Organ donation is where a person offers their organs for transplant. Their organs are given to someone who has damaged organs that need to be replaced.

An organ transplant may save a person’s life, or it may significantly improve their health and quality of life.

The need for donors

In 2009, 3,700 organ transplants were carried out in the UK. However, there are always significantly more people waiting to have an organ transplant than there are suitable donors. For example, at the end of March 2010, 8,000 people were waiting for an organ transplant.

Read more about the waiting times for a transplant on the NHS Blood and Transplant website. 

There is a particular need for more people of African, African-Caribbean and south Asian ethnicities to join the Organ Donor Register. This is because donation rates among these ethnic groups are low.

Black people are three times more likely to develop kidney failure than the general population, and the need for donated organs in Asian communities is three to four times higher than it is in the general population.

Most people who are waiting for a donated organ need to have a kidney, heart, lung or liver transplant. One donor can help several people. This is because a single donor is able to donate a number of organs, including:

• kidneys
• liver
• heart
• lungs
• small bowel
• pancreas

Tissues that can be donated include: 

• the cornea (the transparent layer at the front of the eye)
• bone
• skin 
• heart valves
• tendons
• cartilage

All donors have the choice of which organs and tissues they wish to donate. See Organ donation - when it is used for more information.

How to donate

The NHS Organ Donor Register is a national, confidential database that holds the details of more than 17 million people who want to donate their organs after their death. The register can be accessed by healthcare professionals to find out whether an individual has registered to be an organ donor.

By adding your name to the NHS Organ Donor Register, everyone will be aware of your wishes, making it easier for them to agree to your donation. You can join the register in a number of ways, including:

• by completing an online form 
• by calling the NHS Donor Line on 0300 123 23 23

See Organ donation - how it works for more details about how you can join the NHS Organ Donor Register.

Even though there is a significant number of people on the register, most people will not die in circumstances that will allow them to donate their organs. It is, therefore, important that as many people as possible join the register.

Your relatives cannot overrule your decision to donate your organs. However, it is important that you tell them about your decision while you are alive. This will make your family and NHS staff aware of your wishes regarding potential organ donation after your death. 

Checking for a match

When an organ becomes available for donation, it is checked to make sure that it is healthy. The blood and tissue type of both donor and recipient are also checked to ensure that they are compatible. The better the match, the greater the chance of a successful outcome.

People from the same ethnic group are more likely to be a close match. Those with rare tissue types may only be able to accept an organ from someone of the same ethnic origin. This is why it is so important that people from all ethnic backgrounds register to donate their organs.

Types of donation

There are three different ways of donating an organ. These are known as:

• donation after brain stem death
• donation after cardiac death
• live organ donation

The different types of donation are described below.

Donation after brain stem death

Most organ donations are from brain stem dead donors. This is where the donor has been diagnosed with brain stem death following a severe brain injury, and the circulation continues to be supported by artificial ventilation until the donated organs have been removed.

Heartbeating donations have a high success rate because the organs are supported by oxygenated blood until they are removed from the body of the donor.

Donation after cardiac death

Organs and tissue can also be donated from non-heartbeating donors. In the UK, almost all donors of this type are people who have died in intensive care from severe brain injuries, but who are not quite brain stem dead.

In such cases, the donation must occur within a few minutes of the heart stopping because, otherwise, the organs will be damaged by the lack of oxygenated blood and it will not be possible for them to be transplanted.

Live organ donation

A live organ donation usually involves one family member donating an organ to another family member. The relative is usually blood-related, most commonly a parent, although it could be a spouse (partner).

Following changes in the law, it is now possible to be an altruistic donor. Altruistic donors are unrelated to the patient but become donors as an act of personal generosity.

Kidney donations are often made from living donors as a healthy person can lead a normal life with only one working kidney.

The organs that can be donated include the:

• kidneys
• liver
• heart
• lungs
• small bowel
• pancreas

A number of other body parts can also be donated (see tissue donation).

Kidneys

A kidney can provide a better quality of life to someone who has end stage renal failure (ESRF). Renal failure is where the kidneys stop working properly.

Kidney transplants give better long-term survival rates and quality of life than dialysis (where some of the kidney’s functions are artificially replaced). Kidneys that are used for transplant can come from a living person or from someone who has died.

The demand for donated kidneys is higher than for any other organ. More than 2,600 kidney transplants were carried out during 2009-10. The number of living donor kidney transplants being performed is also increasing, with 1,040 kidney donations from living donors being carried out during the same period.

See the Health A-Z topic about Kidney transplants for more information about this type of transplant.

Liver

A liver transplant is often considered for people with end stage liver disease. In around 85% of cases, transplanted livers still function well a year after surgery.

In 2009-10, more than 600 liver transplants were carried out in the UK. For adults, the average waiting time for a liver transplant is around 150 days, and for children it is about 85 days. 

See the Health A-Z topic about Liver transplants for more information about this type of transplant.

Heart

Most heart transplants are carried out on people with severe heart failure, which is caused by coronary heart disease or cardiomyopathy (diseased heart muscles), who can no longer be helped by medication or other types of surgery. The survival rate after one year of having a heart transplant is approximately 85%.

In 2009-10, around 120 heart transplants were carried out in the UK. The average waiting time for a suitable heart to become available for transplant is around 180 days.

See the Health A-Z topic about Heart transplants for more information about this type of transplant.

Lungs

Lungs can be damaged by illnesses, such as cystic fibrosis (where the lungs become clogged with thick, sticky mucus), or respiratory conditions, such as chronic obstructive pulmonary disease (COPD), which are often the result of smoking.

Patients are considered for lung transplantation when their lung function cannot be significantly improved by medical therapy or surgery. Lung and heart-lung transplants have a 70% success rate one year after surgery.

Around 150 lung transplants are carried out in the UK each year. The average waiting time for a lung transplant is around 520 days.

See the Health A-Z topic about Lung transplants for more information about this type of transplant.

Small bowel

A small bowel transplant is usually recommended if there is not enough bowel left to absorb nutrition (short bowel syndrome), and when the patient is having difficulty with total parenteral nutrition (TPN). TPN is where nutrition is given intravenously (through a vein).

Small bowel transplants are often performed at the same time as a liver and pancreas transplant. This is called a multi-visceral transplant.

Small bowel transplants are not widely available on the NHS. Only around 2,000 have been carried out worldwide to date.

Pancreas

A successful pancreas transplant is the only treatment that can restore complete insulin independence and blood sugar levels in patients with type 1 diabetes.

In 2009-10, 200 pancreas transplants were carried out in the UK. The average waiting time for a combined pancreas and kidney transplant for an adult is around 215 days.  

See the Health A-Z topic about Pancreas transplants for more information about this type of transplant.

Tissue donation

As well as donating organs, it is also possible to donate tissue that can be used to improve a person’s quality of life. Unlike organs, tissue can be donated up to 48 hours after the heart has stopped beating. The tissue can be used to treat a wide variety of conditions, some of which may be life-threatening (see below).

The most common tissues that can be donated are:

• the cornea (the transparent layer of tissue at the front of the eye)
• bone
• skin 
• heart valves
• tendons
• cartilage

It is possible to retrieve tissue from a donor up to 48 hours after a person has died. This is very useful because it allows tissue to be screened for possible infectious agents, and it enables a pool of available tissue to be established.

Corneas

Corneas can be transplanted to restore the sight of a person who has an eye condition or an eye injury. Patients who are closest in age to the donor are usually selected as recipients, wherever they live in the country.

Cornea transplants can be carried out under either a general or local anaesthetic. A total of 5,022 corneas were donated during 2009-10. 

See the Health A-Z topic about Cornea transplants for more information about this type of transplant.

Heart valves

Heart valves can be used to help children who are born with heart defects. They are also used for adults with diseased or damaged valves.

Bones

Bone can be used to help improve or restore mobility. Bone grafts can also be used in a variety of orthopaedic procedures (those that involve the muscles, joints, tendons, ligaments and nerves), including joint replacements and spinal surgery.

Bone transplants can also prevent a limb from being amputated (surgically removed) in people with bone cancer.

Skin

Skin can help to save the lives of severe burns victims. A skin graft helps to reduce pain and prepares underlying tissue for later treatment. It also helps to reduce scarring. However, it can take a number of grafts to treat a severely burned patient successfully.

Tendons

Tendons are tough, flexible tissues that are found throughout the body and connect muscles to bone and cartilage. Donated tendons are usually used to reconstruct injured knees in young people, usually following sports injuries.

Cartilage

Cartilage is used to help reconstruct parts of the body following injury or during joint replacement surgery.

Common reasons for cartilage transplant include injury or wear that is caused by disease, such as osteoarthritis (a common type of arthritis that causes inflammation of the bones and joints).

The shortage of organs has led to more people receiving organs from living donors. Although this involves carrying out major surgery, the results are often very successful.

Before a living donor transplant can take place, strict regulations must be met and there must be a thorough process of assessment and discussion. See the below for more information about the regulations and assessment process.

Living organ donations

Kidneys are the most common organ to be donated by a living person. This is because it is possible for a healthy person to lead a completely normal life with only one working kidney. Nearly one in three of all kidney donations are from living donors.

It is also possible for part of a liver to be transplanted, and in some circumstances it may also be possible to donate a segment of lung. In a very small number of cases, part of the small bowel has also been transplanted.

Success and survival rates

The advantage of a living donor kidney transplant is that kidneys from a living donor last longer than those that are donated from someone who has died.

Research has shown that in people who receive a kidney from someone who has died:

• 77% of kidneys will still be working at 5 years
• 58% of kidneys will still be working at 10 years

However, in kidney transplants where the kidney is donated from a living donor:

• 84% of kidneys will still be working at 5 years
• 66% of kidneys will still be working at 10 years   

Survival rates are also increased for people who receive kidneys from live donors as opposed to donors who have died.

The survival rates of patients who receive kidney transplants from live donors are as follows:

• 94% will still be alive 5 years after the transplant
• 85% will still be alive 10 years after the transplant

For those who receive kidney transplants from donors who have died:

• 85% will still be alive five years after the transplant
• 61% will still be alive 10 years after the transplant

Regulations and assessment

The Human Tissue Act 2004 and the Human Tissue (Scotland) Act 2006 provide the legal background for living donation in the UK. It is regulated by the Human Tissue Authority (HTA).
 
The HTA consists of 12 members, including 11 members from medical and scientific backgrounds, who are appointed by the Secretary of State for Health. The HTA’s role in living donation is to ensure that: 

• donors are not put under pressure to donate an organ
• no payment is made for the donation (paying for donated organs is illegal in the UK)  

After the organ donor and the recipient of the donation have been assessed by the transplant team, an independent assessor from the HTA will assess the donor. They will make sure that all the legal requirements for the donation have been met.

You can visit the Human Tissue Authority (HTA) website to find out more about how organ donations are assessed and regulated.

The NHS Organ Donor Register

In the event of your death, there is a chance that your organs could help to save someone else’s life.

The NHS Organ Donor Register is a national, confidential database that holds the details of more than 16 million people who want to donate their organs after their death. The register can be accessed by healthcare professionals to find out whether an individual has registered to be an organ donor.

By adding your name to the NHS Organ Donor Register, everyone will be aware of your wishes, making it easier for them to agree to your donation. You can join the register in a number of ways, including:

• by completing an online form (click on the logo to the left)
• by completing a form which is available in GP surgeries, libraries, hospitals and pharmacies
• by calling the NHS Donor Line on 0300 123 23 23
• when applying for a driving licence
• when registering with a GP
• when registering for a European Health Insurance Card (EHIC)

When registering, it is important that you tell the people closest to you about your decision. In the event of your death, the person closest to you (usually your next of kin) will be asked to confirm that you had not changed your mind prior to your death.

Many people have gained a great deal of comfort from knowing that the death of a loved one has helped saved the life of another person.

The donation process

If appropriate, brain stem death testing will be carried out by hospital staff to confirm that the patient is dead. Alternatively, a joint decision may be made by medical staff, nursing staff and the patient’s relatives that, although brain stem death has not occurred, the prospect of survival is so low that it is not helpful to continue with artificial ventilation.

The organ donor register will be checked and if the patient is found to be on the register, the local specialist nurse for organ donation (formerly known as the transplant co-ordinator) will be contacted. If the patient is on the donor register, the specialist nurse will speak to the family about the patient’s wishes.

If the family agrees to organ donation, the specialist nurse must ensure that medical tests are carried out, such as blood group and tissue type matching. They will also look at the donor’s medical history and may ask the family some questions about them. This will help to confirm whether or not the organ donation can take place.

You can find the answer to many common questions about organ and tissue donation on the NHS Blood and Transplant website. You can also read the life stories of people who have received organs, and of families who have donated their loved ones' organs.

Conditions that rule out organ donation

There are only two medical conditions that always prevent someone from donating an organ. These are:

• HIV, which is a virus that attacks the immune system (the body’s natural defence against illness and infection) and is spread through the exchange of infected bodily fluids, such as blood.   
• Creutzfeldt-Jakob Disease (CJD), which is a rare condition that affects the nervous system, causing brain damage. Patients who are suspected of having CJD are also prevented from donating organs.

All patients who are waiting for transplants are registered on the National Transplant Database at NHS Blood and Transplant. This is a database that holds records of every person in the UK who is waiting to receive an organ transplant. When organs from a donor become available, a computer search is carried out to find the most suitable recipients.

A team of specialist surgeons is called to the donor's hospital to carry out the surgery to remove and preserve the organs for transport to the transplant unit. Timing is crucial because certain organs need to be transplanted within four to six hours.

During the operation, the surgeon will make a final decision about whether the organs are healthy and suitable to be transplanted. If all is well, the organ is received at the transplant unit and transplanted immediately. After the transplant has been completed, the recovery process and a new life for the transplant recipient can begin.

There are some risks associated with organ donation. These are outlined below.

Virus transmission

To reduce the risk of diseases and viruses being transmitted from an organ donor to a recipient, all potential organ donors have a sample of their blood taken. The blood is tested for:

• HIV, which is an incurable virus that attacks the immune system (the body’s natural defence against illness and infection). HIV is spread through the bodily fluids, such as blood or semen, of an infected person.  
• Hepatitis, which is a virus that causes inflammation (swelling) of the liver. Hepatitis can be passed on through bodily fluids, such as semen, blood and saliva.

Immunosuppressant medication

Most people do not experience any physical problems after receiving a transplanted organ.

However, after the operation you will have to take immunosuppressant medication to prevent your body rejecting the new organ. Without this medication, your body will try to reject the donated organ.

Immunosuppressants work by suppressing (controlling) your immune system, which allows your body to accept the donated organ. However, you will need to take immunosuppressants for the rest of your life. Immunosuppressants have side effects, including:

• an increased risk of developing some types of cancer
• an increased risk of developing infections

Following an organ donation, the side effects that you will experience will depend on the type of immunosuppressant medication and the dosage that you require. You should discuss the potential side effects of immunosuppressants with your surgeon or transplant team.

Other risks

The donor may also experience prolonged wound pain after the donation operation.

Depression and anxiety are also common. There is a risk of a number of long-term complications relating to specific donated organs.

There are ethical questions regarding live organ donation. If more people donated organs after their death it would not be necessary to use live donors. There are also concerns about the possibility of pressure being put on people to donate to a family member.

Maggie Sherwin’s young son, Dilan, died after he was involved in a road accident. But as she and her husband Simon came to terms with losing Dilan, they decided that the six-year-old's death should not be in vain. The couple donated their child's organs to help save others.

"We had seen a programme about organ transplantation on a television in the ward when we were sitting with Dilan. He was very badly injured and unconscious and we began talking about what we should do if he died.

"Dilan was a very caring little boy. Whenever he saw something on the television about children in hospital — he called them 'the poorly children' — he would run and ask me what we could do for them.

"That side of his nature made it easier for us to take the decision to donate his organs.”

Dillan suffered brain damage in the accident on December 18 2001 and died on New Year's Eve.

"We had constantly talked to him as we sat at his bedside and we both knew deep down that he couldn't hear us and would not have been able to understand us fully even if he could. But we both knew he would agree. He was going to be able to do something to help the 'poorly children' at last."

A London boy aged five received Dilan's heart, and one of his kidneys was transplanted into a 39-year-old woman from Manchester. Both are doing well and Maggie recently received a card from the boy.

"It made me really happy to get that card. There was nothing we could have done to save Dilan's life but it is really rewarding to know he helped some other little lad to live.

"I find a lot of comfort in knowing that if Dilan was not to have a full life then at least another little boy will have the chance."

Stephen Masters, 32, died of a brain haemorrhage in January 2001. The decision to allow his organs to be donated was made less heart-rending for his family because they already knew exactly what Stephen would have wanted.

"Stephen had spoken of his wish to donate if the circumstances ever arose. He was a very generous man by nature and making a gift of his organs was entirely in character,” says Stephen's brother Paul.

"We discussed it as a family after the transplant co-ordinator made the initial approach and, in spite of the awful suddenness of his death, we were able to give permission because we wanted to honour his wishes.”

The donation went ahead and Stephen's kidneys, liver and lungs were transplanted into four people that day. His heart had been damaged and was unsuitable for transplant, although his heart valves were stored for later transplants.

"We were told that the man who'd received Stephen's lungs had cystic fibrosis. He'd been on a ventilator before the transplant but within 24 hours of the operation he was breathing on his own again,” says Paul.

Almost a year later, Paul and his family received news from the recipients of Stephen's kidneys.

"When letters arrived from the women who'd received Stephen's kidneys, I saw then that his death had served a purpose, that there had been some meaning to what had seemed to be such a senseless waste of his life.

"Receiving letters from the recipients gave tremendous comfort to us and has helped us come to terms with our loss. I was also pleased to see they appreciated the gift Stephen had made, and had the kindness to let us know what a difference he had made to their lives.”

Nurses Peter Knight and Jan Thompson fell in love at Dorset County Hospital near Dorchester and shared their lives for a few short, blissfully happy years.

In November 2003, Peter, 42, collapsed while working his shift as a theatre nurse at the hospital and hit his head on a trolley wheel. He had suffered a brain haemorrhage, fractured his skull in the fall and had a fit. Peter was rushed to intensive care in the hospital, where colleagues fought to save his life.

Jan, who shared a home with Peter in nearby Charminster, was working as a community staff nurse in Dorchester when she was told about Peter’s collapse. She rushed to his side.

As it became apparent that he was not going to recover, Jan remembered what Peter had told her about wanting to donate organs for transplant if he could.

“Peter and I were very close and we had discussed organ donation. We were both in favour of it but I wasn't sure whether he'd signed up to the NHS Organ Donor Register,” says Jan.

“It turned out that he was on the register, but even then the hospital still needed my permission to go ahead and begin the process of donating his organs to other people.”

“It was made far easier for me at that time because he had taken a positive action to back up our talk: he had signed on the register. I agreed to the donation in the full knowledge that it was what he would have wanted.”

Peter’s heart was transplanted into a 53-year-old man, a kidney was transplanted into a 30-year-old man, his liver went to a woman aged 37 and a man aged 43 received his lungs.

 “It was a terrible time for the family. I can understand the agonies that other families must have to go through if they don't know what their loved one would have wanted. They have to act in a vacuum or to guess what their wishes were.

“It was unbelievable the way it fell into place. I knew that he wanted to donate if he could, then he collapsed and died at work in a hospital, and the way the donation process went on after that, it was incredible.

“I can see now how vital it is to know what your family members want after they've gone. It made it so much easier for me, and for Peter’s father, to decide in favour of donation.

“Peter always wanted to help people. You can’t go into our jobs without wanting to do the best you can for others. To be able to do that even after death is the most fitting tribute there can ever be to this sweet and gentle man.

“The wonderful knowledge that Peter’s organs are now bringing new lives to four other people is just fantastic.

“I've received letters from some of them and it's a great comfort to hear how they're progressing and how they owe their new health to the man I loved.
 
“It's amazing that I've worked in the NHS all my professional life yet I knew absolutely nothing about the organ donation process. It was a complete mystery what happened and how those that work in the field went about it. They did it all so professionally and sensitively. It left me quite awestruck."