Organ and tissue donation

What is donation?#

Organ and tissue donation are medical processes that save and transform lives. Organs are retrieved from a donor and transplanted into someone who is very sick and waiting for a transplant, while tissue donation helps transform lives through eye and tissue grafts. The identities of donor and recipient are kept anonymous in line with the law.

Donation is the giving of an organ or tissue to help someone who needs a transplant, which can save or transform their life. One organ donor can save up to 7 lives and help many more through eye and tissue donation. This relies on donors, and their families, agreeing to donate after death.

Why is donation important?#

At any one time, many people are waiting for an organ transplant. Unfortunately, there are fewer donor organs available than there are people waiting, so some people die while waiting. Others spend weeks or months in hospital, while some make several trips to hospital every week for treatment.

People who need a transplant are usually very sick or dying because one or more of their organs is failing. They range from children through to older adults, and many have a congenital or genetic condition, an illness, or sudden organ failure. We never know when illness could affect a family member, friend or colleague who may one day need a transplant.

Pathways to organ donation#

Organs and tissue from a donor will only be used once the donor has died and consent has been given. There are three main pathways to organ donation.

Brain death#

Brain death is not the same as being in a coma. A person in a coma is unconscious because their brain is injured in some way, but the brain continues to function and may heal. With brain death, the brain has permanently stopped functioning and cannot recover, so there is no possibility of recovery. A person who is brain dead has permanently lost the potential for consciousness and the capacity to breathe, even when a ventilator keeps the heart beating and oxygen circulating. A series of tests is carried out by two independent, suitably qualified senior doctors to confirm that death has occurred.

Circulatory death#

Circulatory death is the irreversible loss of circulation after a cardiac arrest from which the patient cannot or should not be resuscitated. It can also follow the planned withdrawal of life-sustaining treatment, for example in an intensive care unit or emergency department. The patient is monitored closely, and donation proceeds only once circulation has irreversibly ceased. Timeframes are very short for this pathway, because organs cannot be without oxygenated blood and outside the body for long.

Living donation#

While you are still alive, you can choose to donate a kidney, a small section of your liver, or bone that would otherwise be discarded during a hip or knee replacement. Paired kidney exchange programs also exist to help people who need a kidney transplant but do not have a compatible living donor.

Recording your decision#

Many countries have an official register where adults can record their intention to be a donor. Recording your decision means authorised healthcare professionals can check it when needed, and in the event of your death your decision can be shared with your family. Even if you have expressed an intention to donate before, it is important to record it on the appropriate register.

When registering, you can choose to donate all organs and tissues, or only specific ones. At the time of death, health professionals assess what could be safely transplanted. Donation can involve:

• Organs – kidneys, heart, lungs, liver, stomach, intestines and pancreas.
• Tissues – heart valves and tissues, pancreas islets, bone and tendons, skin, and eye tissue.

If you do not want to become a donor, you can usually record that decision too.

Who can donate?#

There are very few medical conditions that would rule out donation, so you should not exclude yourself based on a medical condition or your age. At death, a detailed assessment is carried out by a qualified health professional involved in your care to decide whether some or all organs and tissue are suitable for transplant.

Having the right conditions for donation is rare; fewer than two per cent of all people who die in hospital each year are medically suitable to become organ donors. This is why it is important to record your decision and share it with your loved ones.

More people can donate tissue than organs. Unlike organs, tissue can be stored for a period after donation and may be retrieved up to 24 hours after death, regardless of where the person died.

How organs are allocated#

There are strict ethical guidelines about how organs and tissue are allocated. Allocation depends on a likely “match” between the donor and potential recipients on the waiting list. It also considers how medically urgent a person’s need is and how long they have been waiting. A person’s race, gender or social status is not taken into account.

Sharing your decision with family#

If you are able to donate and have registered, your senior next of kin will usually be asked to support your decision. Letting them know now makes it much easier for them later. When a family member had registered as a donor, around 8 in 10 families agree to donation. But when families are uncertain about what their loved one wanted, only around 4 in 10 say yes. Knowing that donation is what you wanted can make their decision far easier at a difficult time, so do not leave it solely up to your family to decide. Let them know your donation decision.

Key points#

• At any one time, many people are waiting for an organ transplant.
• Some spend weeks or months in hospital, while others make several trips to hospital every week for treatment.
• People who need an organ transplant are usually very sick or dying, because one or more of their organs is failing.
• A person in a coma is unconscious because their brain is injured in some way.

Where to get help#