Living donation

Living donation is the donation of an organ or a portion of an organ by a living person.[1] The most common form is living kidney donation; a healthy person can donate one kidney and live normally with the remaining one. Living donation of a segment of liver is also well established, exploiting the liver's capacity to regenerate, and lobar or segmental donation of lung, pancreas, and intestine has been performed less commonly.[1][2] Living-donor organs frequently offer advantages over deceased-donor organs, including better and longer graft survival, shorter or zero waiting time, and the ability to schedule the operation.[1]

In 2024, there were 7,030 living donors in the United States.[3] Living donation is a separate, donor-initiated process from the deceased-donation pathway and carries its own evaluation, consent, and donor-protection requirements.

Types of living donation

Living donation is categorized by the donor-recipient relationship:[1][4]

• Directed donation, to a specific, known recipient (most often a relative, spouse, or friend).
• Non-directed (altruistic) donation, to a recipient the donor does not know, typically allocated through the waiting list or used to initiate a paired-donation chain.
• Kidney paired donation (KPD) / exchange, when a willing donor and their intended recipient are blood-type or crossmatch incompatible, they can be matched with one or more other incompatible pairs so that each recipient receives a compatible kidney from another pair's donor. KPD is run nationally through the OPTN and supports "swaps" and longer "chains," often initiated by a non-directed donor.[4]

Living kidney donation

The kidney is the most commonly donated organ from living donors. Because a single healthy kidney can meet the body's needs, a carefully selected donor can donate one kidney with low long-term risk.[1] Living-donor kidney transplants generally have superior outcomes to deceased-donor transplants and avoid time on dialysis when performed preemptively.[1][5] Detailed surgical and outcome information appears in Kidney transplantation.

Living liver donation

A living donor can donate a portion (lobe or segment) of the liver; both the donated segment in the recipient and the remnant in the donor regenerate toward normal volume over weeks to months.[2] Living-donor and split-liver techniques expand the donor pool and are particularly important for pediatric recipients and in settings with limited deceased-donor availability. Living liver donation carries greater donor risk than kidney donation and is performed at specialized centers. See Liver transplantation.

Donor evaluation

Prospective living donors undergo an independent and thorough medical and psychosocial evaluation to confirm that they are healthy enough to donate safely, that donation will not unduly harm them, and that the decision is voluntary and informed.[1][6] Evaluation assesses organ function, surgical and anesthetic risk, transmissible disease, and psychosocial readiness, and confirms ABO and crossmatch compatibility (or eligibility for paired exchange). The donor evaluation is conducted separately from the recipient's team.[6]

Risks

Donor surgery carries the risks of any major operation, including bleeding, infection, and anesthetic complications, as well as organ-specific and longer-term considerations.[1][2] Kidney donors have a small long-term risk relative to the general population; liver donors face higher perioperative risk. Donor safety, informed consent, and long-term donor follow-up are central ethical commitments of living-donor programs, and donor outcomes are reported to the national registry.[1][6]

The Independent Living Donor Advocate (ILDA)

U.S. transplant programs are required to provide each prospective living donor with an Independent Living Donor Advocate (ILDA), a person independent of the recipient's care team whose role is to protect the donor's interests, promote the donor's autonomy, and confirm that consent is informed and free of coercion.[6] The requirement derives from CMS transplant-center conditions of participation (2007) and OPTN policy; the advocate is often a social worker or nurse with relevant training.[6]

Financial neutrality

Federal law prohibits the transfer of organs for valuable consideration, so living donors are not paid for donating.[7] However, the prohibition does not bar reimbursement of a donor's reasonable costs, such as travel, lodging, and lost wages. In the United States the National Living Donor Assistance Center (NLDAC) provides means-tested financial assistance to remove cost barriers to donation, consistent with the principle of financial neutrality, that a donor should be neither enriched nor impoverished by donating.[7][8]

See also

• Deceased donation · The donation pathway
• Kidney transplantation · Liver transplantation
• Organ donation · National Organ Transplant Act (NOTA)

References

• HRSA/OPTN. Living donation. https://www.hrsa.gov/optn/professionals/resources/ethical-considerations/living-non-directed-organ-donation
• Liver Transplantation (living-donor/split). StatPearls. NBK559161. https://www.ncbi.nlm.nih.gov/books/NBK559161/
• HRSA. Organ Transplants Exceeded 48,000 in 2024. https://www.hrsa.gov/optn/news-events/news/organ-transplants-exceeded-48000-2024-33-percent-increase-transplants-performed-2023
• OPTN. Kidney paired donation for patients. https://optn.transplant.hrsa.gov/patients/about-donation/living-donation/kidney-paired-donation-for-patients/
• Kidney Transplantation. StatPearls. NBK567755. https://www.ncbi.nlm.nih.gov/books/NBK567755/
• OPTN. Guidance for the informed consent of living donors; CMS transplant-center conditions of participation (Independent Living Donor Advocate). https://optn.transplant.hrsa.gov/professionals/by-topic/guidance/guidance-for-the-informed-consent-of-living-donors/
• National Organ Transplant Act of 1984; 42 U.S.C. §274e. https://www.congress.gov/bill/98th-congress/senate-bill/2048
• National Living Donor Assistance Center. How NLDAC helps. https://www.livingdonorassistance.org/Get-Help/How-NLDAC-Helps