Background: Although the Korea National Organ Transplantation Law was enacted on February 9, 2000, the disparity between supply and demand was problematic with lack of organ donors. On June 1, 2011, 10 years after enacted Law, the establishment of independent organ procurement agency, Korea Organ Donation Agency(KODA) and obligatory reporting potential brain death(PBD) patients to KODA were amended. Accordingly, in the event of brain death, the donation was processed promptly and systematically. We analyze and report on brain death organ donation(BDOD) in Korea retrospectively for 10 years.

Method: A retrospective analysis was conducted on 20,171 PBD and 5,047 BDOD notified to the KODA from 2011 to 2021.

Result: Notifications of PBD increased from 609 in 2011, recording the highest notifications to 2,484 in 2019, and notifications of PBD was 2,141 in 2021. The number of BDOD increased from 368(pmp 7.2) in 2011 to highest 573(pmp 11.39) in 2016. Recently, it is showing a decreasing trend of 515 in 2017, 449 in 2018, 450 in 2019, 478 in 2020, and 442 in 2021(pmp 8.53). 67.8% of BDOD were male, which was more than female. The age groups mainly consisted of 28% in their 50s, 24% in their 40s, 15.4% in their 60s, and 12.3% in their 30s. The average age of them increased by 5.8 years over 10 years from 43.3 years old in 2011 to 49.1 years old in 2021. indicating that the upper age limit for donors is increasing. In 2019, the oldest brain-dead organ donor was 86 years old. The causes of brain death of BDOD were cerebrovascular system/stroke (40.9%), hypoxic brain injury (29.4%), head trauma (27.9%), central nervous system tumor (0.7%), and others 1% in order. As a result of analysis of the two periods from 2011 to 2015 and 2016 to 2021, it was cerebrovascular system/stroke (44.3%), head trauma (29.9%), and hypoxic brain injury (23.8%) in order from 2011 to 2015, but it was cerebrovascular system/stroke (38.4%), hypoxic brain injury (33.6%), and head trauma (26.5%) in order from 2016 to 2021, indicating that the proportion of hypoxic brain injury increased.

Conclusion: Even in the unique Asian cultural and ethical environment such as confucianism, BDOD has made great progress in Korea. The number of notifications of PBD and BDOD increased because of the enforcement of the amended law. However, it is currently stagnant because of various factors such as the enforcement of the「Act On Hospice And Palliative Care And Decisions On Life-sustaining Treatment For Patients At The End Of Life」in February 2018 and the recent COVID-19 outbreak. In order to promote organ donations by BDOD in the future, it is required to prepare for a new leap forward for life sharing by strengthening the role of organ procurement organizations and by preparation of the groundwork for DCD implementation with the amendment of the law.