Abstract Aims Family authorization remains a major constraint on deceased organ donation after brain death. Although the timing of the donation request is known to influence authorization, it is unclear whether this effect varies according to the donor’s physiologic condition at the time of death. Subject and methods A sample of 7142 adults declared with brain death from six US organ procurement organizations (ORCHID, 2015–2021) was analyzed. Multivariable logistic regression was used to identify predictors of family authorization and to test interactions between time from brain death to family approach and routinely collected clinical and laboratory measures. Results Overall, 81.1% of families authorized donation. Longer delays between brain death and the family approach were associated with lower odds of authorization (OR 0.98 per hour, 95% CI 0.97–0.99). Authorization was less likely among families of Black or African American potential donors and more likely following deaths from suicide or non-motor vehicle accidents compared with natural causes. Several physiologic measures, including serum sodium, glucose, white blood cell count, hemoglobin, and platelet count, were independently associated with authorization. Further, total bilirubin and platelet count modified the effect of timing. Delays reduced authorization more when bilirubin was elevated or platelets were low, and less when donors were physiologically stable. Conclusion The influence of timing on family authorization may depend in part on the donor’s clinical condition. Our findings suggest that earlier discussions could be particularly important when laboratory values prior to death indicate physiologic deterioration, whereas modest delays appeared less strongly associated with authorization when physiologic measures were more stable.
Powla et al. (2026) studied this question.