Quick answer: Pennsylvania’s Act 90 of 2018, updated with new rules effective May 1, 2026, requires licensed nurses and physicians to complete at least 2 hours of CE on organ and tissue donation. This post breaks down what the law requires, what clinicians need to know clinically, and how to meet the organ and tissue donation CE requirement in Pennsylvania.
Every 8 minutes, someone new joins the national transplant waiting list. As of 2026, more than 100,000 people are waiting for a lifesaving organ in the United States, and approximately 13 people die each day before one becomes available (Health Resources & Services Administration, 2026). In Pennsylvania alone, more than 6,000 residents are waiting for a transplant.
That gap isn’t only a supply problem. It’s also a missed opportunity problem, and clinicians are in a unique position to close it. The Pennsylvania General Assembly has responded with laws that puts organ and tissue donation education directly into the hands of frontline care providers. Here’s what you need to know.
What does Pennsylvania law require for organ donation CE?
Pennsylvania’s Act 90 of 2018 established the foundation for organ donation education requirements for licensed healthcare professionals. Effective May 1, 2026, registered nurses must complete at least 2 hours of Board-approved continuing education in organ and tissue donation and recovery. They must complete this CE one time within 5 years of initial licensure or within 5 years of licensure renewal, whichever comes first (Pennsylvania State Board of Nursing, 2025).
Physicians have had a similar requirement under Act 90 since 2018.
The Pennsylvania State Board of Nursing approved a six-part curriculum to satisfy this requirement:
- Overview of the organ donation and transplantation system
- Tissue donation process
- Organ donation process
- Determining death and family communication
- Caring for families
- Organ donor management
Nurses must retain a certificate of completion in case of an audit. CE can be obtained through approved providers, including the designated organ procurement organizations (OPOs) for Pennsylvania: the Center for Organ Recovery and Education (CORE) and Gift of Life Donor Program.
View CE course: Supporting Organ and Tissue Donation in Clinical Settings: The Pennsylvania Requirement
How does the U.S. organ donation system work?
The National Organ Transplant Act (NOTA) of 1984 created the legal framework for the modern transplant system, establishing the Organ Procurement and Transplantation Network (OPTN), currently operated by the United Network for Organ Sharing (UNOS). OPTN sets the policies governing organ allocation, matching, and distribution nationwide (UNOS, 2026).
In Pennsylvania, two OPOs divide the state: Gift of Life Donor Program serves southeastern Pennsylvania, while CORE covers western and central regions (Donate Life Pennsylvania, 2024). When clinicians identify a potential donor, the OPO evaluates medical suitability, obtains authorization, coordinates surgical procurement, and facilitates organ placement through UNOS.
Pennsylvania also requires all hospitals to have Required Request Protocols: written procedures ensuring that families of patients who die or are declared brain dead are offered the option of donation. Donor registration happens through the Donate Life PA registry, accessible via PennDOT license renewal or online.
One important point for clinicians: very few absolute contraindications to donation actually exist. Active untreated sepsis in a specific organ, active metastatic cancer (with some exceptions), and certain transmissible infections like untreated Ebola represent true contraindications. For everyone else, including patients with diabetes, hypertension, cancer history, or advanced age, the OPO’s medical director makes the final call on a case-by-case basis (42 CFR, 2010). Clinicians should never independently rule out a patient as a potential donor.
What’s the difference between organ and tissue donation?
Organ donation involves transplantable organs such as the heart, lungs, liver, kidneys, and pancreas. There are two pathways:
- Donation after brain death (DBD): The patient meets neurological criteria for brain death and remains on mechanical ventilation to preserve organ perfusion while authorization and logistics are arranged.
- Donation after circulatory death (DCD): The patient doesn’t meet brain death criteria but has a non-survivable condition, and a decision has been made to withdraw life-sustaining treatment (WLST). Procurement occurs after cardiac death, typically within 60 to 120 minutes. DCD cases have grown significantly over the past decade (HRSA, 2026).
Tissue donation is far more common and often overlooked. A single tissue donor can benefit more than 75 recipients (American Association of Tissue Banks, 2026). Recoverable tissues include:
- Musculoskeletal tissue (bone, tendons, cartilage, ligaments) is used in orthopedic and trauma procedures
- Cardiovascular tissue (heart valves, pericardium, great vessels) is used in cardiac surgeries
- Skin is used in burn treatment and wound coverage
- Corneas and ocular tissue is used to restore vision
- Amniotic membrane is used in ophthalmology and wound care
Tissue donation can occur up to 12 to 24 hours after cardiac death, which significantly expands the eligible donor pool. Eligibility determinations are tissue-specific and always made by the OPO or affiliated tissue bank, not by the bedside clinician.
When should clinicians refer a patient to the OPO?
Referral thresholds should be low. The Joint Commission, CMS, and the Association of Organ Procurement Organizations all emphasize calling the OPO early, not only after death has been declared.
Clinical triggers for referral include (The Alliance, 2026):
- A Glasgow Coma Scale (GCS) score of 5 or less
- Patients on mechanical ventilation with suspected or confirmed brain death
- Any patient in whom withdrawal of life-sustaining treatment (WLST) is being considered
It’s also worth watching for behavioral cues from families that may indicate acceptance of a non-survivable prognosis. Signs include a DNR decision, requests about what WLST looks like, asking for additional family members to come say goodbye, discussing funeral arrangements, or bringing up donation directly.
Once referral is made, the OPO takes over coordination: reviewing medical suitability, supporting the brain death evaluation, approaching the family, and managing procurement logistics.
How is brain death determined and communicated?
Brain death, formally called death by neurological criteria (BD/DNC), is defined as the complete and irreversible cessation of all brain function, including the brainstem. It is recognized as legal death in all 50 states and the District of Columbia (Pennsylvania Anatomical Gift Act, 20 Pa. C.S. §8601).
Brain death is not a coma. It is not a vegetative state. It is death.
Clinical determination of BD/DNC requires (Greer et al., Neurology, 2023):
- An established etiology sufficient to cause irreversible neurological injury
- Exclusion of confounders (adequate blood pressure, temperature above 36°C, absence of CNS-depressant drugs, no significant metabolic derangements)
- Neurological examination confirming absent brainstem reflexes
- Apnea testing confirming absence of spontaneous respiratory effort at a PaCO2 of 60 mm Hg or higher
In Pennsylvania, institutional brain death protocols must comply with the 2023 American Academy of Neurology guidelines. Brain death must be declared by a physician with no conflict of interest regarding donation. The AAN provides an interactive algorithm at aan.com/Guidelines/BDDNC.
How should you talk to families about brain death?
Research consistently supports the principle of decoupling; that is, separating the notification of death from the conversation about donation. When both happen simultaneously, family distress increases and authorization rates decline (Siminoff et al., JAMA, 2001).
Practically, this means a physician and/or nurse first meets with the family to explain the patient’s neurological status and the meaning of brain death. Only after the family has had adequate time to process this should the OPO family support coordinator introduce the topic of donation.
Effective communication strategies include:
- Using plain-language explanations: “The brain has stopped working completely and permanently. The machine is doing all the breathing.”
- Avoiding euphemisms without context. Instead, affirm clearly: “This is legal death; he has died.”
- Inviting questions and allowing silence
What’s involved in caring for families during the donation process?
When a family agrees to donation, the period before and during procurement can last 12 to 24 hours or more. This is an emotionally vulnerable time.
Key supportive interventions include:
- Offering a private space for the family to gather
- Keeping the family informed of the process and expected timeline
- Facilitating meaningful time with their loved one
- Providing food, beverages, and access to bereavement resources
- Coordinating with the OPO family support coordinator, who serves as the primary family liaison
Nurses carry particular weight here. Studies show that nursing staff who communicate empathy, answer questions honestly, and remain present with families significantly improve the family experience, regardless of whether donation ultimately occurs (Bellali & Papadatou, Death Studies, 2006).
Pennsylvania’s OPOs — Gift of Life Donor Program and CORE — both offer aftercare programs for donor families, including grief support groups and annual remembrance events.
Don’t forget yourself in this equation. Caring for brain-dead patients and their families can be psychologically taxing. Institutional debriefs, peer support programs, and Employee Assistance Programs are valuable resources for processing these experiences.
What are the clinical goals for organ donor management?
Once a patient is identified as a donor and the appropriate parties have obtained authorization, clinical management shifts toward preserving organ function for transplant. Brain death triggers a predictable cascade of systemic changes, including hemodynamic instability, diabetes insipidus, hypothermia, coagulopathy, and hormonal deficiencies — all of which can compromise organ viability if left unaddressed.
UNOS has established standardized donor management goals (DMGs) to optimize organ yield and graft survival (Kotloff et al., Critical Care Medicine, 2015):
| Parameter | Target |
| Mean arterial pressure (MAP) | 60–110 mm Hg |
| Central venous pressure (CVP) | 4–12 mm Hg |
| Ejection fraction | ≥50% |
| PaO2/FiO2 ratio | ≥300 on PEEP 5 |
| Sodium | 135–155 mEq/L |
| Blood glucose | ≤180 mg/dL |
| Urine output | ≥0.5 cc/kg/hr |
Key management priorities
- Fluid and vasopressor management: Vasopressin is a cornerstone of donor management. It treats diabetes insipidus, supports hemodynamics, and reduces catecholamine requirements. Norepinephrine at ≤0.2 mcg/kg/min is best when vasopressin alone isn’t sufficient. Clinicians associate high-dose dopamine (above 10 mcg/kg/min) with worse heart and kidney outcomes and should be avoided.
- Hormonal resuscitation: The Papworth protocol supports the use of methylprednisolone, triiodothyronine (T3) or levothyroxine (T4), vasopressin, and insulin for hemodynamically unstable donors (Rosendale et al., Am J Transplant, 2002).
- Lung-protective ventilation: Tidal volume of 6 to 8 mL/kg ideal body weight, PEEP of 6 to 8 cm H2O, and FiO2 titrated to maintain PaO2 of 80 to 120 mm Hg. Lung-protective ventilation increases the number of lungs ultimately transplanted (Mascia et al., JAMA, 2010).
- Temperature management: Maintain core temperature at or above 36°C using warm IV fluids, warming blankets, and heated ventilator circuits.
- Laboratory monitoring: ABG, BMP, CBC, coagulation studies, lactate, liver function tests, and cardiac enzymes every 4 to 6 hours. Monitor urine output hourly.
Achieving all or most DMGs is associated with significantly higher organ yield per donor and improved recipient outcomes (Malinoski et al., J Trauma, 2011).
Frequently asked questions about Pennsylvania organ donation CE
Who must complete organ donation CE in Pennsylvania?
Pennsylvania requires registered nurses to complete 2 hours of Board-approved organ and tissue donation CE, effective May 1, 2026, one time within 5 years of initial licensure or licensure renewal. Physicians have had a similar requirement under Act 90 of 2018.
Can physician assistants complete this CE course?
While the Pennsylvania law specifically mandates nurses and physicians, clinicians in any state, including physician assistants, can benefit from organ donation education. Many CE courses covering Pennsylvania organ donation law are open to all healthcare team members.
What topics does the required Pennsylvania organ donation CE cover?
The six-part Board-approved curriculum covers the organ donation and transplantation system, tissue and organ donation processes, determining death, family communication, caring for families, and organ donor management.
Does tissue donation require brain death?
No. Tissue donation can occur following both cardiac death and brain death, and it can proceed even when organ donation isn’t possible. Tissue recovery can occur up to 12 to 24 hours after cardiac death, making it available to a much broader donor population.
Can a clinician rule out a patient as a potential donor?
No. Clinicians should never independently determine that a patient is ineligible. Very few absolute contraindications exist, and the OPO’s medical director makes the final suitability determination on a case-by-case basis.
What should I do if a family asks about donation before I’ve discussed brain death?
Follow the decoupling principle. Address the patient’s neurological status and prognosis first. Give the family time to process, then allow the OPO family support coordinator to introduce the donation conversation separately.
What happens after organ donation? Is there follow-up for families?
Yes. Pennsylvania’s Gift of Life Donor Program and CORE both provide aftercare programs for donor families, including grief support, remembrance events, and the option to correspond with recipients.
