Organ donation, encompassing both deceased and living contributions, offers a life-saving opportunity for individuals facing end-stage organ failure. Registering as an organ donor expresses a willingness to donate, but eligibility is determined by a comprehensive medical evaluation at the time of death or during a living donor assessment. While most people can donate, specific medical conditions can prevent the recovery of organs or tissues, primarily to protect the recipient’s health. The overarching principle is maximizing the gift of life while ensuring the transplant is safe and successful.
General Exclusions for Deceased Donors
The most absolute disqualifications for deceased donation involve conditions that pose a severe, widespread risk to the recipient’s health. Active, aggressive cancers that have spread throughout the body (metastatic disease) generally exclude a person from donating solid organs due to the risk of transmitting malignant cells. However, past, successfully treated, and localized cancers, such as certain skin cancers, do not automatically prevent donation.
Systemic infections that are uncontrolled or severe also prevent donation, as they can rapidly transmit pathogens to a recipient whose immune system is suppressed. Examples of these infections include active sepsis, which is a life-threatening response to infection, and certain viral infections like Creutzfeldt-Jakob disease. Historically, specific communicable diseases, most notably Human Immunodeficiency Virus (HIV), were exclusion factors.
Current medical protocols are evolving to expand the donor pool while managing risk. Organs from donors who are HIV-positive or have certain strains of Hepatitis C can now be safely transplanted into recipients who are already positive for the same virus. This “positive-to-positive” donation allows organs that would have previously been discarded to be used. The final decision rests on a careful risk-benefit analysis tailored to the recipient’s needs.
Specific Conditions Affecting Organ Viability
Beyond systemic exclusions, many chronic illnesses can damage a specific organ, rendering it unsuitable for transplant. The individual can still be a donor, but not for the affected organ. For example, severe, long-term coronary artery disease can render the heart muscle too damaged for transplantation, though other healthy organs may still be used.
Chronic obstructive pulmonary disease (COPD) or other forms of severe, irreversible lung damage due to smoking or environmental exposure often disqualify the lungs. The liver may be rejected if the donor had advanced cirrhosis (scarring of the liver tissue) or other severe hepatic failure. Long-standing, poorly controlled conditions like hypertension and diabetes can cause microvascular damage that severely impairs the function of kidneys and the pancreas, making those specific organs non-viable.
The organ procurement team assesses the functional integrity of each major organ independently. A person who dies from a heart condition may not donate their heart but might be able to donate healthy kidneys, liver, or other tissues. This case-by-case assessment ensures that only organs with a high probability of successful function are offered for transplant.
Restrictions for Living Donors
The criteria for living donation, primarily involving a kidney or a portion of the liver, are significantly stricter because the procedure must not compromise the donor’s long-term health. Absolute medical exclusion factors ensure the donor can live a full life with only one kidney or a reduced liver volume. Uncontrolled high blood pressure, diabetes (Type 1 or Type 2 requiring medication), and active cancers are definitive contraindications.
High body mass index (BMI), often set above 35, can also disqualify a potential living donor due to increased surgical risks and a higher lifetime risk of kidney disease. Screening extends beyond physical health to include comprehensive psychological and social evaluations. The team must ensure the donor is mentally stable, understands the risks, and is acting without coercion or financial incentive.
These rigorous standards protect the donor. The evaluation process includes detailed testing of organ function, such as measuring the glomerular filtration rate (GFR) to confirm excellent kidney function. The focus remains on absolute donor safety, differentiating the process significantly from deceased donor screening, which focuses on disease transmission risk to the recipient.
The Final Determination Process
The ultimate decision regarding a person’s suitability for organ donation is made by medical professionals when death occurs or during a living donor evaluation, not at the time of registration. Organ Procurement Organizations (OPOs) work with the transplant team to conduct an immediate, comprehensive medical screening. This process involves a detailed review of the donor’s medical history, extensive blood work, and virology screening for infectious diseases.
Specialized tests, including tissue typing and assessments of organ function, are performed rapidly to determine which organs are viable and to find the best match for waiting recipients. This process utilizes the most current medical science and transplant protocols available. The final determination is always made by the medical team based on the condition of the organs, the cause of death, and the urgency of the recipient’s need. Individuals with complex medical histories should still register, as they might be eligible to donate tissues or organs that can save a life.