Organ donation involves transferring a healthy organ or tissue from a donor to a recipient. This includes deceased donation, where organs are recovered after death, and living donation, where a person donates a renewable organ while alive. A common belief is that age or health issues automatically disqualify most people. However, eligibility is determined by medical professionals at the time of death, not at the time of donor registration. Registration is encouraged for almost everyone, as very few conditions absolutely rule out the possibility of donation.
Absolute Medical Contraindications
Severe systemic health conditions disqualify a person from deceased organ donation because they compromise organ viability or pose a risk to the recipient. Malignancy is a prominent contraindication, especially if the cancer is metastatic or widespread, creating a high risk of transferring cancerous cells. Hematological malignancies, such as leukemia, lymphoma, and multiple myeloma, also generally rule out donation because they affect the blood and immune system throughout the body.
Systemic diseases causing multi-system organ failure (MSOF) are absolute barriers, as the organs are too damaged to function in a recipient. This often occurs in cases of overwhelming sepsis, an uncontrolled infection causing widespread tissue damage. However, localized cancers, such as some basal cell skin cancers or primary central nervous system tumors without evidence of spread, may not prevent donation. Doctors evaluate each organ individually; for example, a person with diabetes might be unable to donate their pancreas but could still donate their heart or lungs.
Risk of Transmissible Diseases
Infectious diseases that carry a high risk of pathogen transmission to the recipient are major disqualifications. Active systemic infections, such as untreated tuberculosis or severe bacterial infections, are typically grounds for rejection because the recipient would be unable to fight off the infection. Certain neurological conditions, including Creutzfeldt-Jakob disease, caused by infectious proteins called prions, are absolute contraindications due to the irreversible and fatal nature of the disease.
Viral infections like active Hepatitis B or C have historically been barriers, but this context is changing in modern transplant medicine. Organs from donors with these infections can sometimes be transplanted into recipients who also have the same condition. Similarly, organs from donors with HIV are now sometimes transplanted into recipients who are also HIV-positive, expanding the limited donor pool. If the donor has a transmissible disease, the organ procurement organization assesses the risk to the recipient on a case-by-case basis before proceeding.
Logistical and Procedural Barriers
Even when a person is medically suitable, logistical hurdles can prevent donation. The circumstances of death must align with procedural requirements, often meaning the donor must be maintained on a ventilator in a hospital setting. For successful solid organ donation, a brain-dead patient is kept on life support to ensure organs receive oxygenated blood. If death occurs outside this controlled environment, such as at home or after prolonged circulation loss, only tissue and eye donation may be possible.
The time-sensitive nature of organ viability is another major logistical barrier. Organs must be recovered and transplanted within a short window known as the cold ischemia time. Delays in transport, communication errors, or procedural slowdowns can cause organs to become unusable. Furthermore, while registration expresses a person’s wishes, the final decision often involves the legal next-of-kin. If family members object to the donation, even against a registered donor’s wishes, the process can be halted.
The Role of Age and Organ Function
A common misconception is that age limits organ donation, but there is no absolute upper age limit for registration or donation. The determining factor is the physiological function and overall health of the specific organs, not the number of years the person has lived. Older donors have successfully donated organs, with some donors in their 80s and 90s providing viable organs, including livers.
For instance, a 70-year-old with excellent heart function may be a better donor than a 40-year-old with severe heart disease. Due to medical advancements and the increasing need for organs, the criteria for acceptable donors have been extended significantly. While older organs may be allocated to older recipients, the health of each specific organ is individually assessed. Older donors regularly contribute life-enhancing tissue and corneas.