, safety and professionalism. 

Criteria for Surgeons Performing Deceased Donor Procurements

  • A surgeon must have a US medical license or institutional license (form of restricted medical license to practice) and transplant training as outlined below:
  • A surgeon with a US medical license should: 
  • Have completed an ASTS-accredited transplant fellowship with a total of 25 multi-organ procurements, including five (5) DCD procurements (Qualified Transplant Surgeon); or 
  • Be in the process of completing an ASTS-accredited transplant fellowship and must have completed a total of at least 10 multi-organ procurements, including two (2) DCD procurements, with observation from a qualified procurement surgeon and approval from an attending surgeon(s) in his or her fellowship program; or 
  • Have completed transplant training or organ procurement training in another format with a total of 25 multi-organ procurements (including five (5) DCD procurements) under the observation of a Qualified Transplant Surgeon, and obtain a letter of approval from that Qualified Transplant Surgeon.   
  • A surgeon with an institutional license, restricted medical license, or international degree should:
  • Have completed transplant training or organ procurement training in another format; and
  • Have completed 25 multi-organ procurements (including five (5) DCD procurements) under the observation of a Qualified Transplant Surgeon; and
  • Provide documentation of review and approval from a Qualified Transplant Surgeon.
  • Regardless of age or experience, a surgeon who has not completed an organ procurement in the last six (6) years and is not a practicing transplant surgeon should only perform organ recovery in the presence of a Qualified Transplant Surgeon. Supervision of one procurement and approval prior to independent procurements is sufficient to perform independent recoveries.

Additional Recommendations 

ASTS recommends that OPOs track the quality of the procurement services provided by those who procure organs for transplantation and that performance issues, including behavioral issues, be noted in the ACIN system and reported to the entity with which the procuring surgeon is affiliated. If poor performance leads to the loss of a potentially transplantable organ, a report must be filed with the Organ Procurement and Transplantation Network. A surgeon can lose transplant program or OPO privileges to perform donor recoveries if quality issues arise or if the surgeon fails to comply with an established code of conduct. 

Procedural Standards for Deceased Donor Organ Recovery, Approved by the ASTS Council - January 2022