Systemic Lupus Erythematosus (SLE), commonly known as Lupus, is a chronic autoimmune disease in which the immune system mistakenly produces autoantibodies that attack healthy tissues and organs. This systemic condition can affect virtually any part of the body, including the skin, joints, kidneys, and brain. Whether a person with Lupus can participate in organ donation is complex, requiring a careful assessment of the disease’s impact on individual organs and the specific type of donation being considered. Eligibility criteria for both deceased and living donation must be clarified to understand how a Lupus diagnosis affects a potential donor.
Eligibility for Deceased Organ Donation
A diagnosis of Lupus does not automatically exclude an individual from becoming a deceased organ donor. The decision to proceed is made on an organ-by-organ basis by medical professionals and the transplant team. The primary factor determining suitability is the health and function of each specific organ at the time of death.
If Lupus has damaged one organ, such as the kidneys, other organs that remain unaffected may still be viable for transplantation. For instance, a person with kidney failure from Lupus Nephritis may still be able to donate a healthy heart or lungs. This organ-specific assessment ensures the maximum number of life-saving gifts can be recovered while maintaining safety for the recipient.
The screening process is extensive and is conducted rapidly after a donor’s death. Physicians review the donor’s complete medical history, looking for evidence of current disease activity or irreversible structural damage caused by the autoimmune condition. The presence of certain conditions associated with Lupus, such as Antiphospholipid Syndrome (APS), may require additional scrutiny. However, even the presence of APS is not an absolute disqualification if the specific organs being considered show no signs of thrombotic complications or damage.
Lupus and Living Organ Donation
The criteria for living organ donation are significantly more stringent than those for deceased donation because the procedure must not introduce any undue long-term health risks to the donor. Living donation typically involves donating one kidney or a portion of the liver, and the donor must be in excellent health to ensure their continued well-being with a reduced organ capacity.
Because Lupus is a systemic disease, it carries an inherent, unpredictable risk of future organ involvement, even when the condition is currently in remission. The concern is that the stress of surgery or the act of donation itself could precipitate a future Lupus flare or accelerate organ damage in the remaining tissue. For example, removing one kidney leaves the donor with a single organ that is at risk of developing Lupus Nephritis later in life.
For this reason, a diagnosis of Lupus is almost always considered a contraindication for living organ donation. Transplant centers are mandated to prioritize the donor’s lifelong health, and the risk that Lupus could cause future damage to the remaining organ is generally deemed unacceptable. The evaluation process focuses on the potential donor’s future risk of developing chronic kidney disease or other complications related to their underlying autoimmune condition.
Even individuals with very mild, non-systemic forms of Lupus, such as cutaneous-only disease, are frequently excluded from living donation. The medical community maintains a high threshold for safety, meaning any pre-existing condition that could potentially compromise the donor’s future health is typically a reason for exclusion.
Assessing Lupus Activity and Organ Damage
The final decision regarding organ suitability rests on a detailed clinical assessment of the impact of Lupus on specific tissues. Transplant teams focus on two primary aspects: the current level of disease activity and the extent of permanent organ damage. An active Lupus flare suggests ongoing inflammation, which makes the affected organ unsuitable for transplant due to the potential for immediate failure or disease transmission to the recipient.
To gauge current activity, clinicians rely on laboratory markers that indicate systemic inflammation. These may include elevated anti-dsDNA antibody titers and low complement levels (C3 and C4), which often signal an active disease process, particularly if the kidneys are involved. Clinical scoring systems, such as the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), can also be used to quantify the current severity and breadth of the disease across multiple body systems.
The second factor is irreversible damage, which is assessed regardless of the current disease activity. Organs that have sustained permanent structural changes, such as scarring (fibrosis) in the lungs or kidneys, are non-functional and cannot be used for transplantation. For the kidneys, this damage is often quantified using the Glomerular Filtration Rate (GFR); a GFR of 15 milliliters per minute or less indicates end-stage kidney failure, meaning the organ is not viable.
In cases of suspected kidney damage, a biopsy might be performed to determine the exact extent of tissue scarring versus active inflammation, providing a clearer picture of the organ’s function. The history of treatment, including the use of immunosuppressive medications, is also considered. The use of these drugs does not automatically disqualify an organ if the tissue itself remains healthy and functional. The overall aim is to ensure the transplanted organ offers the recipient the best possible chance for long-term survival and health.