{ "id": "organ-donation", "title": "Organ Donation", "lang": "en", "source_lang": "en", "summary": "The authorized provision of organs from living or deceased donors for transplantation, involving medical assessment, consent, allocation, and donor protection.", "category": "health", "subcategory": "medicine", "type": "concept", "aliases": [ "Human organ donation" ], "generated_at": "2026-10-22", "model": "pro/gpt-6.1-sol", "url": "https://aiwiki.page/en/organ-donation/", "translations": { "zh-Hans": { "url": "https://aiwiki.page/zh/organ-donation/", "json": "https://aiwiki.page/zh/organ-donation.json" } }, "sections": [ { "heading": "", "text": "Organ donation is the authorized provision of an organ, or part of an organ, from a living or deceased person for transplantation into another person. Deceased donation can provide organs including the kidneys, liver, heart, lungs, pancreas, and intestine; living donation most commonly involves a kidney or part of the liver. Donation is distinct from transplantation itself and from the related donation of tissues, blood, or blood-forming stem cells. (organdonor.gov)\n\nDonated organs provide treatment for selected patients with severe organ failure, but transplantation needs exceed the organs available. Donation therefore involves not only clinical assessment and organ preservation but also systems for authorization, matching, allocation, and oversight. Its governing principles include informed consent, protection of living donors, reliable determination of death in deceased donors, equitable access, and prevention of commercial exploitation. Laws and organizational arrangements vary among countries, while the World Health Organization provides an international ethical framework. (hrsa.gov)" }, { "heading": "Organs Donated and Forms of Donation", "text": "The principal solid organs donated for transplantation are the kidneys, liver, heart, lungs, pancreas, and intestine, principally the small intestine. These may be recovered after death; kidneys and certain other organs or organ portions can also come from living donors. “Whole-organ” donation describes an intact anatomical organ, not necessarily all organs of that type in the donor: donating one kidney is whole-organ donation. Partial-organ donation provides a functional segment rather than the entire organ. Thus, the distinction between whole and partial donation is separate from the distinction between living and deceased donation. (organdonor.gov)\n\nDeceased donation permits recovery of organs whose complete removal would be incompatible with the donor’s continued life, including the heart and the whole liver. A deceased donor’s liver can be transplanted intact or, when suitable, divided into two grafts for different recipients. In a typical split-liver transplant, the smaller left-sided graft goes to a child and the larger right-sided graft to an appropriately sized adult. This illustrates why one recovered organ need not correspond to one transplant recipient. Whether a liver can be split depends on donor characteristics and the suitability of the resulting grafts, rather than simply on the availability of two recipients. (organdonor.gov)\n\nLiving donation is constrained by the need to retain sufficient functioning tissue in the donor. The paired anatomy of the kidneys makes donation of one kidney possible while the other remains. Living liver donation instead removes a portion: both the retained liver and transplanted graft can increase in volume through regeneration. Graft size varies with the recipient; an adult may require a right-lobe graft, whereas a child may receive the smaller left lateral segment. Donation of a lung lobe or portions of the pancreas or intestine is much rarer. Unlike liver tissue, these donated portions do not regrow; the procedure depends on the functional capacity of the tissue remaining in the donor. Anatomical feasibility does not eliminate operative or longer-term risks. (organdonor.gov)\n\nTissue donation is commonly coordinated with organ donation but supplies different kinds of grafts. Corneas are donated to restore sight; other donated tissues include skin, bone, tendons, blood vessels, and heart valves. A donated heart valve is therefore a tissue graft, distinct from a transplanted heart. These categories should not be combined indiscriminately when describing donation activity: a tissue graft, a whole solid organ, and a partial-organ graft represent different anatomical materials and therapeutic uses. (organdonor.gov)\n\nBlood donation supplies whole blood or components such as red cells, platelets, and plasma for transfusion, rather than a surgically implanted solid organ. Donation for hematopoietic stem-cell transplantation supplies blood-forming cells collected from bone marrow, peripheral blood, or umbilical-cord blood; these cells establish blood production in the recipient’s marrow. Whole-body donation after death serves another purpose: anatomical teaching, scientific research, or training in clinical and surgical techniques, rather than transplantation of a functioning organ into a recipient. It is arranged through body-donation programmes, with acceptance requirements distinct from those for transplant donation. (redcrossblood.org)" }, { "heading": "Historical Development", "text": "On 23 December 1954, a team led by Joseph Murray at Boston’s Peter Bent Brigham Hospital transplanted a kidney from Ronald Herrick into his identical twin, Richard Herrick, achieving the first durable success in human solid-organ transplantation. The twins’ genetic identity largely removed the immunological barrier that had defeated earlier attempts: a recipient’s immune system ordinarily recognizes a genetically different donor organ as foreign and attacks it. The operation demonstrated that a living person could provide a functioning kidney, but it did not yet establish a treatment applicable to most donor–recipient pairs. Its success depended on exceptional biological compatibility rather than effective drug control of rejection. (transplant.uthscsa.edu)\n\nDuring the 1960s, anti-rejection treatment made transplantation between genetically different people increasingly practicable. Azathioprine combined with corticosteroids produced sustained immunosuppression, although infection and rejection remained major limitations. Organ-specific milestones followed: Richard Lillehei and William Kelly performed a combined kidney–pancreas transplant at the University of Minnesota in 1966; Thomas Starzl achieved successful liver transplantation at the University of Colorado in 1967. On 3 December 1967, Christiaan Barnard’s team at Groote Schuur Hospital in Cape Town transplanted Denise Darvall’s heart into Louis Washkansky. Washkansky survived 18 days before dying of pneumonia, illustrating the distinction between completing an operation and achieving long-term recipient survival. (organdonor.gov)\n\nCyclosporine, approved by the United States Food and Drug Administration in 1983, substantially improved the control of rejection by suppressing T-cell activity. More effective immunosuppression helped transplantation develop from a limited experimental intervention into a treatment available to broader groups of patients, increasing demand for donated organs. Thoracic transplantation also advanced: Bruce Reitz’s Stanford team achieved successful combined heart–lung transplantation in 1981; Joel Cooper’s Toronto team achieved successful single-lung transplantation in 1983 and double-lung transplantation in 1986. These milestones concerned sustained clinical success, rather than necessarily the first attempted transplantation of each organ. (transplant.uthscsa.edu)\n\nDonation infrastructure developed alongside clinical capability. The New England Organ Bank, established in 1968, pioneered dedicated identification and coordination of deceased donors. Regional cooperation subsequently expanded beyond individual hospitals: in 1977, the Southeast Organ Procurement Foundation implemented a computerized organ-matching system called the United Network for Organ Sharing. The United States National Organ Transplant Act of 1984 established the Organ Procurement and Transplantation Network (OPTN), authorized support for procurement organizations, and prohibited organ sales. In 1986, the federal government awarded UNOS the initial contract to operate the national network. Its registry for matching organs to waiting candidates served a different purpose from donor-decision registers: the United Kingdom NHS Organ Donor Register, launched on 6 October 1994, enabled individuals to record their willingness to donate after death. (organdonor.gov)\n\nInternational standard-setting addressed the ethical and organizational consequences of expanding transplantation. Following resolutions expressing concern about commercial trade in organs, the World Health Assembly endorsed the World Health Organization Guiding Principles on Human Organ Transplantation in 1991 through resolution WHA44.25. In May 2010, resolution WHA63.22 endorsed revised principles covering human cells, tissues, and organs. The revision retained the earlier framework while responding particularly to increased living donation and the wider use of cells and tissues. Its provisions addressed voluntary authorization, donor protection, non-commercial donation, allocation according to clinical criteria and ethical norms, traceability, and transparency; implementation remained the responsibility of individual jurisdictions. (iris.who.int)" }, { "heading": "Deceased Donation and Determination of Death", "text": "Donation after death determined by neurological criteria—often called donation after brain death (DBD)—can occur while mechanical ventilation maintains oxygen delivery and the heart continues to circulate blood. Brain death is not a prediction that recovery is unlikely: it is a determination of death following permanent loss of the brain functions required by the applicable standard. It differs from coma, which does not itself establish death, and from vegetative or minimally conscious states, in which some brain functions remain. A person in a vegetative state may open their eyes and breathe independently; these findings are incompatible with brain death. Chest movement produced by a ventilator does not indicate spontaneous breathing or recovery. (pmc.ncbi.nlm.nih.gov)\n\nNeurological determination requires an established cause of catastrophic brain injury and exclusion of conditions that could mimic its effects, including sedating drugs, hypothermia, and severe metabolic disturbances. The 2023 United States consensus guideline issued by four professional societies, including the American Academy of Neurology, specifies coma, absent brainstem reflexes, and absence of breathing during an adequately stimulating apnea test. Examination includes responses such as pupillary reactions to light and corneal, gag, and cough reflexes. Ancillary investigations are reserved for circumstances in which required examination or apnea testing cannot be completed or interpreted adequately; they are not routine substitutes for clinical assessment. Spinally mediated limb movements can persist and do not, by themselves, invalidate the diagnosis. (pmc.ncbi.nlm.nih.gov)\n\nDonation after circulatory determination of death (DCD) follows a different pathway: death is established using circulatory and respiratory criteria rather than neurological testing. In controlled DCD, a critically ill patient may not meet brain-death criteria, but a decision has independently been made to withdraw life-sustaining treatment because it offers no overall benefit. Following withdrawal, clinicians monitor the patient and confirm death under the applicable protocol before recovery begins. Uncontrolled DCD follows an unexpected circulatory arrest when resuscitation has failed or is not undertaken in accordance with the clinical circumstances. Neither pathway makes circulatory arrest alone sufficient authorization for immediate organ recovery. (odt.nhs.uk)\n\nUnlike DBD, in which circulation can support organs until recovery, DCD exposes organs to declining oxygen delivery during the dying process and to absent circulation after arrest. This produces warm ischemic injury and limits which organs remain suitable. Consequently, preparations must account for the possibility that donation will not proceed. DCD is not restricted to abdominal organs: NHS Blood and Transplant dates the introduction of DCD heart transplantation at several United Kingdom centres to 2015. In that pathway, a recovered heart can be restarted and assessed outside the donor’s body using a perfusion machine. (odt.nhs.uk)\n\nThe dead-donor rule requires that deceased donors be dead before organ procurement begins and that procurement must not cause their death. Death determination must follow applicable law and accepted medical standards, independently of a recipient’s need for an organ. Guiding Principle 2 of the World Health Organization framework specifies that physicians determining a potential donor’s death should neither participate directly in organ removal or subsequent transplantation nor be responsible for intended recipients’ care. This separation addresses conflicts between duties to the donor and potential recipients. (optn.transplant.hrsa.gov)\n\nEnd-of-life decisions and donation authorization are likewise distinct. In controlled DCD, the decision to withdraw treatment precedes donation planning; palliative care remains directed toward the dying patient. In DBD, ventilation and other artificial support may continue after death to maintain organ oxygenation while authorization, assessment, and recovery arrangements are completed. Such support preserves organ function rather than reversing death. United States federal donor information explicitly distinguishes the team that treated the patient from the transplant surgical team that subsequently recovers authorized organs. (odt.nhs.uk)" }, { "heading": "Consent, Authorization, and Registration", "text": "In explicit-consent, or opt-in, systems, deceased donation requires an affirmative decision by the donor during life or authorization from a legally designated surrogate after death. Depending on national law, evidence may include a donor-register entry, a driving licence, a donor card, a medical record, or an oral statement. In presumed-consent, or opt-out, systems, legislation permits donation from specified categories of people unless they expressed an objection. The World Health Organization’s guiding principles, endorsed in 2010, accommodate both models but require compliance with applicable consent law and the absence of reason to believe that the deceased opposed donation. They also specify that opt-out systems should provide public information and an accessible means of recording refusal. These are legal defaults, not complete descriptions of clinical practice: relatives may still be consulted under either model. (edqm.eu)\n\nEngland introduced deemed consent on 20 May 2020. Its exclusions include children under 18, people who lacked the capacity to understand the arrangements and take the necessary action, visitors, people not living there voluntarily, and those resident for less than 12 months before death. Families remain involved when donation is possible. NHS guidance distinguishes this consultation from automatic organ recovery: relatives may provide evidence of a more recent decision than the register records. Where deemed consent would otherwise apply, but no decision to donate is registered and no family or friends are available, donation does not proceed. Thus, absence of a recorded objection does not invariably result in donation. (organdonation.nhs.uk)\n\nDonor registers preserve decisions for retrieval when donation becomes possible; they do not certify medical eligibility. In the United States, the organ procurement organization checks the state registry and, where necessary, other legally recognized documentation. An adult’s valid registration supplies legal permission, whereas an unrecorded decision may require authorization from next of kin. Medical and social history and organ suitability must still be assessed: registering years earlier neither guarantees that death will occur in circumstances permitting donation nor establishes that particular organs can be transplanted. The NHS Organ Donor Register additionally records decisions not to donate and allows people to select some rather than all listed organs or appoint a representative. Recorded decisions can be amended during life. (organdonor.gov)\n\nThe authority of relatives depends on jurisdiction and on whether a valid donor decision already exists. U.S. federal public guidance states that relatives cannot change an adult’s registered consent. Under the Human Tissue Act framework in England, Wales, and Northern Ireland, valid expressed consent likewise cannot legally be revoked by relatives, although permission to proceed does not compel clinicians to undertake recovery. Where surrogate consent is required, the law identifies who may provide it rather than treating every relative as equally authorized. The statutory hierarchy places a spouse or partner before a parent or child, followed by other specified relationships. A nominated representative has a distinct role; appointment as executor does not automatically confer that authority. (organdonor.gov)\n\nValid informed consent requires adequate information, decision-making capacity, and voluntariness; a signature alone does not establish validity. The Human Tissue Authority requires opportunities to discuss the proposed activity, ask questions, and make an informed choice without coercion, with the decision and its scope documented. Rules for minors differ: U.S. public guidance requires parental or guardian permission for deceased donation below 18, while England excludes under-18s from deemed consent. An exclusion from presumed consent is not itself a prohibition on donation, but requires another lawful basis for authorization. A valid objection must be respected, and authorization must remain within its stated scope: in England, deemed consent covers routine transplantation, not donation of a face, hands, limbs, or uterus. (hta.gov.uk)" }, { "heading": "Living Donation and Donor Protection", "text": "Directed living donation designates a particular recipient, such as a sibling, spouse, friend, or named stranger. Biological relationship and direction are separate classifications: an unrelated donor may still donate to a specified person. Nondirected donation does not designate a recipient; a transplant program arranges allocation, and donor and recipient may never learn each other’s identities. Both forms require assessment of the donor’s decision-making capacity, motivation, and freedom from coercion; absence of a family relationship does not remove these requirements. (hrsa.gov)\n\nMedical evaluation assesses whether organ removal presents an acceptable risk to the donor, independently of its potential benefit to the recipient. It includes medical and family history, physical examination, organ-function testing, and anatomical imaging. Psychosocial assessment examines understanding, expectations, mental health, substance use, social support, family pressure, and practical arrangements for recovery. In the United States, an independent living donor advocate protects the donor’s interests rather than promoting transplantation. Voluntary informed consent includes discussion of operative and longer-term risks, financial consequences, recipient treatment alternatives, and the possibility that transplantation will fail. Candidates may withdraw before surgery, and their reasons remain confidential; agreement to undergo evaluation is not an obligation to donate. (pmc.ncbi.nlm.nih.gov)\n\nLiving donation exposes a person without a therapeutic need for organ removal to major surgery. Complications include bleeding, infection, blood clots, injury to adjacent structures, and reactions to anesthesia. Kidney donation permanently reduces nephron mass, although the remaining kidney increases its filtration. A 2014 study by Abimereki Muzaale and colleagues examined 96,217 US kidney donors and estimated the 15-year risk of end-stage kidney disease at 30.8 per 10,000 donors, compared with 3.9 per 10,000 matched healthy nondonors. These estimates imply approximately eight times the relative risk, but an absolute difference of 26.9 cases per 10,000 people, or 0.269 percentage points. The study therefore illustrates why a large relative increase and a small absolute risk can coexist; its population estimates are not individualized predictions. (hrsa.gov)\n\nPartial-liver donation has different risks, including bile leakage, biliary strictures, and, rarely, liver failure. Regeneration does not eliminate postoperative complications. A US study published in 2012 followed 4,111 liver donors and estimated 90-day mortality at 1.7 per 1,000 donors. Later problems can include incisional hernia and bowel obstruction. In the multicenter Adult-to-Adult Living Donor Liver Transplantation Cohort Study, assessments extending to 11 years found generally favorable average quality-of-life scores, while identifying donors with impaired physical or mental well-being at every assessment point. Favorable group averages therefore do not describe every donor’s experience. (hrsa.gov)\n\nDonor protection continues after recovery. The 2017 Kidney Disease: Improving Global Outcomes guideline specifies annual kidney-donor follow-up covering blood pressure, body mass index, serum creatinine with estimated filtration rate, urine albumin, and psychological well-being. Registry reporting and linkage to health records can identify delayed kidney failure, hospitalizations, and deaths beyond a transplant center’s routine observation period. Interpretation remains difficult: donors are selected for good health, so comparisons with the unscreened general population may conceal donation-associated harm. Even matched healthy comparison groups may differ in unmeasured characteristics, and incomplete follow-up can miss late complications. (pmc.ncbi.nlm.nih.gov)\n\nPsychological and financial consequences also require follow-up. Distress may accompany prolonged recovery, changes in family relationships, recipient graft failure, or recipient death. Travel, accommodation, caregiving, and lost earnings can impose costs even when the recipient’s insurance covers evaluation and surgery; coverage of lifelong follow-up and donation-related complications is not necessarily equivalent to coverage of the operation. These outcomes are distinct from surgical success and are relevant to both pre-donation disclosure and post-donation support. (pmc.ncbi.nlm.nih.gov)" }, { "heading": "Donor Assessment and Biological Compatibility", "text": "Donor assessment distinguishes the suitability of individual organs from the donor’s overall eligibility. Evaluation combines medical records, examination, laboratory testing, imaging, and medical and social histories, including previous disease and potential infectious exposures. In deceased donation, relatives and treating clinicians supply information that the donor cannot provide, sometimes within a short assessment period. Organ-specific investigations include serum creatinine for kidney function, coagulation measurements for liver function, echocardiography for the heart, and chest imaging for lungs. Living kidney donors undergo blood and urine testing, while CT or MRI defines organ anatomy; selected liver donors also undergo a biopsy. Living-donor evaluation must establish both the organ’s suitability for transplantation and the donor’s ability to tolerate its removal. (nhsbt.nhs.uk)\n\nScreening seeks evidence of transmissible infections and malignancy, but negative results do not eliminate transmission risk. The United States Public Health Service’s 2020 guideline recommended testing all living and deceased solid-organ donors for HIV, hepatitis B, and hepatitis C using both serological assays and nucleic acid testing, which detects viral genetic material. It specified collecting deceased-donor specimens within 96 hours before procurement, and testing living donors as close to surgery as possible, within 28 days before procurement. Recent infection can remain undetectable during a diagnostic window period. Cancer assessment likewise combines the donor’s history with examination, imaging, and applicable screening tests rather than relying on a single assay. Relevant findings and exposure histories are communicated to receiving transplant teams so that organ acceptance and recipient discussions reflect the identified risks. (cdc.gov)\n\nCompatibility testing addresses whether the recipient’s immune system is likely to attack a particular donor organ. The ABO blood group system distinguishes A and B antigens and the antibodies directed against them. For example, a group O recipient normally has both anti-A and anti-B antibodies, making a group A kidney incompatible under conventional transplantation conditions. Blood-group incompatibility is not necessarily an absolute barrier: specialized programs can undertake selected incompatible transplants. ABO compatibility is therefore a biological assessment, distinct from the allocation rules determining which compatible candidate receives an offer. (nhs.uk)\n\nHuman leukocyte antigens (HLA), the human major histocompatibility complex, are inherited cell-surface markers used in tissue typing. Recipients may develop anti-HLA antibodies after pregnancy, blood transfusion, or previous transplantation; antibodies recognizing the proposed donor’s HLA are termed donor-specific antibodies. A physical crossmatch tests recipient serum against donor white blood cells for antibody reactivity. A virtual crossmatch instead compares the recipient’s current and historical antibody profile with the donor’s HLA typing. HLA matching is particularly important in kidney transplantation, whereas close HLA matching is not normally a primary consideration for liver or cardiothoracic transplantation. Antibody assessment and the degree of HLA matching are related but distinct: a donor need not be an identical tissue match to be immunologically acceptable. (nhsbtdbe.blob.core.windows.net)\n\nKidney paired donation rearranges living donations when willing donor–recipient pairs cannot proceed directly because of blood-group or antibody incompatibility. In a two-pair exchange, the donor from the first pair gives to the second pair’s recipient, while the second donor gives to the first recipient, provided both new combinations are compatible. Exchanges can include more than two pairs. A nondirected donor can initiate a chain by donating to a recipient whose intended donor then donates to another compatible recipient, continuing through further pairs. These arrangements change the donor–recipient combinations rather than removing the underlying incompatibility; each proposed transplant still requires donor assessment and compatibility testing. (organdonor.gov)" }, { "heading": "Organ Recovery, Preservation, and Transport", "text": "Organ recovery requires coordinated scheduling among the donor hospital, procurement organization, retrieval surgeons, laboratories, transport services, and receiving transplant centers. In the United States, the organ procurement organization (OPO) coordinates donor evaluation and organ offers, while recipient teams decide whether to accept individual organs. Laboratories provide blood-group, infection-screening, and compatibility results; retrieval and recipient teams coordinate operating-room readiness with expected recovery and arrival times. After authorization and determination of death, donor organ support continues until recovery. The OPO arranges transport, which may involve ambulances, helicopters, or commercial aircraft; different organs from one donor may travel to different hospitals. (organdonor.gov)\n\nDuring conventional recovery, surgeons expose and inspect the organs, preserve the vessels needed for implantation, and flush the circulation with cold preservation solution. In static cold storage, the recovered organ remains in preservation fluid within cooled packaging, without continuous circulation. Solutions such as University of Wisconsin solution and histidine–tryptophan–ketoglutarate solution provide a controlled chemical environment during preservation. Cooling reduces metabolic demand but does not eliminate injury from inadequate oxygen delivery. Warm ischemia occurs when blood supply is insufficient while the organ remains warm; cold ischemia describes the subsequent oxygen-deprived period under hypothermic preservation. Donation after circulatory death introduces a warm-ischemic interval before preservation, with the liver and pancreas particularly vulnerable. (nice.org.uk)\n\nPreservation constraints differ substantially among organs. HRSA describes usual transplantation intervals after removal as within six hours for hearts and lungs, within approximately twelve hours for liver, pancreas, and intestine, and within thirty-six hours for kidneys. These are practical ranges, not guaranteed viability limits: transplant teams prefer shorter intervals and judge suitability individually. Transport planning therefore encompasses more than journey time; packaging, transfer between vehicles, recipient preparation, and implantation must fit within the preservation plan. Machine-supported preservation can change that plan, so total time outside the body is not necessarily equivalent to time spent in cold ischemia. (hrsa.gov)\n\nIdentification and documentation maintain a traceable chain of custody. Under U.S. OPTN policies effective October 1, 2026, organs transported outside the recovery facility require internal and external packaging; conventional internal packaging includes a triple sterile barrier, with a rigid layer required for kidneys and pancreas. Labels identify the organ, donor identification number, and blood group, while accompanying documentation includes source blood-group and available infectious-disease results. The OPTN organ-tracking system supports standardized labeling. Receiving hospitals conduct documented pre-transplant checks linking the donor organ to the intended recipient and verifying blood-group compatibility. These linked identifiers and records preserve donor-to-recipient traceability through packaging, shipment, receipt, and implantation. (hrsa.gov)\n\nMachine perfusion circulates fluid through an organ’s vessels rather than leaving it motionless in cold solution. Hypothermic perfusion combines cooling with circulation; systems differ in whether supplemental oxygen is supplied. Normothermic perfusion uses warmed, oxygenated perfusate—often red-cell-based—to support metabolism and permit functional assessment outside the body. Preservation and assessment are distinct purposes, and physiological activity does not establish that every protocol improves transplant outcomes. In a 2023 randomized controlled trial reported by Sarah Hosgood and colleagues, adding one hour of normothermic perfusion after cold storage of circulatory-death donor kidneys did not reduce delayed graft function: rates were 60.7% with perfusion and 58.5% with cold storage alone. (nice.org.uk)\n\nEx situ perfusion treats an organ after removal; normothermic regional perfusion restores oxygenated circulation to a defined region within the deceased donor before recovery. The United Kingdom’s May 2025 abdominal protocol specifies an extracorporeal circuit circulating oxygenated blood at approximately 37°C, typically for two hours, to replenish cellular energy reserves and assess organ function. The abdominal circulation is isolated by occluding the descending thoracic aorta and venting the aorta above the occlusion, preventing perfusion of the heart and brain. Organs are subsequently recovered for cold storage or further ex situ preservation. (nhsbtdbe.blob.core.windows.net)" }, { "heading": "Allocation and Access to Transplantation", "text": "Assessment for transplantation, waiting-list registration, allocation ranking, and acceptance of an organ offer are separate decisions. In the United States, a transplant center first evaluates whether transplantation is appropriate for a patient; acceptance by the program permits registration with the Organ Procurement and Transplantation Network (OPTN). Registration does not establish a fixed place in a chronological queue. For each deceased-donor organ, the matching system generates an offer sequence using donor information and organ-specific allocation rules. The receiving center then reviews the donor’s medical history, organ characteristics, and the candidate’s current condition before accepting or declining. If it declines, the organ is offered to other candidates according to the match sequence. Thus, high allocation priority does not itself guarantee transplantation. (organdonor.gov)\n\nAllocation combines biological suitability with competing objectives: preventing deaths while waiting, recognizing time already waited, and obtaining sustained benefit from scarce organs. Blood-group compatibility and donor–recipient size are common considerations, but their importance and implementation differ among organs. U.S. kidney allocation considers waiting time, immune matching, pediatric status, previous living donation, distance, and survival benefit. Heart and liver allocation emphasize medical urgency and distance; lung allocation incorporates both urgency and predicted survival after transplantation. Distance matters partly because transport prolongs the interval between organ recovery and implantation. Giving greater geographical reach to urgent candidates can therefore involve a trade-off between access and preservation time, rather than simply favoring the nearest recipient. (hrsa.gov)\n\nExpected benefit can be incorporated through specific matching mechanisms rather than a general judgment about a patient’s worth. The U.S. Kidney Allocation System, implemented in December 2014, introduced longevity matching using the Kidney Donor Profile Index (KDPI) and Estimated Post-Transplant Survival (EPTS) score. Within its allocation sequence, kidneys with KDPI values of 20% or less receive preferential matching to adult candidates in the most favorable 20% of EPTS scores. A different approach began for U.S. lungs on March 9, 2023: continuous distribution assigns a composite allocation score specific to each candidate–donor match. At introduction, medical urgency and predicted five-year post-transplant survival each contributed up to 25 points, alongside biological matching disadvantages, pediatric status, previous living donation, and placement efficiency. These are predictive allocation measures, not guarantees of an individual outcome. (hrsa.gov)\n\nSpecial priorities address disadvantages that ordinary waiting-time rules may not overcome. Highly sensitized kidney candidates have antibodies against many potential donors’ human leukocyte antigens, leaving fewer compatible organs. U.S. kidney allocation therefore awards increasing priority through a sliding scale based on calculated panel-reactive antibody (CPRA), rather than treating an equally long wait as an equal opportunity to receive a transplant. Pediatric provisions are also organ-specific: U.S. kidney rules provide additional points and priority classifications for candidates registered before age 18. Under the lung system introduced in 2023, being younger than 18 at registration contributed 20 points to the composite score. These provisions modify ranking; they do not remove compatibility requirements. (hrsa.gov)\n\nThe World Health Organization’s Guiding Principle 9 requires allocation to follow clinical criteria and ethical norms rather than financial or other extraneous considerations; its revised principles were endorsed on May 21, 2010. Fairness within an allocation algorithm is nevertheless distinct from equitable access to evaluation and listing. U.S. matching rules exclude financial and celebrity status from ranking, but reaching transplantation still involves referral, center evaluation, insurance coverage, travel, and continuing treatment costs. Consequently, equitable ordering of registered candidates does not establish that everyone who could benefit has an equal opportunity to become a candidate. (who.int)" }, { "heading": "Health-System Organization and Global Patterns", "text": "Donation systems distribute operational and regulatory responsibilities differently. In Spain, the Organización Nacional de Trasplantes (ONT), established in 1989, supports a three-tier network of national, autonomous-community, and hospital coordination. Hospital coordination units identify potential donors and organize donation pathways; they include physicians and nurses, with intensive-care specialists playing a prominent role. Coordinators report to hospital management rather than being hierarchically subordinate to transplant teams, while regional health authorities authorize procurement hospitals. In the United States, geographically organized organ procurement organizations receive hospital referrals, assess potential deceased donors, establish authorization, enter donor information into the national matching system, and arrange recovery. Federal responsibilities are divided: the Centers for Medicare & Medicaid Services certifies procurement organizations, while the Health Resources and Services Administration oversees the Organ Procurement and Transplantation Network. (ont.es)\n\nCross-border cooperation can link national systems without replacing their competent authorities. Eurotransplant coordinates deceased-donor organ allocation across Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, the Netherlands, and Slovenia. Its network connects donor hospitals, transplant centers, and tissue-typing laboratories, allowing matching across a larger recipient pool than any member country alone. National organizations retain responsibilities such as organizing domestic organ transport; Eurotransplant is therefore an allocation and exchange organization, not a supranational hospital regulator or comprehensive procurement service. (eurotransplant.org)\n\nInternational activity is assembled through the Global Observatory on Donation and Transplantation (GODT), a collaboration between the World Health Organization and Spain’s ONT. Since 2007, its annual questionnaires have collected information on donation, transplantation, legislation, and organizational structures from health authorities and officially designated national contacts. Discrepancies are clarified through direct communication with contributors. Results are presented as absolute counts and rates per million population (pmp), permitting comparisons between differently sized countries. The observatory cautions that some submissions remain provisional and may subsequently be revised. (transplant-observatory.org)\n\nThe GODT’s 2024 reporting cycle covered 92 countries, using submissions received by October 29, 2025. It recorded 173,727 solid-organ transplants: 110,467 kidney, 42,497 liver, 10,287 heart, 8,236 lung, 2,066 pancreas, and 174 small-bowel transplants. There were 47,180 deceased donors, of whom 28% donated after circulatory determination of death. Living donation included 40,996 kidney and 9,861 liver donations. Population-adjusted comparisons reveal different patterns from absolute totals: India reported 15,504 living donors, or 10.8 pmp, whereas Türkiye reported 4,660, or 54 pmp. (transplant-observatory.org)\n\nDonor counts, recovered-organ counts, and transplant counts measure different stages. One deceased donor may provide several organs, while recovery does not guarantee transplantation; bilateral or combined procedures also require explicit counting conventions. International comparisons therefore depend on whether a registry counts donors from whom organs were recovered or only donors whose organs were transplanted. Reporting completeness differs by variable and country, and GODT methodology allows previous observations to be carried forward for some missing activity data. Rates additionally reflect health-system capacity, including intensive care, laboratories, surgical services, transport, and continuing recipient care—not merely willingness to donate. Recorded waiting lists likewise measure recognized, evaluated demand rather than total population need: the 668,160 patients reported as waitlisted during 2024 came from 75 reporting countries and excluded people who never reached assessment or listing. (pmc.ncbi.nlm.nih.gov)" }, { "heading": "Ethical Standards and Prevention of Exploitation", "text": "The World Health Organization (WHO) Guiding Principles, endorsed by the World Health Assembly in May 2010 through resolution WHA63.22, link respect for autonomy and bodily integrity to valid authorization, voluntary informed consent, and protection of donor welfare. For living donors, willingness alone is insufficient: understandable risk information, appropriate selection, professional care, and follow-up are also required. For deceased donation, a valid objection expressed during life precludes organ removal. These are international ethical standards whose implementation depends on national law, rather than a single worldwide legal code. (who.int)\n\nWHO Guiding Principle 5 distinguishes purchasing an organ from reimbursing the costs of donation. It rejects monetary payment and rewards with monetary value, while permitting reasonable, verifiable donation-related expenses, including lost income, and legitimate recovery, preservation, and supply costs. Thus, replacing documented earnings lost during recovery differs from negotiating a price for a kidney. The 2018 Declaration of Istanbul describes the intended outcome as financial neutrality: donors and their families should neither gain nor lose financially through donation. Reimbursement is therefore cost replacement, not compensation for the organ’s market value. (apps.who.int)\n\nInternational terminology distinguishes overlapping forms of exploitation. The 2008 Declaration of Istanbul defined transplant commercialism as treating an organ as a commodity through purchase, sale, or material gain. Its 2018 edition defines organ trafficking more broadly than an unlawful removal operation: it includes removal without valid consent or authorization, removal for financial gain or comparable advantage, subsequent use of such organs, corrupt facilitation, and recruitment for gain. Separately, trafficking in persons for organ removal concerns recruitment or control of people through coercion, fraud, deception, or abuse of vulnerability. Apparent agreement does not establish valid consent when those means have been used. (declarationofistanbul.org)\n\nCross-border treatment is not intrinsically exploitative. Under the 2018 declaration, travel for transplantation means movement across jurisdictional borders for transplantation. It becomes transplant tourism when it involves organ trafficking or trafficking in persons, or when services supplied to non-residents undermine transplant provision for the resident population. Conversely, equitable sharing arrangements between jurisdictions are compatible with the declaration. The distinction therefore depends on organ provenance, consent, and effects on local access—not simply on whether the recipient travels abroad. (declarationofistanbul.org)\n\nIndependent assessment addresses pressures that a consent form alone may conceal. The 2017 KDIGO living-kidney-donor guideline recommends psychosocial evaluation covering motivation, voluntariness, understanding, social support, and the donor–recipient relationship, preferably by someone uninvolved in the recipient’s care. This separation reduces conflicts between protecting the donor and obtaining an organ for the recipient. WHO likewise calls for qualified, independent evaluation to identify coercion or disguised payment; safeguards apply even where the proposed donor is a relative rather than a stranger. (pmc.ncbi.nlm.nih.gov)\n\nConfidentiality and transparency operate at different levels. WHO Principle 11 calls for public information about transplant activity, outcomes, organization, and funding while shielding identifying donor and recipient information. Regulatory accountability includes scrutiny of service fees to detect disguised organ payments, professional sanctions for participation in exploitative procurement, and oversight of donation practices. Traceability permits authorized investigation without making personal medical information public. (tts.org)" }, { "heading": "Families, Culture, and Public Understanding", "text": "Communication with a potential donor’s family involves explaining the patient’s condition, establishing their previously expressed wishes, and describing what donation would entail. NICE guideline CG135, published in 2011 and updated in 2016, specifies a coordinated approach involving the treating team and a specialist donation nurse, with a trained interpreter, faith representative, or bereavement service where needed. It calls for private, compassionate discussions and sufficient time for relatives to understand that death is inevitable or has occurred. Discussion of withdrawal of life-sustaining treatment or neurological death should precede, and normally occur separately from, discussion of donation, unless relatives raise both together. Information includes the proposed procedures, interventions before recovery, likely timing, and reasons donation might not proceed despite authorization. These are communication standards, not evidence that any particular conversation will produce consent. (nice.org.uk)\n\nRespectful care extends beyond authorization to the treatment of the body and support after death. United States federal public information states that organ recovery does not prevent an open-casket funeral. NHS Blood and Transplant’s follow-up guidance includes opportunities to view the deceased, requests for particular clothing, and keepsakes such as handprints or locks of hair. Families are offered a follow-up letter within two weeks of donation, information about bereavement support, and opportunities for later contact or remembrance activities. These arrangements distinguish continuing family care from the immediate task of organizing organ recovery. (organdonor.gov)\n\nReligious and cultural concerns can involve bodily integrity, the determination of death, prayers, washing and dressing the deceased, and the timing of burial. Religious affiliation alone does not establish an individual’s position: NHS guidance explicitly recognizes different schools of thought within religions and differences between religious and medical understandings of death. Its information for Muslim communities likewise describes multiple viewpoints rather than a single binding position. A practical accommodation introduced on the NHS Organ Donor Register in December 2018 allows registrants to indicate that their faith or beliefs should be discussed with relatives or another appropriate person. This records a need for individual discussion rather than inferring wishes from community membership. (nhsbtmediaservices.blob.core.windows.net)\n\nPublic education must distinguish recording a donation decision from actually becoming a donor. Registration does not establish medical suitability; specialists assess organs and the circumstances of death at the time donation becomes possible. Explanations of brain death also need to distinguish it from recoverable unconsciousness: federal guidance describes it as an irreversible condition in which the person cannot breathe independently. Information about clinical independence addresses a separate concern. The World Health Organization’s 2010 Guiding Principles require that physicians determining death not participate directly in organ removal or transplantation, or care for the intended recipients. Such explanations describe safeguards and eligibility conditions; promotional statements about lives saved do not, by themselves, explain these processes or guarantee that a registered person’s organs will be transplanted. (organdonation.nhs.uk)\n\nInformation sharing after transplantation is governed by confidentiality requirements and the arrangements of the responsible donation service. WHO Guiding Principle 11 combines public transparency about donation and transplantation systems with protection against disclosure of identifiable donor and recipient information. In the United Kingdom, NHS Blood and Transplant mediates correspondence between donor families and recipients: either side may initiate a letter, card, or email, but staff check it for identifying details before forwarding it. Surnames, addresses, workplaces, and hospital details are excluded, and recipients choose whether to receive available correspondence. This mechanism permits voluntary communication without automatically revealing identities or creating an obligation to reply. (edqm.eu)" }, { "heading": "Safety Monitoring and Evaluation of Donation Systems", "text": "Safety surveillance connects donor assessment, organ recovery, transplantation, and subsequent follow-up through traceable records. Guiding Principle 10 of the World Health Organization’s transplantation principles, endorsed in May 2010, calls for quality systems incorporating traceability, vigilance, and reporting of adverse events and reactions, including those involving exported organs. Its scope includes procedural deviations that could increase risk even when harm has not yet been demonstrated, as well as long-term outcomes for living donors and recipients. Traceability allows an unexpected donor finding to be linked to every affected recipient without making donor identities publicly available. (iris.who.int)\n\nSuspected donor-derived infection or malignancy requires communication before transmission is conclusively established. In the United States, Organ Procurement and Transplantation Network (OPTN) guidance specifies notification as soon as possible and within 24 hours of suspected donor-derived transmission, without waiting for all test results. The organ procurement organization can then contact other centers whose patients received organs from the same donor, allowing clinicians to assess additional testing, treatment, or prophylaxis. New information may include a positive donor culture or a pathology result received after recovery. Individual investigations and aggregate case reviews serve different purposes: the former establish whether recipients share an exposure, while the latter identify recurring transmission risks and inform guidance or policy changes. (hrsa.gov)\n\nDonation-pathway indicators measure distinct stages rather than a single success rate. Referral records notification of a potential donor to the donation service; authorization records permission for recovery; and recovery records organs surgically obtained for transplantation. Referral audits can therefore identify missed opportunities before authorization is considered. (nhsbtdbe.blob.core.windows.net) Utilization must specify its denominator—for example, organs transplanted per donor or the proportion of recovered organs transplanted. The OPTN/SRTR reporting definition of nonuse is an organ recovered for transplantation but not transplanted; its rate is the number not transplanted divided by the number recovered for transplantation. Organs never recovered are outside that denominator. (pmc.ncbi.nlm.nih.gov) These measures differ from recipient survival and graft survival after transplantation. Scientific Registry of Transplant Recipients (SRTR) reports, for example, measure survival with a functioning graft at specified intervals and calculate expected outcomes adjusted for donor, recipient, and transplant characteristics. (srtr.hrsa.gov)\n\nAudits examine whether reported activity corresponds to clinical records and whether required processes were followed. OPTN monitoring includes site surveys, donor-record review, data validation, and focused follow-up reviews. Findings of potential noncompliance generate written reports and requests for corrective action plans; unresolved concerns can be referred to the Membership and Professional Standards Committee. (hrsa.gov) Public SRTR program-specific reports provide a separate accountability mechanism by publishing transplant activity and outcomes. Their risk-adjusted comparisons distinguish observed results from results expected for similar patients and donors; they are not simply rankings of unadjusted survival percentages. (srtr.hrsa.gov)\n\nEvaluation of preservation technologies requires comparative evidence rather than technical feasibility alone. In a 2018 randomized controlled trial reporting 220 liver transplants, David Nasralla and colleagues found that normothermic preservation reduced enzyme-measured graft injury and organ discard relative to static cold storage, but did not demonstrate significant differences in graft or patient survival. (pubmed.ncbi.nlm.nih.gov) Results are organ- and protocol-specific: Sarah Hosgood and colleagues’ 2023 kidney trial found that adding one hour of normothermic perfusion after cold storage did not reduce delayed graft function. (nature.com) Economic evaluation also requires an explicit perspective and time horizon; a Canadian liver-preservation analysis published in 2022 modeled costs and health benefits over five years from the public payer’s perspective. (sciencedirect.com) For organizational changes, referral, authorization, recovery, and nonuse data provide intermediate measures, while donor safety and recipient follow-up establish whether increased activity is accompanied by acceptable clinical outcomes; WHO monitoring principles encompass both donors and recipients rather than transplant volume alone. (nhsbtdbe.blob.core.windows.net)" } ], "links": [ "organ-transplantation", "informed-consent", "world-health-organization", "kidney", "pancreas", "hematopoietic-stem-cell-transplantation", "bone-marrow", "immune-system", "united-states", "united-kingdom", "brain-death", "law", "palliative-care", "mental-health", "surgery", "anesthesia", "quality-of-life", "insurance", "biopsy", "infectious-disease", "cancer", "hiv-aids", "hepatitis-b", "hepatitis-c", "abo-blood-group-system", "major-histocompatibility-complex", "antibody", "randomized-controlled-trial", "spain", "health-system", "family", "religion", "culture", "data-privacy" ], "sources": [ { "title": "Glossary", "url": "https://www.organdonor.gov/learn/glossary" }, { "title": "What Can Be Donated", "url": "https://www.organdonor.gov/learn/what-can-be-donated" }, { "title": "Types of liver transplant - Organ transplantation - NHS Blood and Transplant", "url": "https://www.nhsbt.nhs.uk/organ-transplantation/liver/is-a-liver-transplant-right-for-you/types-of-liver-transplant/" }, { "title": "Living Organ Donation", "url": "https://www.organdonor.gov/learn/process/living-donation" }, { "title": "Living donor liver transplant - Organ transplantation - NHS Blood and Transplant", "url": "https://www.nhsbt.nhs.uk/organ-transplantation/liver/receiving-a-liver/living-donor-liver-transplant/" }, { "title": "Plasma, Platelets and Whole Blood", "url": "https://www.redcrossblood.org/donate-blood/how-to-donate/types-of-blood-donations/blood-components.html" }, { "title": "Stem Cell and Bone Marrow Transplants for Cancer - NCI", "url": "https://www.cancer.gov/about-cancer/treatment/types/stem-cell-transplant" }, { "title": "Medical school and body donation FAQs", "url": "https://www.hta.gov.uk/body-donation-faqs" }, { "title": "How Transplant Science Has Advanced Over The Years", "url": "https://transplant.uthscsa.edu/celebrating-50-years-and-5000-transplants/how-transplant-science-has-advanced-over-the-years/" }, { "title": "The Landmark Identical Twin Case", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2993573/" }, { "title": "Donation & Transplantation History", "url": "https://www.organdonor.gov/learn/history" }, { "title": "Learn about the history of transplant", "url": "https://optn.transplant.hrsa.gov/patients/about-transplantation/history/?sf210907141=1" }, { "title": "Chris Barnard Collection", "url": "https://atom.lib.uct.ac.za/index.php/chris-barnard-collection" }, { "title": "The history of organ donation and transplantation", "url": "https://unos.org/about/unos-history/" }, { "title": "About the OPTN", "url": "https://www.hrsa.gov/optn/about" }, { "title": "Organ Donor Register (Hansard, 17 February 1995)", "url": "https://api.parliament.uk/historic-hansard/written-answers/1995/feb/17/organ-donor-register" }, { "title": "More than 100,000 lives saved through organ donation in the UK over last 30 years", "url": "https://www.nhsbt.nhs.uk/news/more-than-100-000-lives-saved-through-organ-donation-in-the-uk-over-last-30-years/" }, { "title": "WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation", "url": "https://iris.who.int/bitstream/handle/10665/341814/WHO-HTP-EHTCPR-2010.01-eng.pdf?sequence=1" }, { "title": "WHO guiding principles on human cell, tissue and organ transplantation", "url": "https://www.who.int/publications/i/item/WHO-HTP-EHT-CPR-2010.01" }, { "title": "Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline: Report of the AAN Guidelines Subcommittee, AAP, CNS, and SCCM", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10791061/" }, { "title": "NHS 111 Wales - Health A-Z: Brain death", "url": "https://111.wales.nhs.uk/braindeath/" }, { "title": "Donation after circulatory death", "url": "https://www.odt.nhs.uk/deceased-donation/best-practice-guidance/donation-after-circulatory-death/?trk=public_post_comment-text" }, { "title": "Strengthening Systems: Advancing Accountability, Safety, and Public Trust", "url": "https://www.hrsa.gov/optn-modernization/updates/september-2025" }, { "title": "Types of heart donation", "url": "https://www.nhsbt.nhs.uk/organ-transplantation/heart/receiving-a-heart/types-of-heart-donation/" }, { "title": "OPTN/UNOS Ethics Board Report 2015-12", "url": "https://optn.transplant.hrsa.gov/media/1546/ethics_boardreport_20151201.pdf" }, { "title": "WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation", "url": "https://tts.org/108-tts/about/tts-and-the-who/604-who-guiding-principles-on-human-cell-tissue" }, { "title": "Identify and refer a potential organ donor", "url": "https://odt.nhs.uk/deceased-donation/best-practice-guidance/identify-and-refer-a-potential-organ-donor/" }, { "title": "Donation After Life", "url": "https://www.organdonor.gov/learn/process/donation-after-life" }, { "title": "Organ donation law in England", "url": "https://www.organdonation.nhs.uk/organ-donation-laws/organ-donation-law-in-england/?campaign=2509" }, { "title": "What is the opt out system in England?", "url": "https://www.organdonation.nhs.uk/opt-out-faq/" }, { "title": "Consent", "url": "https://www.organdonation.nhs.uk/about-organ-donation/consent/" }, { "title": "Organ Donation FAQ", "url": "https://www.organdonor.gov/learn/faq" }, { "title": "Code A: Glossary", "url": "https://www.hta.gov.uk/code-glossary" }, { "title": "Code A: Section two - The fundamental guiding principle of consent", "url": "https://www.hta.gov.uk/guidance-professionals/codes-practice-standards-and-legislation/codes-practice/code-guiding-principles-and-fundamental-principle-consent/code-section-two-fundamental-guiding-principle-consent" }, { "title": "Living Non-Directed Organ Donation", "url": "https://www.hrsa.gov/optn/professionals/resources/ethical-considerations/living-non-directed-organ-donation" }, { "title": "Living Donation FAQs", "url": "https://www.hrsa.gov/optn/patients/organ-donation/living-donation/living-donation-faqs" }, { "title": "OPTN Policies Effective as of Dec 11, 2025", "url": "https://www.hrsa.gov/sites/default/files/hrsa/optn/optn_policies.pdf" }, { "title": "KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5540357/" }, { "title": "Risk of end-stage renal disease following live kidney donation", "url": "https://pubmed.ncbi.nlm.nih.gov/24519297/" }, { "title": "Estimates of early death, acute liver failure, and long-term mortality among live liver donors", "url": "https://pubmed.ncbi.nlm.nih.gov/22108193/" }, { "title": "Long-term quality of life after liver donation in the adult to adult living donor liver transplantation cohort study (A2ALL)", "url": "https://pubmed.ncbi.nlm.nih.gov/25195558/" }, { "title": "Long-Term Medical and Psychosocial Outcomes in Living Liver Donors", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5510163/" }, { "title": "About your donor", "url": "https://www.nhsbt.nhs.uk/organ-transplantation/kidney/receiving-a-kidney/about-your-donor/" }, { "title": "Donor and Organ Characterisation, Assessment and Allocation in Deceased and Living Donation and Transplantation", "url": "https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/4387/donor_and_organ_characterisation_assessment_and_allocation_in_deceased_and_living_donatation_and_transplantation_-_nop001.pdf" }, { "title": "Assessing Solid Organ Donors and Monitoring Transplant Recipients for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infection — U.S. Public Health Service Guideline, 2020", "url": "https://www.cdc.gov/mmwr/volumes/69/rr/rr6904a1.htm" }, { "title": "Blood groups", "url": "https://www.nhs.uk/tests-and-treatments/blood-groups/" }, { "title": "Having a live donor kidney transplant when blood groups are incompatible", "url": "https://yourhealth.leicestershospitals.nhs.uk/library/renal-respiratory-cardiovascular-rrcv/renal/2079-having-a-live-donor-kidney-transplant-when-blood-groups-are-incompatible/file" }, { "title": "Donor Matching System", "url": "https://www.hrsa.gov/optn/patients/organ-donation/donor-matching-system" }, { "title": "Histocompatibility testing for kidney transplant patients", "url": "https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/25413/2122-0550-inf25521-histocompatibility-testing-for-kidney-transplant-patients.pdf" }, { "title": "2025 Histo Guidance Document: Histo Lab Bylaws and Policies", "url": "https://www.hrsa.gov/sites/default/files/hrsa/optn/histo_labguidancedoc_202505.pdf" }, { "title": "Histocompatibility and Immunogenetics: INF136", "url": "https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/29939/inf136.pdf" }, { "title": "From Matching Theory to Matching Kidneys", "url": "https://www.nsf.gov/impacts/kidney-exchanges" }, { "title": "Organ preservation (renal) - machine perfusion & static storage: appraisal consultation", "url": "https://www.nice.org.uk/guidance/ta165/documents/organ-preservation-renal-machine-perfusion-static-storage-appraisal-consultation-document-" }, { "title": "Cold storage organ perfusion fluid issue", "url": "https://www.odt.nhs.uk/cold-storage-organ-perfusion-fluid-issue/" }, { "title": "Donation after circulatory death", "url": "https://www.odt.nhs.uk/deceased-donation/best-practice-guidance/donation-after-circulatory-death/" }, { "title": "How Organ Allocation Works", "url": "https://www.hrsa.gov/optn/patients/organ-transplants/how-organ-allocation-works" }, { "title": "EVNP", "url": "https://www.nhsbt.nhs.uk/clinical-trials-unit/trials-and-studies/organ-donation-and-transplantation/evnp/" }, { "title": "Normothermic machine perfusion versus static cold storage in donation after circulatory death kidney transplantation: a randomized controlled trial", "url": "https://pubmed.ncbi.nlm.nih.gov/37231075/" }, { "title": "UK National NRP protocol", "url": "https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/36508/uk-protocol-for-normothermic-regional-perfusion-version-114-final.pdf" }, { "title": "The Organ Transplant Process", "url": "https://www.organdonor.gov/learn/process/transplant-process" }, { "title": "Kidney Allocation System", "url": "https://www.hrsa.gov/optn/professionals/resources/kidney-pancreas/kidney-allocation-system" }, { "title": "The New Kidney Allocation System (KAS) Frequently Asked Questions", "url": "https://www.hrsa.gov/sites/default/files/hrsa/optn/kas_faqs.pdf" }, { "title": "New Lung Allocation Policy in Effect", "url": "https://www.hrsa.gov/optn/news-events/news/new-lung-allocation-policy-effect" }, { "title": "Lung CAS Calculator", "url": "https://www.hrsa.gov/optn/data-calculators/allocation-calculators/lung-cas-calculator" }, { "title": "Human organ and tissue transplantation: WHA63.22", "url": "https://resolutionsportal.who.int/es/akn?query=%2Fakn%2Fun%2Fstatement%2Fdeliberation%2Fwhowha%2F2010-05-21%2Fwha63_22%2Feng%40%2F%21main" }, { "title": "Qué es el modelo Español", "url": "https://www.ont.es/informacion-al-ciudadano-3/que-es-el-modelo-espanol-3-3/" }, { "title": "Volunteer Locally", "url": "https://www.organdonor.gov/get-involved/volunteer" }, { "title": "Organ Procurement & Transplantation Network (OPTN)", "url": "https://www.hrsa.gov/optn?from=optn.transplant.hrsa.gov" }, { "title": "Press - Eurotransplant", "url": "https://www.eurotransplant.org/press" }, { "title": "How can we help you? - Eurotransplant", "url": "https://www.eurotransplant.org/contact" }, { "title": "Methodology - GODT", "url": "https://www.transplant-observatory.org/methodology/" }, { "title": "Data (Charts and tables) - GODT", "url": "https://www.transplant-observatory.org/data-charts-and-tables/" }, { "title": "Organ Donation and Transplantation Worldwide: The Global Observatory on Donation and Transplantation 2024 Report", "url": "https://www.transplant-observatory.org/wp-content/uploads/2026/03/glostatpubTransplantation.pdf" }, { "title": "Organ Donation and Transplantation Worldwide: The Global Observatory on Donation and Transplantation 2024 Report", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12908642/" }, { "title": "Transforming organ donation and transplantation: challenges, innovations, and future directions", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13487882/" }, { "title": "WHO Global Strategy on Donation and Transplantation", "url": "https://www.ishlt.org/docs/default-source/default-document-library/who_global-strategy-on-donation-and-transplantation.pdf" }, { "title": "WHO/HTP/EHT/CPR/2010.01: WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation", "url": "https://iris.who.int/bitstream/handle/10665/341814/WHO-HTP-EHT-CPR-2010.01-eng.pdf" }, { "title": "Executive Board: Human organ and tissue transplantation, EB123/5", "url": "https://apps.who.int/gb/archive/pdf_files/EB123/B123_5-en.pdf" }, { "title": "The Declaration of Istanbul on Organ Trafficking and Transplant Tourism, 2018 Edition", "url": "https://www.declarationofistanbul.org/images/documents/doi_2018_English.pdf" }, { "title": "The Declaration of Istanbul, 2008 Edition", "url": "https://www.declarationofistanbul.org/images/documents/doi_2008_English.pdf" }, { "title": "Recommendations | Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation | Guidance | NICE", "url": "https://www.nice.org.uk/guidance/cg135/chapter/recommendations" }, { "title": "Organ Donation Follow up - ODT Clinical - NHS Blood and Transplant", "url": "https://www.odt.nhs.uk/odt-structures-and-standards/organ-donation-retrieval-and-transplantation-teams/organ-donation-follow-up/" }, { "title": "Organ Donation and Religious Beliefs", "url": "https://nhsbtmediaservices.blob.core.windows.net/organ-donation-assets/pdfs/Organ_Donation_Registry_Fact_Sheet_3_21337.pdf" }, { "title": "Islam - NHS Organ Donation", "url": "https://www.organdonation.nhs.uk/about-organ-donation/your-faith-and-beliefs/islam/" }, { "title": "What is the opt out system? - NHS Organ Donation", "url": "https://nhsbt-cms-organs-prod-one.azurewebsites.net/about-organ-donation/faq/what-is-the-opt-out-system/" }, { "title": "Who can donate? - NHS Organ Donation", "url": "https://organdonation.nhs.uk/about-organ-donation/who-can-donate/" }, { "title": "Donor family and recipient contact - NHS Blood and Transplant", "url": "https://www.nhsbt.nhs.uk/how-we-help/donor-family-care-service/donor-family-and-recipient-contact/" }, { "title": "Resource for Reporting Potential Donor-Derived Disease Transmission Events (PDDTE)", "url": "https://www.hrsa.gov/optn/professionals/resources/guidance/resource-for-reporting-potential-donor-derived-disease-transmission-events-pddte" }, { "title": "Potential Donor Audit Record", "url": "https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/3178/frm4361.pdf" }, { "title": "OPTN/SRTR 2023 Annual Data Report: Deceased Organ Donation", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12334191/" }, { "title": "Technical Methods for the Program-Specific Reports", "url": "https://srtr.hrsa.gov/transplant-professionals/program-specific-report/technical-methods-for-the-program-specific-reports/" }, { "title": "OPTN Member Monitoring Processes", "url": "https://www.hrsa.gov/sites/default/files/hrsa/optn/optn_member_monitoring_processespdf.pdf" }, { "title": "Program-Specific Reports (PSR)", "url": "https://srtr.hrsa.gov/transplant-professionals/program-specific-report/program-specific-reports-psr/" }, { "title": "A randomized trial of normothermic preservation in liver transplantation", "url": "https://pubmed.ncbi.nlm.nih.gov/29670285/" }, { "title": "Normothermic machine perfusion versus static cold storage in donation after circulatory death kidney transplantation: a randomized controlled trial", "url": "https://www.nature.com/articles/s41591-023-02376-7" } ], "license": "https://creativecommons.org/licenses/by/4.0/" }