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Organ donation is a testament to human generosity, offering a lifeline to individuals facing end-stage organ failure in the United States.
Donating organs can save and significantly enhance recipients’ lives, providing a renewed opportunity for health and well-being. However, the need for organs far outweighs the supply. Over 103,000 men, women, and children are currently on the national transplant waiting list as of September 2024, each hoping for a second chance at life. Tragically, approximately 13 people die every day while waiting for a transplant that never comes.
The Health Resources and Services Administration (HRSA) and the Organ Procurement and Transplantation Network (OPTN) work together to facilitate organ donation and transplantation across the nation. This article provides an overview of organ donation and transplantation in the United States based on information from HRSA OPTN.
The Role of HRSA
The Health Resources and Services Administration serves as the foundation of the national organ donation and transplantation program. As the primary healthcare agency of the federal government, HRSA operates under the U.S. Department of Health and Human Services (HHS).
HRSA’s mission is to improve health equity and access to quality healthcare for all Americans, particularly those who are geographically isolated, economically or medically vulnerable. Within HRSA, the Division of Transplantation (DoT) is a crucial component of the Healthcare Systems Bureau (HSB).
HRSA manages the nation’s Organ Donation and Transplantation program, dedicated to extending and enhancing the lives of individuals with end-stage organ failure. To foster transparency and inform the public, HRSA makes data and visualizations related to organ donation and transplantation activities available at HRSA’s organ donation data page.
HRSA also oversees both the OPTN and the Scientific Registry of Transplant Recipients (SRTR) contractors, ensuring accountability and adherence to national standards within the organ donation and transplantation network.
The Organ Procurement and Transplantation Network
The Organ Procurement and Transplantation Network (OPTN) is a national network established to streamline the process of organ donation and transplantation in the US. Since its inception, the OPTN has been operated under a contract with HHS by the United Network for Organ Sharing (UNOS). As of March 30, 2024, the OPTN’s board of directors operates independently from the board of the OPTN contractor.
The official OPTN website serves as a resource for information about the network. The OPTN is a unique public-private partnership connecting all professionals involved in the US donation and transplantation system. Its primary objective is to enhance the national system to ensure more life-saving organs become available for transplantation.
A core function of the OPTN is maintaining a fair and equitable system for allocating donated organs to patients on the national waiting list. This is achieved through:
- Developing and implementing data-driven organ allocation policies
- Continuous quality improvement
- Strategic use of technology to match donor organs with suitable transplant candidates
Patient safety remains at the forefront of all OPTN activities, guiding the work of transplant hospitals, Organ Procurement Organizations (OPOs), and laboratories within the network. The OPTN establishes and upholds the operational rules governing the transplant process (policies), the organizational framework and responsibilities (bylaws), and the membership criteria within the network.
The Current State of Organ Donation and Transplantation
The statistics surrounding organ donation and transplantation highlight both the critical need and the profound impact of this medical field. The national transplant waiting list includes over 103,000 individuals, with a new person being added approximately every eight minutes.
The waiting list comprises patients needing various organs:
- Kidneys (most commonly needed)
- Liver
- Heart
- Lungs
- Pancreas
- Intestines
Despite the significant demand, the number of transplants performed annually reflects the life-saving potential of organ donation:
- Over 48,000 in 2024
- Over 46,000 in 2023
- Over 42,800 in 2022
- Over 41,300 in 2021
These transplants are made possible through the contributions of both deceased and living donors. There has been a consistent upward trend in deceased organ donation over the past decade, indicating a positive shift in awareness and registration.
Despite these encouraging figures, a significant disparity remains between the number of people waiting for organs and the number of organs donated. While about 90% of US adults express support for organ donation, only about 60% were registered as donors in 2019 (with 170 million registered by 2022). This gap suggests an opportunity to increase the donor pool through enhanced public education and addressing barriers to registration.
Only about 3 in 1,000 people die under circumstances that allow for deceased organ donation, highlighting the rarity and immense value of each donation.
Types of Organ Donation
Deceased Donation
Deceased organ donation takes place after an individual has been declared legally dead, determined either by the cessation of all brain function (brain death) or by the irreversible cessation of circulatory and respiratory functions (circulatory death). The circumstances that most commonly lead to deceased organ donation involve sudden and severe medical events such as stroke, heart attack, or traumatic head injury.
The process of deceased donation involves several critical steps:
- The medical team confirms the patient’s death
- They check the state donor registry to see if the individual had registered as an organ donor
- If not registered, the medical team approaches the patient’s family to discuss donation and seek consent
- A thorough medical evaluation determines which organs are healthy and suitable for transplantation
- Potential recipients are identified through the OPTN’s matching system
- The organ recovery surgery is carefully performed
The medical team treating the patient is entirely separate from the transplant team involved in the organ recovery process. Following donation, the donor’s body is treated with respect and care, allowing families to proceed with funeral arrangements, including open casket funerals if desired.
A single deceased donor can save up to eight lives by donating vital organs (heart, kidneys, liver, lungs, pancreas, and intestines). Additionally, the donation of tissues like corneas, skin, bone, and heart valves can enhance the lives of over 75 more people.
Living Donation
Living organ donation involves the donation of an organ or part of an organ from a living person to a recipient in need. Living donors can donate:
- One of their two kidneys
- A lobe of their liver
- A segment of a lung
- Part of their pancreas
- Part of their intestine
Living donation can dramatically reduce the waiting time for transplant candidates and often leads to better outcomes for recipients compared to deceased donor transplants. Beyond the medical benefits, living donation can provide profound emotional benefits for both donor and recipient.
The process for living donors involves a thorough evaluation to ensure they are healthy enough to undergo the donation surgery and that the donated organ is a good match for the recipient.
Kidney Paired Donation
Kidney paired donation represents an innovative approach to expand the possibilities of living donation. This program helps individuals who have a willing living donor whose kidney is not a compatible match for them. Through the kidney paired donation program, these incompatible pairs can be matched with other incompatible pairs, facilitating a “swap” of kidneys so that both recipients receive a compatible transplant. This strategy significantly increases the chances of finding a suitable living donor for patients in need.
The Transplantation Process
The journey to receiving an organ transplant begins when individuals with end-stage organ failure are referred to specialized transplant centers for a comprehensive evaluation. This evaluation process determines if the patient is a suitable candidate for transplantation, considering their overall health, the severity of their organ failure, and their ability to adhere to the post-transplant medical regimen.
If deemed eligible, the patient is added to the national transplant waiting list managed by the OPTN. A patient waiting for more than one organ or listed at multiple transplant centers will have multiple registrations on the waiting list.
The OPTN uses a sophisticated computer system to match donated organs with potential recipients on the national list. The process of organ allocation is guided by two fundamental principles:
- Justice: ensuring fair consideration of candidates’ medical needs and circumstances
- Medical utility: maximizing the number of successful transplants and the longevity of both patients and transplanted organs
Matching Factors
Several key factors are considered when matching a donated organ with a potential recipient:
- Compatibility of blood types
- Size of the donated organ in relation to the recipient’s body
- Medical urgency of the recipient’s condition
- Time the recipient has been on the waiting list
- Geographic proximity between donor and transplant hospitals
- Specific medical criteria relevant to the particular organ being transplanted
For kidney transplants, additional factors include the level of donor-recipient immune system match, the recipient’s pediatric status, whether the recipient has been a prior living donor, and the potential survival benefit.
Heart allocation prioritizes the medical urgency of the candidate’s condition and the distance from the donor hospital. Lung allocation considers the potential survival benefit, medical urgency, waiting time, and distance. For liver transplants, the primary considerations are medical urgency and distance.
Factors such as celebrity status or personal wealth play absolutely no role in the organ allocation process. The system ensures fairness and prioritizes those with the greatest medical need and the highest likelihood of a successful transplant.
Common Myths About Organ Donation
Despite widespread support for organ donation, several myths and misconceptions persist:
Myth: Donor status affects medical care
Truth: The primary focus of medical professionals is always to save every patient’s life, regardless of donor status. The medical team treating a patient is entirely separate from the transplant team.
Myth: Donation interferes with funeral arrangements
Truth: Organ donation does not prevent open casket funerals. The donor’s body is treated with respect throughout the donation process.
Myth: Age restrictions for donors
Truth: There is no upper age limit for organ donation, and even newborns can be donors. The health of the organs is the determining factor, not age.
Myth: Medical conditions disqualify donation
Truth: While some conditions might affect certain organs, very few conditions completely preclude donation.
Myth: Donation costs the donor’s family
Truth: The donor’s family never incurs costs associated with organ donation. These expenses are covered by the recipient’s insurance or the organ procurement organization. The donor’s family is only responsible for medical costs before death and funeral expenses.
Myth: Celebrities get preferential treatment
Truth: Organ allocation is based strictly on medical need, compatibility, and other objective criteria, not on fame or financial status.
For reliable information about organ donation, visit OrganDonor.gov or OPTN’s website.
How to Become an Organ Donor
Becoming an organ donor is a straightforward process with several options:
- Register through your state’s online donor registry at OrganDonor.gov
- Indicate your wish to be a donor when obtaining or renewing your driver’s license or state ID
- In some states, register through health applications on smartphones
In many states, individuals under 18 can register as donors, but parental or legal guardian consent is typically required for donation to proceed.
Regardless of how you register, it’s vital to discuss your decision with your family. While registering in the state registry provides legal authorization for donation after death for adults in many states, ensuring your family knows your wishes can provide them comfort during a difficult time.
For professionals and workplaces interested in promoting organ donation, OrganDonor.gov/professionals offers resources, including outreach materials and guidance on organizing donor registration drives.
Benefits of Organ Donation
The benefits of organ donation extend far beyond the individual recipient:
For Recipients
- A life-saving and transformative event for those facing end-stage organ failure
- Significant improvements in energy levels
- Ability to return to normal activities, spend time with loved ones, and pursue passions
For Donor Families
- Knowing their loved one’s organs have saved lives can provide comfort and meaning during grief
- Some donor families learn about the positive impact of their loved one’s gift on recipients’ lives
For Society
- Increased productivity as recipients return to work and contribute to their communities
- Reduced burden on the healthcare system, particularly by decreasing the need for costly long-term treatments like dialysis
- An act of profound charity and generosity, supported by most major religions
The Future: OPTN Modernization Initiative
HRSA launched the OPTN Modernization Initiative in March 2023 to improve the nation’s organ donation and transplantation system. This initiative focuses on strengthening accountability, equity, and overall performance within the system, with HRSA remaining committed to serving patients, donors, and their families while ensuring transparency throughout these reforms.
The OPTN Modernization Initiative concentrates on five key areas:
Technology
- Modernizing the crucial technology used for organ matching
- Upgrading the IT infrastructure
Data Transparency
- Publishing more data on organ donation and transplantation
- Making information more accessible to patients, clinicians, and researchers
- Launching a new data dashboard and Public Use File
Governance
- Establishing an independent OPTN Board of Directors
- Ensuring greater accountability and oversight
- Conducting a special election to seat the new board
Operations
- Improving processes for monitoring patient safety
- Enhancing performance monitoring of OPTN members
- Strengthening compliance with regulations
- Implementing a new system for reporting allegations of misconduct
Quality Improvement
- Fostering innovation and continuous improvement in practices involved in organ donation, procurement, and transplantation
Resources for More Information
For detailed information and data on organ donation and transplantation:
- HRSA Data Warehouse – Interactive dashboards and downloadable data including national and state-level information, trends, and visualizations
- OPTN Data Reports – Comprehensive data section with national, regional, state, and center-specific reports on waiting lists, transplants performed, donor information, and survival rates
- OPTN Patient Services Line: 1-888-894-6361 (Monday through Friday, 8:30 AM to 5:00 PM ET) or email at [email protected] – Direct support and answers to questions for patients, families, and friends
These resources demonstrate HRSA and OPTN’s commitment to transparency and public access to information about organ donation and transplantation.
Our articles make government information more accessible. Please consult a qualified professional for financial, legal, or health advice specific to your circumstances.
