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Patients never declared brain dead may represent an additional source of donor organs.To determine the number of likely brain dead potential donors who are never declared brain dead and to compare them with brain dead and donation after cardiac death potential organ donors.This study was a retrospective chart review of all catastrophically brain-injured patients referred to a single-organ procurement organization (OPO) over a 4-year period. This study identified 159 likely brain dead potential organ donors, 902 brain dead potential organ donors, and 357 potential donation after circulatory death donors over a 4-year period.None.This study did not predetermine outcome measures before data collection because the study group, likely brain dead potential organ donors, had not previously been described.Likely brain dead potential donors were significantly older than brain dead potential donors (P < .0001) but were otherwise not different demographically. They were more likely to be a late referral to the OPO (P < .0001) and less likely to be in the donor registry (P < .0001). The most commonly identified factors associated with a failure to declare brain death were an unwillingness to continue supportive care by the family, premention of donation, a nontimely imminent death referral, known prior objection to donation, terminal instability, and a lack of cooperation with the OPO.