Registering as an organ donor takes less than five minutes and can be done online, at your local motor vehicle office, or through the Health app on an iPhone. More than 103,000 people are currently on the national transplant waiting list, and 13 people die each day waiting for a transplant. Whether you want to register for donation after death or explore living donation, here’s what the process actually looks like.
How to Register as a Donor
There are three ways to sign up. The fastest is your state’s online donor registry, where you’ll typically need your driver’s license or state ID number to complete a short form. You can also register in person at your local motor vehicle office, which many people do when renewing a license. The third option is through the Health app on an iPhone, which links directly to your state registry.
Registration counts as legal consent. When someone dies, the local Organ Procurement Organization (OPO) checks the state registry to confirm whether that person signed up. If you’re registered, no further permission is needed. If you’re not, the OPO may look for another legal document or ask your next of kin. Telling your family about your decision ahead of time prevents confusion during an already difficult moment.
What You Can Donate
Organ donation covers more than hearts and kidneys. A single deceased donor can provide organs, tissues, and grafts that help dozens of people. Transplantable organs include the heart, lungs, liver, kidneys, pancreas, and intestines. Beyond those, tissue banks can store corneas, skin, heart valves, bone, veins, cartilage, tendons, ligaments, and middle ear structures. Surgeons also graft muscle, nerves, and blood vessels.
Almost anyone can be a potential donor regardless of age or medical history. The medical team evaluates each donor’s organs and tissues individually at the time of death, so having a chronic condition doesn’t automatically disqualify you. The decision about what’s usable is made case by case.
What Happens After Death
Deceased donation follows a specific sequence. If you’re near death or die in a hospital, federal rules require the hospital to notify the local OPO. The OPO then determines whether you’re a potential donor. Doctors run tests to confirm brain death, meaning there is no brain activity, the patient cannot breathe independently, and recovery is not possible. Once brain death is confirmed, the time of death is noted and organ donation becomes possible.
After confirming legal consent through the registry, a driver’s license, or family approval, the OPO conducts a full medical and social history evaluation. If the evaluation supports donation, the OPO contacts the national Organ Procurement and Transplantation Network (OPTN), which runs the computerized matching system.
How Organs Are Matched to Recipients
The matching system is managed by the United Network for Organ Sharing (UNOS). When a transplant hospital accepts someone as a candidate, it enters their blood type, medical urgency, body size, and hospital location into the network. When a donor becomes available, the same data points are entered for the donor.
The system automatically screens out any candidates who are incompatible based on blood type, height, weight, or other medical factors. From the remaining pool, the highest-ranked candidates are those in the most urgent medical need and those most likely to survive after transplant. Each organ type has its own allocation policy reflecting factors unique to that organ. For example, organ size is critical, which is why children often respond better to child-sized organs.
Living Donation
You don’t have to wait until death to donate. Living donors most commonly give a kidney (since you can live with one) or a portion of the liver (which regenerates). Living donation involves a thorough evaluation process designed to protect your health and ensure the decision is genuinely yours.
Physical Evaluation
The transplant team gives you a full physical exam along with several rounds of testing. Blood tests check your overall health, blood type compatibility with the recipient, tissue match, cross-matching for rejection risk, and screening for transmissible infections. You’ll also have heart and lung tests, including a chest X-ray and electrocardiogram, to confirm you can safely undergo surgery. Imaging like a CT or MRI scan lets the team examine the organ you plan to donate. Kidney donors get additional blood and urine tests for kidney function, while liver donors may need a small needle biopsy. Depending on your age, routine screenings like a colonoscopy or skin cancer check may also be part of the workup.
Psychological and Financial Screening
The transplant team also assesses your mental health and life circumstances through a psychosocial evaluation. They’ll ask why you want to donate, whether anyone is pressuring you, how well you understand the risks, and who will help you recover. They explore how donation might affect your job, finances, childcare, or other caregiving responsibilities. They’ll also ask how you think you’ll feel afterward, including if the outcome isn’t what you hoped for.
An independent living donor advocate makes sure you have clear information about the financial realities: non-medical expenses like travel, time away from work, and any potential insurance implications. The goal is to confirm that you can afford the recovery period and that your decision is fully informed.
Surgery and Recovery
For kidney donors, the surgery typically lasts about three hours. Hospital recovery averages four to five days, and most donors need six to eight weeks off work before returning to normal activity. The recipient’s insurance generally covers the donor’s surgery and related medical costs, but non-medical expenses like travel, lodging, and lost wages usually fall on the donor unless covered by a separate assistance program.
Costs to the Donor’s Family
For deceased donation, the donor’s family pays nothing for the donation procedure itself. All surgical and organ recovery costs are covered by the recipient’s insurance or the organ procurement organization. However, current policy creates an odd gap: families who donate a loved one’s whole body (for research, for instance) can receive funeral expense reimbursement, but families of deceased organ donors cannot. Some policy advocates have proposed capping funeral reimbursement at $6,000 to $8,000 to reflect median funeral costs, framing it as societal gratitude rather than payment. For now, though, no such program exists for organ donor families, and donation does not affect the ability to have an open-casket funeral or any other type of service.