The diagnosis of death has legal as well as clinical implications. The codes of practice for the diagnosis of brain death have become country or jurisdiction specific. Brain death is associated with hypothalamic failure and the inability to maintain a normal body temperature. The confirmation of brain death requires the simultaneous demonstration of the irreversible loss of the capacity for consciousness as well as the capacity to breathe. Donor management requires a proactive approach that is based on a sound understanding of the physiological derangements exhibited by the brain-dead heartbeating donor. The falling incidence of brain death, together with the ever-increasing demand for donor organs, has prompted many healthcare systems to review their potential for controlled death circulatory death (DCD). In UK practice, approximately 40% of potential DCD donations are stood down because the time period from treatment withdrawal to asystole extends beyond the limits set by the retrieval surgeons.