Organ donation is defined as the process when a person authorizes an organ of their own to be removed and transplanted to another person, legally, either by consent while the donor is alive, through a legal authorization for deceased donation made prior to death, or for deceased donations through the authorization by the legal next of kin.
Donation may be for research or, more commonly, healthy transplantable organs and tissues may be donated to be transplanted into another person. When the donor is still living, this is called a living organ donation; about 6,500 of these occur in the U.S. each year.
Common transplantations include kidneys, heart, liver, pancreas, intestines, lungs, bones, bone marrow, skin, and corneas. Some organs and tissues can be donated by living donors, such as a kidney or part of the liver, part of the pancreas, part of the lungs or part of the intestines.
In 2019, Spain had the highest donor rate in the world at 46.91 per million people, followed by the US (36.88 per million), Croatia (34.63 per million), Portugal (33.8 per million), and France (33.25 per million).
As of April 21, 2026, there were 103,223 people waiting for life-saving organ transplants in the United States. More than 48,000 organ transplants were performed in the U.S. in 2024. While views of organ donation are positive, there is a large gap between the number of registered donors and the number of people awaiting organ donations on a global level.
To increase the number of organ donors, especially among underrepresented populations, current approaches include the use of optimized social network interventions, exposing tailored educational content about organ donation to target social media users.
Process in the United States
Organ donors are usually dead at the time of donation, but may be living. For living donors, organ donation typically involves extensive testing before the donation, including psychological evaluation to determine whether the would-be donor understands and consents to the donation. On the day of the donation, the donor and the recipient arrive at the hospital, just like they would for any other major surgery.
For deceased donors, the process begins with verifying that the person is undoubtedly deceased, determining whether any organs could be donated, and obtaining consent for the donation of any usable organs. Normally, nothing is done until the person has already died, although if death is inevitable, it is possible to check for consent and to do some simple medical tests shortly beforehand, to help find a matching recipient.
The verification of death is normally done by a neurologist (a physician specializing in brain function) who is not involved in the previous attempts to save the patient's life. This physician has nothing to do with the transplantation process. Verification of death is often done multiple times, to prevent doctors from overlooking any remaining sign of life, however small. After death, the hospital may keep the body on a mechanical ventilator and use other methods to keep the organs in good condition. The donor's estate and their families are not charged for any expenses related to the donation.
The surgical process depends upon which organs are being donated. The body is normally restored to as normal an appearance as possible, so that the family can proceed with funeral rites and either cremation or burial.
The lungs are highly vulnerable to injury and thus the most difficult to preserve, with only 15–25% of donated organs used.
Potential vulnerabilities and opportunities related to the limits of reliably assessing consciousness in critically ill, behaviorally unresponsive patients undergoing controlled organ donation after circulatory determination of death have been identified, and neurologically informed safeguards in this setting were advanced.
History
The first living organ donor in a successful transplant was Ronald Lee Herrick (1931–2010), who donated a kidney to his identical twin brother Richard (1931–1963) in 1954. The lead surgeon, Joseph Murray, and the nephrologist, John Merrill, won the Nobel Prize in Physiology or Medicine in 1990 for advances in organ transplantation.
The youngest organ donor was a baby with anencephaly, born in 2014, who lived for only 100 minutes and donated his kidneys to an adult with renal failure. The oldest known cornea donor was a 107-year-old Scottish woman, whose corneas were donated after her death in 2016. The oldest known organ donor for an internal organ was an Italian woman, who donated her liver after she died in 2022 in Florence at the age of 100 years, 10 months and one day.
The oldest altruistic living organ donor was an 85-year-old woman in Britain, who donated a kidney to a stranger in 2014 after hearing that many people needed a transplant.
Researchers were able to develop a novel way to transplant human fetal kidneys into anephric rats to overcome a significant obstacle in impeding human fetal organ transplantations. The human fetal kidneys demonstrated both growth and function within the rats.
Brain donation Donated brain tissue is a valuable resource for research into brain function, neurodiversity, neuropathology and possible treatments. Both divergent and healthy control brains are needed for comparison. Brain banks typically source tissue from donors who had registered with them before their death, since organ donor registries focus on tissue meant for transplantation. In the United States, the nonprofit Brain Donor Project facilitates this process.
Legislation and global perspectives
The laws of different countries allow potential donors to permit or refuse donation, or give this choice to relatives. The frequency of donations varies among countries.
Consent process The term consent is typically defined as a subject adhering to an agreement of principles and regulations; however, the definition becomes difficult to execute concerning the topic of organ donation, mainly because the subject is incapable of consent due to death or mental impairment. There are two types of consent being reviewed: explicit consent and presumed consent. Explicit consent is when the donor gives direct consent through proper registration depending on the country. The second consent process is presumed consent, which does not need direct consent from the donor or the next of kin. Presumed consent assumes that donation would have been permitted by the potential donor if permission had been sought. Of possible donors, an estimated twenty-five percent of families refuse to donate a loved one's organs.
Opt-in versus opt-out
As medical science advances, the number of people who could be helped by organ donors increases continuously. As opportunities to save lives increase with new technologies and procedures, the demand for organ donors rises faster than the actual number of donors. To respect individual autonomy, voluntary consent must be determined for the individual's disposition of their remains following death. There are two main methods for determining voluntary consent: "opt in" (only those who have given explicit consent are donors) and "opt out" (anyone who has not refused consent to donate is a donor). In terms of an opt-out or presumed consent system, it is assumed that individuals do intend to donate their organs to medical use when they die. Opt-out legislative systems dramatically increase effective consent rates for donation as a result of the default effect. For example, Germany, which uses an opt-in system, has an organ donation consent rate of 12% among its population. In contrast, Austria, a country with a very similar culture and economic development, but which uses an opt-out system, has a consent rate of 99.98%.
Opt-out consent, otherwise known as "deemed" consent, refers to the notion that the majority of people support organ donation. Still, only a small percentage of the population are actually registered, because they fail to go through the actual step of registration, even if they want to donate their organs at the time of death. This could be resolved with an opt-out system, where many more people would be registered as donors, and only those who object have to register to be on the non-donation list.
For these reasons, countries such as Wales have adopted a "soft opt-out" consent model, meaning that if a citizen has not clearly opted out, they will be treated as registered and participate in the organ donation process. Likewise, opt-in consent refers to the consent process of only those who are registered to participate in organ donation. Currently, the United States has an opt-in system, but studies show that countries with an opt-out system save more lives due to more availability of donated organs. The current opt-in consent policy assumes that individuals are not willing to become organ donors at the time of their death, unless they have documented otherwise through organ donation registration.
Registering to become an organ donor heavily depends on the attitude of the individual; those with a positive outlook might feel a sense of altruism towards organ donation, while others may have a more negative perspective, such as not trusting doctors to work as hard to save the lives of registered organ donors. Some common concerns regarding a presumed consent ("opt-out") system are sociological fears of a new system, moral objection, sentimentality, and worries of the management of the objection registry for those who do decide to opt out of donation. Additional concerns exist with views of compromising the freedom of choice to donate, conflicts with extant religious beliefs and the possibility of posthumous violations of bodily integrity. Even though concerns exist, the United States still has a 95 percent organ donation approval rate. This level of nationwide acceptance may foster an environment where moving to a policy of presumed consent may help solve some of the organ shortage problem, where individuals are assumed to be willing organ donors unless they document a desire to "opt out", which must be respected.
Because of public policies, cultural, infrastructural and other factors, presumed consent or opt-out models do not always translate directly into higher effective donation rates. The United Kingdom has several different laws and policies for the organ donation process, such as the requirements that consent of a witness or guardian must be provided to participate in organ donation. This policy was consulted on by the Department of Health and Social Care in 2018, and was implemented starting May 20, 2020.
In terms of effective organ donations, in some systems like Australia (14.9 donors per million, 337 donors in 2011), family members are required to consent or refuse, or may veto a potential recovery even if the donor has consented. Some countries with an opt-out system, like Spain (40.2 donors per million inhabitants), Croatia (40.2 donors/million) or Belgium (31.6 donors/million) have high donor rates, however some countries such as Greece (6 donors/million) maintain low donor rates even with this system. The president of the Spanish National Transplant Organisation has acknowledged that Spain's legislative approach is likely not the primary reason for the country's success in increasing the donor rates, starting in the 1990s.
Looking to the example of Spain, which has successfully adopted the presumed consent donation system, intensive care units (ICUs) must be staffed with enough doctors to maximize the identification of potential donors and maintain organs while families are consulted for donation. The characteristic that enables the Spanish presumed consent model to be successful is the resource of transplant coordinators; it is recommended to have at least one at each hospital where opt-out donation is practiced to authorize organ procurement efficiently.