Summary We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4–5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life‐sustaining measures were withdrawn in 413/553 of non‐donors (75%).

Donation after the circulatory determination of death (DCDD) has emerged as a valuable strategy to increase the availability of organs for transplantation. 1 In 2018, 23% of the 39 357 deceased organ donors reported to the Global Observatory on Donation and Transplantation had been declared dead by circulatory criteria. 2,3 DCDD also provides the opportunity of posthumous donation when patients die following an unsuccessfully-resuscitated cardiac arrest (uncontrolled DCDD [uDCDD]) or the decision to withdraw of life-sustaining therapies (WLSTs) that are no longer deemed beneficial to the patient (controlled DCDD [cDCDD]). 4cDCDD programs already exist in 17 countries throughout the world. 2,3,5 In cDCDD, the effects of warm ischemia during the agonal period after the WLST and following the cessation of circulation are further exacerbated during the later phase of cold

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The early success described in this case report demonstrates the technical and clinical feasibility of transplanting all the tissues of the with all its aesthetic and functional units intact.