Organ donation is where a person donates their organs for transplant.
There are two types of organ donation: living and deceased.
Donated organs are given to someone who has damaged organs that need to be replaced.
An organ transplant may save a person's life or significantly improve their health and quality of life.
The need for donors
Between April 1 2013 and March 31 2014, 4,655 organ transplants were carried out in the UK thanks to the generosity of 2,466 donors.
But there are always significantly more people waiting for an organ transplant than there are suitable donors. At the time of writing (24 November 2014), 6,856 people were waiting for transplants.
This is because donation rates among these ethnic groups are low but the need is great.
People from black, Asian and ethnic minority communities are more likely to develop health conditions that can lead to kidney failure, and on average they'll wait a year longer for a kidney transplant than a white patient.
There's no upper age limit for joining the register and recording your wish to be a donor.
If you die in circumstances where you could potentially donate, specialist healthcare professionals decide which organs and tissues are suitable based on a number of factors, including your medical and travel history.
Tissue from people in their 70s and 80s is often transplanted successfully, although organs are only selected from those under 80 years of age.
Most people waiting for a donated organ need to have a kidney, heart, lung or liver transplant. One donor can help several people as they can donate a number of organs, including:
Tissues that can be donated include:
the cornea (the transparent layer at the front of the eye)
All donors can choose which organs and tissues they wish to donate.
How to donate
Adding your name to the register and telling your family and friends that you want to be a donor will make it easier for them to agree to donation in the event of your death.
You can join the register in a number of ways. For example, you can:
complete an online form
text SAVE to 62323
Even though about a third of the population have joined the register, less than 5,000 people a year die in circumstances that allow them to donate their organs.
This means it's even more important for as many people as possible to talk about donation and join the register so no donation is wasted.
Remember to discuss your decision with your family so they're aware.
Checking for a match
When an organ becomes available for donation, it's checked to make sure it's healthy.
The blood and tissue type of both donor and recipient are also checked to ensure they're compatible. The better the match, the greater the chance of a successful outcome.
People from the same ethnic group are more likely to be a close match. Those with rare tissue types may only be able to accept an organ from someone of the same ethnic origin. This is why it's important that people from all ethnic backgrounds register to donate their organs.
Types of donation
There are three different ways of donating an organ. These are known as:
donation after brain stem death
donation after circulatory death
living organ donation
These are described below.
Donation after brain stem death
Most organ donors are patients who die as a result of a brain haemorrhage, severe head injury or stroke and are on a ventilator in a hospital intensive care unit (ICU). These donors are called donation after brain stem death donors.
Death is diagnosed by brain stem tests. There are very strict standards for doing these tests and they're always carried out by two experienced doctors.
A ventilator provides oxygen, which keeps the heart beating and blood circulating after death. Organs such as hearts, lungs and livers can be donated by a DBD donor.
Donation after circulatory death
Patients who die in hospital but aren't on a ventilator can donate their kidneys and, in certain circumstances, other organs. They're called donors after circulatory death.
In these cases, the organs must be removed within a few minutes of the heart stopping to prevent them being damaged by a lack of oxygenated blood.
Both types of donors can donate their corneas and other tissue.
Living organ donation
Living organ donation usually involves one family member donating an organ to another family member or partner. The relative is usually related by blood – a parent, brother, sister, or child.
It's also now possible to be an altruistic donor. Altruistic donors are unrelated to the patient but become donors as an act of personal generosity.
Kidneys are often donated from living donors as a healthy person can lead a normal life with only one kidney.
Organs that can be donated
Organ donation can lead to life-saving transplants or help improve a person's health and quality of life. It's also possible to donate tissue.
Organs that can be donated include:
Several types of tissue can also be donated. See tissue donation to learn more.
A kidney can provide a much better quality of life to someone who has end-stage renal failure (ESRF). Renal failure is where the kidneys stop working properly.
Kidney transplants give better long-term survival rates and quality of life than dialysis (where some of the kidney's functions are artificially replicated). Kidneys used for transplant can come from a living person or from someone who's died.
The demand for donated kidneys is higher than for any other organ. During 2013-14, 3,242 kidney transplants were carried out, 1,114 of which were from living donors. This is a significant increase from 2011-12.
A liver transplant is often considered for people with end-stage liver disease. The survival rate after one year of having a liver transplant is about 93%.
In 2013-14, a total of 872 liver transplants were carried out in the UK. For adults, the average waiting time for a liver transplant is about 145 days and 72 days for children.
Most heart transplants are carried out on people with severe heart failure caused by coronary heart disease or cardiomyopathy (diseased heart muscles) who can no longer be helped by medication or other surgery. The survival rate after one year of having a heart transplant is about 81%.
In 2013-14, 205 heart transplants were carried out in the UK. The average waiting time for a suitable heart to become available for transplant is around 441 days for adults and 214 days for children.
Lungs can be damaged by illnesses such as cystic fibrosis (where the lungs become clogged with thick, sticky mucus) or respiratory conditions such as chronic obstructive pulmonary disease (COPD), which is often caused by smoking.
People are considered for a lung transplant when their lung function can't be significantly improved by medical therapy or surgery.
Lung transplants have an 82% success rate one year after surgery, and heart-lung transplants have a 85% success rate.
In 2013-14, 218 lung transplants were carried out in the UK. The average waiting time for a lung transplant is around 265 days.
A small bowel transplant (intestinal transplant) is usually recommended if there's not enough bowel left to absorb nutrition (short bowel syndrome), and when a person is having difficulty with total parenteral nutrition (when nutrition is given through a vein).
Small bowel transplants are often carried out at the same time as a liver and pancreas transplant. This is called a multivisceral transplant.
Small bowel transplants are fairly uncommon. Only 26 transplants were carried out during 2013-14. On average, patients wait six months for a transplant of this type.
A successful pancreas transplant is the only treatment that can restore complete insulin independence and blood sugar levels in people withtype 1 diabetes.
In 2013-14, 214 pancreas transplants were carried out in the UK. The average waiting time for a combined pancreas and kidney transplant for an adult is around 392 days.
Unlike organs, tissues can be donated up to 24 hours after someone has died, and in some cases up to 48 hours. Tissues can be used to treat a wide variety of conditions, some of which may be life threatening.
The most common tissues that can be donated are:
the cornea (the transparent tissue layer at the front of the eye)
As there's a longer period of time between someone dying and being able to donate tissues, it means donors can be screened for possible infectious agents and a pool of available tissue can be established.
Corneas can be transplanted to restore the sight of a person with an eye condition or eye injury. Patients closest in age to the donor are usually selected as recipients.
Cornea transplants can be carried out under either general anaestheticor local anaesthetic. During 2013-14, 3,660 people had their sight restored through a cornea transplant.
Heart valves can be used to help children born with heart defects. They're also used for adults with diseased or damaged valves.
Bone can be used to help improve or restore mobility. Bone grafts can also be used in a variety of orthopaedic procedures (those that involve muscles, joints, tendons, ligaments and nerves), including joint replacements and spinal surgery.
Bone transplants can also reduce the need for amputation (where a limb is surgically removed) in people with bone cancer.
Skin can help save the lives of people with severe burns. A skin graft helps reduce pain and prepares underlying tissue for later treatment. It also helps reduce scarring. However, it can take a number of grafts to successfully treat someone with severe burns.
Tendons are tough, flexible tissues found throughout the body that connect muscles to bone and cartilage. Donated tendons are usually used to reconstruct injured knees in young people, usually followingsports injuries.
Cartilage is used to help reconstruct parts of the body following injury or during joint replacement surgery.
Common reasons for a cartilage transplant include injury or wear caused by conditions such as osteoarthritis (a common type of arthritisthat causes inflammation of the bones and joints).
Living organ donation
The shortage of organs has led to more people receiving organs from living donors. Although this involves carrying out major surgery, results are often very successful.
Before a living donor transplant can take place, strict regulations must be met and there must be a thorough process of assessment and discussion.
Living organ donations
Kidneys are the most common organ donated by a living person. It's possible for a healthy person to lead a completely normal life with only one working kidney. Around half of all kidney transplants carried out are now from living donors.
It's also possible for part of a liver to be donated, and in some circumstances it may also be possible to donate a segment of lung (although this hasn't been done in the UK). In a very small number of cases, part of the small bowel may also be transplanted.
Who can be a living donor?
Living organ donation usually involves one family member donating an organ to another family member or a partner. The relative is usually blood related – a parent, brother, sister or child.
It's also possible to be an altruistic donor. These are donors who are unrelated and unconnected to the patient. They become donors as an act of personal generosity.
Living donation will only go ahead if the blood group and tissue type of the donor and recipient are compatible.
If a relative or spouse wishes to donate but isn't a match for the person who needs a transplant, the couple can be paired with a similar donor and recipient who don't match. This allows each recipient to benefit from a transplant that they wouldn't otherwise have had.
Success and survival rates
Kidneys from a living donor tend to last longer than those donated from someone who has died.
In people who receive a kidney from someone who has died, research has shown:
94% of kidneys will still be working after one year
85% of kidneys will still be working after five years
72% of kidneys will still be working after 10 years
However, in kidney transplants where the kidney is donated from a living donor:
97% of kidneys will still be working after one year
91% of kidneys will still be working after five years
77% of kidneys will still be working after 10 years
Regulations and assessment
The Human Tissue Act 2004 and the Human Tissue (Scotland) Act 2006 provide the legal background for living donation in the UK. It's regulated by the Human Tissue Authority (HTA).
The HTA consists of a chair and 11 authority members, nine of whom are appointed by the Secretary of State for Health. Most members have medical and scientific backgrounds.
The HTA's role in living donation is to ensure:
donors or their family members aren't put under pressure to donate an organ
no payment is made for the donation – paying for donated organs is illegal in the UK
After the organ donor and the recipient have been assessed by the transplant team, an independent assessor from the HTA will assess the donor. They'll make sure all the legal requirements for the donation have been met.
How organ donation works
The Organ Donor Register is a confidential national database that holds the details of around 21 million people who want to donate their organs after their death.
In the event of your death, there's a chance your organs could help save someone else's life.
If you want to be a donor, add your name to the register and tell those closest to you. This will make it easier for them to ensure donation goes ahead in the event of your death.
There are a number of ways you can join the register, including:
completing an online form
completing a form available in GP surgeries and hospitals
texting SAVE to 62323
when applying online for a driving licence or vehicle tax
when registering with a GP
when registering online for a European Health Insurance Card (EHIC)
In the event of your death, the person closest to you (usually your next of kin) will be asked to confirm that you hadn't changed your mind before your death.
Many people have gained a great deal of comfort from knowing that the death of a loved one has helped save someone else's life.
The donation process
Organs are only removed for transplantation after a person has died. Death is confirmed by doctors at consultant level who are entirely independent of the transplant team. The process for confirming death is exactly the same for people who donate organs as for those who don't.
If appropriate, brain stem death testing will be carried out to confirm the person is dead. Alternatively, a joint decision may be made by medical staff, nursing staff and the person's relatives that although brain stem death hasn't occurred, the prospect of survival is so low continuing with current treatment would not be helpful.
The Organ Donor Register will be checked by a specialist nurse for organ donation to see if the potential donor is on the register. If they are, the specialist nurse will speak to the family about the person's decision to be a donor.
If the family agrees to organ donation, the specialist nurse must ensure medical tests are carried out, such as blood group and tissue type matching. They'll also look at the donor's medical history and ask the family some questions about them. This will help confirm whether or not the organ donation can take place.
Organ donation and medical conditions
In most circumstances, having a medical condition doesn't necessarily prevent a person becoming an organ or tissue donor. The decision about whether some or all organs or tissue are suitable for transplant is made by a healthcare professional, taking the person's medical history into account.
There are three conditions where organ donation is ruled out completely. A person can't become an organ or tissue donor if they've had:
cancer that has spread in the last 12 months
a severe or untreated infection
Creutzfeldt-Jakob Disease (CJD) – a rare condition that affects the nervous system and causes brain damage
There are also other conditions that can affect which organs can be transplanted.
A team of specialist surgeons is called to the donor's hospital to remove and preserve the organs for transport to the transplant unit. Timing is crucial because certain organs need to be transplanted within four to six hours.
During the operation to retrieve the organs, the surgeon will make a final decision about whether the organs are healthy and suitable to be transplanted. If all is well, the organ will be taken to the transplant unit and transplanted immediately.