*Purpose: Donation after cardiac death (DCD) donors are subject to an observation period after asystole to monitor for cardiopulmonary autoresuscitation (AR). Periods vary between and within Organ Procurement Organizations (OPOs) from 2-5 minutes, though 92% use 5 minutes. Recommendations stem from expert opinions by the Institute of Medicine (5 minutes), American Society of Transplant Surgeons (2 minutes), and Society of Critical Care Medicine (2-5 minutes). We aim to provide evidence regarding frequency and timing of AR to guide policies.

*Methods: A review of a single OPO was performed for DCD donors from March 2008 to November 2018, with a standard observation of 5 minutes. Demographic information, cause of death, time from withdrawal to asystole, and AR events were reviewed. Statistics were analyzed with SPSS 25.0. Continuous data presented as Median (Interquartile Range), Categorical as N (%). Significance determined by Pearson Chi-square or Mann-Whitney U test as appropriate.

*Results: There were 73 potential donors; 63 progressed. Of the donors, 39 (62%) were male, 44 (70%) Caucasian, median age was 38 years (IQR 26, 49), and median BMI was 28.1 kg/m² (IQR 22.7, 33.3). Most died from head trauma at 30 cases (47.6%). AR occurred in 7/63 donors (11.1%), with 5 in the 1^st minute and 2 in the 2^nd minute of observation. Two experienced multiple ARs, all less than 2 minutes. No donor had AR after 2 minutes observation. Four AR donors yielded livers for transplant, and 1 donor had a respiratory AR with breaths noted during asystole.

*Conclusions: DCD remains a vital opportunity to expand the donor pool; concerns of delayed graft function and ischemic cholangiopathy limit its enthusiastic utilization by all. Complications from DCD donors are linked to warm ischemic times. Lowering the observation period from 5 to 2 minutes represents an evidence-based opportunity to improve the quality of DCD allografts without compromising care of potential donors.

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