Organ donation

Organ donation is the giving of organs or tissue from a donor so that they can be transplanted into another person (the recipient).[1] Donation occurs after death (deceased donation) or, for organs such as a kidney or a portion of the liver, during life (living donation).[1][2] In the United States, donation is authorized either by the individual during life through a donor registry or driver's-license designation (first-person authorization) or, absent such a record, by a legally authorized surrogate under the Uniform Anatomical Gift Act.[3] Organ and tissue donation is governed federally by the National Organ Transplant Act, which, among other things, prohibits the transfer of human organs for valuable consideration.[4]

This article describes who can donate, what can be donated, how donation is authorized, the difference between deceased and living donation, and the registries and ethics involved. The end-to-end clinical process of deceased donation is described in The donation pathway.

Who can donate

Most people can register as organ, eye, and tissue donors regardless of age or medical history; suitability for donation is a clinical determination made at the time of death by the organ procurement organization and the medical team, not a reason to decline registration.[1][5] Very few medical conditions automatically rule out donation, and advances in donor evaluation and organ-specific testing continue to expand the pool of usable organs.[5] Living donors must be healthy adults who pass an independent medical and psychosocial evaluation; in the United States a living donor's interests are protected by an Independent Living Donor Advocate (see Living donation).[2]

What can be donated

A single deceased donor can provide multiple organs and tissues. Donatable items include:[5]

• Organs: kidneys, liver, heart, lungs, pancreas, and intestines (and vascularized composite allografts such as the hand and face).
• Eyes and corneas.
• Tissue: skin, bone and other musculoskeletal tissue, heart valves, blood vessels, and connective tissue. See Tissue donation and transplantation.

U.S. public-health messaging summarizes the potential impact as one donor being able to save up to eight lives through organ donation and to heal or enhance the lives of many more through tissue and corneal donation.[5][6]

The donation process

Deceased organ donation begins only after a patient has died and death has been formally determined, either by neurologic criteria (brain death) or by circulatory criteria.[7] Hospitals are federally required to notify their organ procurement organization (OPO) of every imminent death and death so the OPO, not the bedside care team, can evaluate donation potential; the donation conversation with the family is handled by the OPO or trained requestors after the care team's efforts to save the patient have ended.[8] If donation proceeds, organs are recovered surgically, allocated through the national system, and transported to transplant centers. The full clinical sequence is described in The donation pathway and Deceased donation.

Authorization and consent

In the United States, the legal basis for donation is the Uniform Anatomical Gift Act (UAGA), a model law adopted by all states (originally 1968; revised 1987 and 2006).[3] Under first-person authorization, a person's registration as a donor (through a state registry, the National Donate Life Registry, or a driver's-license designation) is a legally binding decision that does not require additional family approval.[3] If the deceased made no documented decision, authorization is sought from a legally authorized surrogate in a defined priority order (typically spouse, adult children, parents, and so on).[3] The field generally uses the term "authorization" rather than "consent" for deceased donation.[3]

Internationally, two broad consent models exist: opt-in (a person must affirmatively register, as in the United States) and opt-out / presumed consent (donation is permitted unless the person registered an objection during life). The comparative evidence on opt-out is mixed; systematic reviews find that opt-out legislation is associated with higher donation rates in some analyses, but that organizational and infrastructural capacity, rather than the consent law alone, appears decisive, this is discussed neutrally in dedicated articles on consent models.[9]

Deceased versus living donation

• Deceased donation is the source of most transplanted organs and supplies organs (heart, lungs, intestine, and most kidneys, livers, and pancreases) that cannot generally be obtained from living donors.[7] In 2024, 16,988 deceased donors enabled the majority of U.S. transplants.[10]
• Living donation allows a healthy person to donate a kidney or a segment of an organ (most commonly liver) during life; in 2024 there were 7,030 living donors in the United States.[10] Living-donor organs often have better outcomes and shorter waiting times, and living donation can be directed to a known recipient, non-directed (altruistic), or arranged through kidney paired donation. See Living donation.[2]

Registries

In the United States, people can record a donation decision through a state donor registry (often via the department of motor vehicles) or the National Donate Life Registry maintained by Donate Life America.[6] Registration is the most reliable way to ensure one's donation wishes are honored under first-person authorization.[3][6]

Ethics and oversight

Organ donation in the United States is built on the principle that organs are a gift, not a commodity: NOTA prohibits the transfer of organs for valuable consideration (financial neutrality), although reasonable reimbursement of a living donor's expenses, such as through the National Living Donor Assistance Center, is permitted.[4] Globally, the Declaration of Istanbul and the WHO Guiding Principles set out ethical standards against organ trafficking and transplant tourism and in favor of voluntary, unpaid donation.[11][12] Other ethically significant topics, the determination of death and the dead donor rule, and the ethics of newer recovery techniques, are covered in dedicated articles and presented with a neutral point of view.

By country

Donation systems vary widely. Spain, operating the "Spanish Model" through its Organización Nacional de Trasplantes with in-hospital donation coordinators, has long reported the world's highest deceased-donation rates per million population.[13] The United Kingdom moved to a "deemed consent" (opt-out) model across its nations between 2015 and 2021.[14] Eurotransplant coordinates allocation across eight European countries.[15] These systems are described in comparative articles.

See also

• Organ transplantation
• The donation pathway
• Deceased donation · Living donation
• Tissue donation and transplantation
• National Organ Transplant Act (NOTA)

References

• organdonor.gov (HRSA). Organ donation overview. https://www.organdonor.gov
• HRSA/OPTN. Living donation. https://www.hrsa.gov/optn/professionals/resources/ethical-considerations/living-non-directed-organ-donation
• Uniform Anatomical Gift Act. StatPearls. NBK470922. https://www.ncbi.nlm.nih.gov/books/NBK470922/
• National Organ Transplant Act of 1984, Pub. L. 98-507; 42 U.S.C. §274e. https://www.congress.gov/bill/98th-congress/senate-bill/2048
• organdonor.gov (HRSA). What can be donated. https://www.organdonor.gov/learn/what-can-be-donated
• Donate Life America. National Donate Life Registry. https://donatelife.net/donation/donor-registries/national-donate-life-registry/
• HRSA/OPTN. Deceased donation. https://www.hrsa.gov/optn/patients/organ-donation/deceased-donation
• Hospital duty to notify the OPO, 42 CFR §482.45. https://www.law.cornell.edu/cfr/text/42/482.45
• Organ Donation Opt-Out Policies and the comparative evidence. StatPearls / NBK56888. https://www.ncbi.nlm.nih.gov/books/NBK56888/
• 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
• Declaration of Istanbul on Organ Trafficking and Transplant Tourism (2008, updated 2018). https://www.declarationofistanbul.org/the-declaration
• World Health Organization. WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation (WHA63.22, 2010). https://www.who.int/publications/i/item/WHO-HTP-EHT-CPR-2010.01
• Spanish Model / Organización Nacional de Trasplantes. PMC10249502. https://pmc.ncbi.nlm.nih.gov/articles/PMC10249502/
• NHS Blood and Transplant. Max and Keira's Law comes into effect in England. https://www.nhsbt.nhs.uk/news/max-and-keira-s-law-comes-into-effect-in-england/
• Eurotransplant. About us. https://www.eurotransplant.org/about-us