Whether an individual with an autoimmune disease can donate organs is a complex medical question without a simple yes or no answer. Autoimmune disease occurs when the body’s immune system mistakenly attacks healthy cells, tissues, and organs, causing inflammation and damage. Eligibility depends entirely on the specific disease, its current severity, the degree of organ damage, and the particular organ or tissue being considered. The final decision is made by transplant physicians based on a rapid assessment at the time of the donor’s death.
Why Autoimmune Disease Affects Donor Eligibility
Transplant teams approach organs from donors with autoimmune diseases cautiously due to two primary concerns: the quality of the organ and the potential risk of disease transfer. Autoimmune conditions often cause chronic inflammation, leading to scarring, microvascular damage, or fibrosis within organs like the kidneys, lungs, or liver. An organ compromised by disease may not function reliably in a recipient, defeating the purpose of the transplant.
The secondary concern is the theoretical risk of transferring the autoimmune condition. While rare, the transfer of immune cells or autoantibodies could potentially trigger a similar disease process in the recipient. Additionally, many individuals with these conditions take long-term immunosuppressive medications, which can alter the organ structure or increase the risk of infection. These factors require careful assessment to balance the recipient’s urgent need against potential risks.
Systemic Conditions That Prevent Organ Donation
Conditions involving multiple organ systems and causing widespread inflammation are considered the highest risk for solid organ donation. Examples include Systemic Lupus Erythematosus (SLE), active Rheumatoid Arthritis (RA) with significant systemic involvement, and active vasculitis. SLE, for instance, frequently targets the kidneys, heart, and central nervous system, making it difficult to ensure the health of major solid organs.
These diseases are high-risk because they cause chronic inflammation and damage across various body systems. Severe SLE can lead to lupus nephritis, dramatically reducing kidney function and making those organs unsuitable. The resulting fibrosis and microvascular damage mean the organs may fail prematurely in the recipient. However, if the specific organ being evaluated is healthy and unaffected by the disease, donation may still be possible.
Accepted Donations and Localized Autoimmune Issues
Donation remains highly possible when the autoimmune condition is localized or involves tissues instead of solid organs. Diseases affecting only one area, such as mild psoriasis or well-controlled Hashimoto’s thyroiditis, often do not disqualify a donor if the specific organ is healthy. The medical assessment focuses narrowly on the health and function of the organ itself rather than the donor’s entire medical history.
Tissue donation, including the cornea, bone, skin, tendons, and heart valves, is far more frequently accepted than solid organ donation. Tissues are often avascular, meaning they lack blood vessels, which significantly reduces the risk of transferring immune cells or disease. Cornea donation is often acceptable for nearly everyone, as it is an immune-privileged site and can be processed to mitigate immune cells before transplantation. Specific protocols are used to clean and treat tissues, further lowering the risk of disease transmission.
The Final Medical Review and Eligibility Determination
Donor eligibility is not determined when a person registers, but is a procedural step performed by medical professionals at the time of death. Transplant physicians and surgeons conduct a rapid assessment, reviewing the donor’s medical history, performing laboratory tests, and often conducting biopsies or imaging. This process determines the current functional status and suitability of each specific organ.
Each organ is evaluated individually; even if one organ is damaged by disease, others may be healthy and usable. When a recipient is in dire need, the transplant team may weigh the risk of using an organ from a donor with mild autoimmune disease against the near-certainty of death for the recipient. Therefore, individuals with a history of autoimmune disease are encouraged to register as donors, leaving the final complex medical decision to experts who assess the risk-benefit balance in real time.