Organ donation is a profound gift that can save or significantly enhance the lives of multiple recipients. Before any transplant can occur, a rigorous, multi-layered screening process is necessary to ensure the safety of the recipient and a successful outcome. Eligibility is not determined by a person’s donor registration card alone, but is a medical decision made at the time of death or imminent death by specialized medical professionals. This evaluation identifies any condition that could compromise the organ’s function or transmit a harmful disease to the recipient.
Absolute Medical Conditions
Certain health issues are non-negotiable disqualifiers for solid organ donation because they pose an unacceptable risk of disease transmission. Active systemic malignancies, particularly metastatic cancer or blood cancers like leukemia or lymphoma, generally exclude a person from donation. The primary concern is that cancerous cells could be transferred to the immunosuppressed recipient, leading to a new, aggressive cancer. Organs from individuals with a history of high-risk cancers, such as melanoma, may also be excluded due to the likelihood of late recurrence and transmission.
Another major category of absolute disqualifiers involves acute, uncontrolled systemic infections like sepsis. Transplanting organs from an individual with active sepsis would transfer the infection, overwhelming the recipient’s weakened immune system. Similarly, conditions caused by unconventional pathogens, such as Creutzfeldt-Jakob disease (CJD), are absolute contraindications because they are incurable and transmissible through donated tissue.
While Human Immunodeficiency Virus (HIV) historically excluded all donors, modern medicine allows for a nuanced approach. Organs from HIV-positive donors can now be transplanted into HIV-positive recipients, a practice known as “HIV-to-HIV” donation. This significantly increases the donor pool for this specific population and is a major exception to the general rule, requiring strict protocols and informed consent. However, for the general population awaiting a transplant, a donor with an untreated, systemic infectious disease remains disqualified to prevent transmission.
Organ-Specific Damage
A person may be unable to donate a specific organ if it is non-functional or severely damaged, even if other organs are viable for transplant. This focuses on the functional integrity of the individual organ, separate from systemic disease risks. For example, a person who dies from a massive heart attack may have an unusable heart due to extensive muscle damage, but their kidneys, liver, and lungs could be healthy and suitable for donation. The decision is made on an organ-by-organ basis, ensuring a single failing organ does not exclude the entire donation.
Chronic diseases that cause end-stage organ damage are common reasons for organ-specific disqualification. Severe, uncontrolled diabetes can result in irreversible damage to the pancreas or kidneys, making them unsuitable for transplant. Similarly, a history of severe alcoholism or Hepatitis C can lead to end-stage liver cirrhosis, disqualifying the liver.
The assessment for organ-specific viability includes reviewing the donor’s medical history for conditions such as chronic hypertension or cardiovascular disease, which impair function over time. Severe coronary artery disease might render the heart unusable, but other organs are often still accepted. Transplant teams examine each organ through imaging, biopsies, and functional tests to determine its health and projected lifespan in a recipient.
Lifestyle and Behavioral Risk Factors
A donor’s past lifestyle and behavioral history are reviewed because certain activities increase the risk of latent, undetected infectious diseases. A history of intravenous (IV) drug use is a major disqualifier, regardless of the donor’s current health status. This behavior is strongly associated with an elevated risk of exposure to bloodborne pathogens like HIV and Hepatitis C, which may be undetectable or in an early incubation stage. The uncertainty of the viral status makes the risk of transmission too high for most transplant situations.
High-risk sexual behaviors or recent incarceration can also necessitate exclusion or intense scrutiny. These factors raise concerns about potential exposure to infectious agents not immediately apparent through routine testing. Similarly, receiving a tattoo or piercing within the last several months in a non-sterile environment can lead to exclusion. This “look-back” period minimizes the risk of transmitting a disease that has not yet seroconverted, meaning the body has not yet produced detectable antibodies.
Travel history is another factor that can lead to temporary or permanent exclusion, particularly travel to regions with specific infectious disease risks. For example, individuals who spent time in the United Kingdom during the Bovine Spongiform Encephalopathy (BSE, or “Mad Cow Disease”) outbreaks may be excluded. This is a precautionary measure against the theoretical risk of transmitting variant Creutzfeldt-Jakob disease, a fatal neurodegenerative disorder. These factors are necessary public health screens to protect the transplant recipient.
Age and Dynamic Screening
There is no upper chronological age limit for organ donation. The determining factor for eligibility is the physiological health and function of the organs, not the number of years a person has lived. Donors in their 70s, 80s, and even 90s have successfully donated life-saving organs, such as the liver or kidneys, because those specific organs remained robust and healthy. Medical teams assess each organ’s condition individually, often using imaging and biopsies to determine its suitability for transplant.
The final, dynamic screening occurs in the moments leading up to the recovery procedure and focuses on immediate physiological and logistical factors. A significant immediate disqualifier is prolonged warm ischemia time (WIT), which is the period an organ is without blood circulation and oxygen supply after death. If the time between circulatory arrest and cold perfusion of the organs is too long, the resulting cellular damage can render the organs unusable. Maintaining the donor’s stability and optimizing organ perfusion is a constant goal for the medical team.
Severe trauma that physically damages the organs, such as in a fatal car accident, may also disqualify a person at the last moment. Furthermore, certain active infections present at the time of death, even if not systemic, could rule out donation. Ultimately, the decision to proceed is a dynamic risk-benefit calculation performed by the transplant coordinator and surgical team. This final assessment determines which organs are viable, ensuring the highest chance of success for the recipient.