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The objective of this study was the investigation of the maximal potential donor pool and causes of non-realized organ donation. On-site retrospective medical-record review was performed for all cases of patient death ( n=1608) occurring in 1999 at 34 (83% of all) intensive care units (ICUs) in the region of the transplant center in Prague, Czech Republic. Two hundred and eighty-eight (18%) patients died with clinical signs of brain death. ICU physicians considered 111 of them as being potential donors at the time; 63 became donors and 48 did not. The remaining 177 patients with clinical signs of brain death were, in retrospect, assessed as being unsuitable ( n=105) or suitable ( n=72) for donation. The maximal potential donor rate was 55.7 per million population (pmp), with a more conservative estimate of 37.4 pmp. The actual donor rate was 18.1 pmp. For the maximal level to be approached, further educational efforts are warranted, targeting ICU physicians and concentrating on the identification of potential donors.