Introduction: Declaration of brain death (BD) and subsequent management of potential donors for organ transplant along with obtaining the consent of the family for procurement is a highly sensitive issue. The Argentine Law 27447, approved on 2018, makes all citizens donors unless they explicitly express otherwise. Thus, in 2019 transplants increased almost by 60 % compared to 2018. In the present work, and in order to deeply analyze the evolution of the brain donors, we studied the management of brain death patients as transplant donors.

Methods: The National Transplant Information System (SINTRA) was used to analyzed the evolution of the total number (3038) of certified brain deaths in the Argentine Republic during the 2019-2021 period. Ages between 1 day and 83 years. Average age: 41,1 years. 39 % female and 61 % male. The analysis included 437 public and private institutions of the 24 jurisdictions of the Country.

Results: From a total of 3038 certified BD, 83 % (n = 2535) was approached to family to the donation. Only 7 % (n= 183) of them presented express manifestation in life about donation (15% negative, and 85% affirmative), while 82 % (n=2075) and 11 % (n = 335) were done to relatives of potential adult and 18 younger age donors, respectively. It is important to mention that, according to law 27447, potential adult donors are considered presumed donors. Among adult donors, 91% were affirmative and 9% negative, while for donors under 18 years of age were 43% negative and 57% affirmative). Among the total number of BD, 64 % (n=1957) became real donors. The remaining 36% were not ablated due to: opposition to donation (11 %, n = 335), cardiac arrest prior to ablation (3%, n=101), judicial refusal (0.75 %, n=23), other causes of non-ablation (1%, n=33), and absolute medical contraindication (19%, n=589), of which 7% (n=39) (7%) were ruled out due to COVID-19 (29 in 2020 and 10 in 2021).

Conclusions: The lowest rate of opposition to donation was observed in the group of potential donors considered presumptive donors. This allows us to conclude that Law 27447 is an effective tool when communicating the donation, exempting family members from having to make the decision. The highest rate of opposition to donation was observed in the group of minors, in whom the family is the one who must decide on the donation. Likewise, regarding the manifestations of donation by the family, it was evidenced that the majority of the people made an affirmative organ donation. Overall, most of the BD detected became real donors, being those that did not, due to expected/reasonable causes, and even with percentages below those considered at the international level, demonstrating the optimization and quality of the process from its beginning.