Photo courtesy of Mayo Clinic
Organ and tissue transplantation is one of the most complex, serious procedures in medicine—requiring a precise diagnosis, as well as a team of experts who understand not just the surgery, but the underlying health issues that necessitate the surgery. And it requires dedicated health providers after the transplant to ensure a full recovery. Here to answer your questions about organ donation and living donor options is Julie K. Heimbach, M.D., a Mayo Clinic transplant surgeon whose primary focus is adult and pediatric liver transplantation and living-donor surgery.
Is the National Donate Life Registry the same thing as signing up with my driver’s license?
JULIE HEIMBACH: These are two separate registries. Both your state donor registry (your driver’s license) and the National Donate Life Registry are checked by donation professionals at the time of a person’s death, in cases where donation may be possible (which depends on factors such as whether people are in a hospital at the time of their death). The most recent donor registration is honored as the legal document of gift. The national registry was created in 2015 to increase access to organ donor registry opportunities using innovations such as a mobile platform and partnerships with other national organizations working to promote organ donation.
Do you need to be the same blood type as the donor recipient, and what is the most requested blood type for living organ donors?
To donate directly, in most cases you need to be a compatible blood type with your intended recipient. However, in the case of living donation, there are paired donor opportunities for recipients with incompatible living donors to be matched with others in the same situation, which can facilitate transplants for both pairs. The most common blood type for people in in the United States is blood type O. The Rh factor O+ or O- is not important in solid organ transplantation.
Is there any age limit for being considered as a living donor?
Yes, for legal consent, the lower age limit is 18, though some programs require an age of 21. There is not a specific upper age limit for living kidney donation, though underlying health conditions become more prevalent as we age, so it is more likely that a medical reason will be discovered which can preclude safe donation in older people. The safety of living liver donation relies on the ability of the liver to fully regenerate, and this process slows as we age. Based on this, we have set an upper age limit of 60 for living liver donation.
What organs can you donate while living, and which organs can you only donate when deceased?
Kidney, liver, and bone marrow are the organs which are safely and commonly donated by living donors. The organs which are only eligible for donation by deceased donor are heart, and whole lung, pancreas, and small intestine. Tissues such as heart valves, corneas, and tendons are also donated after death.
What are the health requirements for being an considered an eligible living organ donor?
The criteria vary between kidney, bone marrow, and liver—but in general, a donor needs to be healthy without chronic medical conditions which may impact the donor’s health.
Do you need to know the organ recipient to become a living organ donor?
No—it is possible to be a non-directed donor. Non-directed donors can at times be used to facilitate a chain between several incompatible pairs so that multiple waiting recipients can benefit from the remarkable generosity of a single organ donor.
Is there an option to know the recipient?
Yes, if both the donor and recipient consent, this can be possible though individual circumstances vary.
Can you become a living organ donor for a specific recipient?
Yes.
What are the risks associated with becoming a living organ donor?
In the case of kidney or liver donation, it is a major surgical procedure, requiring general anesthesia, a hospital stay following the surgery, and time away from work to recover from the operation. Though most living donors recover completely without a complication, like other surgical procedures, there are risks of complications, including life-threatening complications. Bone marrow donation does not require an operation or a hospital stay, but still requires procedure(s) to remove bone marrow cells and has a small risk of complications and discomfort.
Are there costs associated with becoming a living organ donor (is the living organ donor responsible for the cost of the operation and recovery)?
The donor is not responsible for the cost of the evaluation to be an organ donor and is also not responsible for the cost of the surgery, the hospital stay, or the follow-up from the surgery. However, there are out-of-pocket costs such as cost of travel and lodging for the evaluation/donation, as well as time off from work that must be considered. There are some private companies as well as many state employees and all federal employees who do provide paid time off for organ donation, and there is also a national program called NLDAC, which allows for donor out-of-pocket costs to be covered—though there is a maximum income requirement for the recipient to qualify for this program.
How big is the need for living organ donors versus deceased organ donors? Is there currently a wait list for organ transplants? If so, how large is the list and what is the most needed organ for transplants?
There is a critical shortage of available organs for donation, and many patients die each day while waiting for organs. The waiting list is updated continuously. The most common organ people are waiting for is kidney, with approximately 90,000 individuals currently awaiting kidney transplantation in the United States (as of November 2022).
Are there noninvasive living organ donation options?
All organ donation requires a major surgical procedure with an associated risk for complications, though progress has been made to minimize the size of the incision required, which makes the recovery for both kidney and liver donors easier than in the past.
How are organs from deceased or living donors distributed? How is priority determined?
For deceased organs, the allocation system is based on a variety of factors which vary slightly by each organ system but include medical urgency (to reduce the risk of death for patients who are waiting), as well as other factors such as blood type and HLA compatibility, waiting time, and distance between donor and recipient hospital. Living donor allocation is based on the donor’s intended recipient—either directly or as part of a chain or pair in cases of directed donation—or based on many factors like deceased organ donation, plus ability to facilitate living donor pairs or chains in the case of non-directed living donation.
Will the need for organ donors ever cease? Will artificially- or lab-grown organs ever be a replacement for living or deceased organ donors?
Much work is being done to reduce the need for organ donation through curing the diseases that lead to transplant. A major recent success is the development of highly effective therapies to cure the Hepatitis C virus, which previously was the most common reason that people needed a liver transplant. There is also exciting work being done in tissue engineering, such as the use of a re-cellularized tissue matrix, as well as remarkable recent progress in xenotransplantation, which is amazing. However, at present, there remains a critical shortage. To reduce this need, it is important to know that living donation is possible, and that registration to be a deceased donor is a selfless act that everyone can consider.
Mayo Clinic’s Transplant Center delivers some of the best outcomes in the country, including patient survival, organ acceptance, and how quickly a person receives a transplant. Click here to learn more.
