Trends and determinants of organ and tissue donation at a level I trauma centre in north India (2022-2025)

Background and objectives Globally, India ranks the third highest for the number of organ transplants performed; however, its deceased organ donations remain limited. Despite numerous brain injury cases and potential brain-dead donors, the organ retrieval rates and donor conversions remain low across trauma centres. This study evaluated the donor pathway, conversion rates, and barriers to organ donation in a tertiary trauma centre. Methods We conducted a retrospective audit of prospectively collected data from potential deceased brain donors at a level I Trauma Centre from January 2022 - December 2025. Yearly trends in donor conversion, family consent, medical exclusion, organ yield, workflow timelines, and barriers to successful donations were assessed. Results Of 1575 hospital deaths, 805 (51.1%) were identified as potential donors. Total 148 (18.4%) progressed to brainstem death declaration; consent was obtained in 47 (31.7%) of these. A total of 43 patients proceeded to organ donation, yielding an overall donor conversion rate of 29% (which declined from 39.5% in 2022 to 16.1% in 2025 despite increased donor identification). Hemodynamic instability was the leading cause of medical exclusion, while family refusal accounted for most non-conversions after brainstem death declaration. A total of 187 organs and tissues were retrieved, with an overall mean yield of 4.35 per donor (2.5 organs and 1.84 tissues per donor). Kidneys (n=59) and corneas (n=64) were the most frequently retrieved, while thoracic organ retrieval remained limited (16 hearts and 4 lung donations). Interpretation and conclusions Our data showed that despite consistent donor identification, the donation and consent rates remained low. Hemodynamic instability was the major barrier to potential organ donation, suggesting that strengthening early donor stabilisation, structured counselling, faculty sensitisation, and donation after circulatory death programmes may improve conversion in organ yield. We recommend routine audits for course correction and to support the development of stronger donation programmes nationwide.