Organ Donation Eligibility Criteria

It is not yet possible for individuals to donate their organs and tissues following medical aid in dying, although this may change in the future. While the practice of organ and tissue donation after medical aid in dying (MAID) is becoming increasingly common in Belgium, the Netherlands, Canada and Spain, this combined procedure remains a new concept in the United States. The decision to donate organs and tissues after selecting MAID introduces ethical considerations surrounding patient autonomy, non-maleficence and vulnerability. These concerns can be challenging to navigate in a country where the practice of MAID is less widespread compared to other countries where it is more socially and legally accepted. 

It is important to note that organs and tissues generally remain viable after medical aid in dying, and the decision to die by this practice typically would not damage organs and tissues that might otherwise be suitable for transplantation. Cases in the Netherlands have demonstrated success in procuring organs such as livers, kidneys and lungs. Difficulties in effective implementation generally pertain to logistics and additional time investment from medical staff. Similar to any other organ or tissue donation process, it is crucial for the organs to be procured as soon as possible after the donor has died. 

As perspectives and policies about medical aid in dying continue to evolve, the ethical considerations associated with it in relation to organ and tissue donation will also likely change. 

Advocates for MAID will likely need to look to its efficacy and implementation in other countries as evidence-based examples of what donation practices and policies may involve in the future. Ultimately, patients’ end-of-life decisions and autonomy must be respected and upheld with utmost importance. 

Sources

“Directed Organ Donation After Euthanasia”. Frontiers. https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11259/full 

“Organ Donation after Medical Assistance in Dying — Canada’s First Cases”. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMc1915485 

“Organ donation after medical assistance in dying at home”. Canadian Medical Association Journal. https://pmc.ncbi.nlm.nih.gov/articles/PMC6217602/ 

Yes, a donor may donate their organ to a specific individual, such as a family member. This is typically known as a directed donation or designated donation. Directed donations may include organs and tissues donated by living donors or those who have died. If the person who died was a donor and did not indicate a preference regarding who receives their organs, the donor’s family may manage the directed donation instead. 

It is important to note that requesting to donate to a specific person does not guarantee that a transplant will occur, since additional testing must be conducted to determine if the recipient is a match for the loved one’s organ. If the individual is not a match for the designated organ, the organ will be donated to another recipient on the National Transplant Waitlist. Directed donations are the most common type of living donation. Donors who provide living donations can be: 

• A biological relative (parent, sibling, or adult child)
• A biologically unrelated person (friend, coworker, or partner)
• A biologically unrelated person aware of a candidate’s need 

Overall, the intention to improve a family member’s health outcome by providing an organ donation is an honorable gesture. Since it cannot be guaranteed that these organs will be an appropriate match for the intended recipient, individuals considering directed donations are encouraged to be open to the possibility of their donations being distributed to those in greatest need. Potential donors are advised to contact a local organ procurement organization or transplant center for more information about the most appropriate options based on their respective circumstances. 

Sources

“Frequently asked questions about organ donation.” Gift of Life Donor Program. Accessed 18 September 2024. https://www.donors1.org/learn-about-organ-donation/how-does-organ-and-tissue-donation-work/frequently-asked-questions/ 

“Living donation.” UNOS. Accessed 18 September 2024. https://unos.org/transplant/living-donation/ 

“What is directed donation?” LifeSource. Accessed 18 September 2024. https://www.life-source.org/latest/what-is-directed-donation/ 

Some medical conditions, such as active infections and certain chronic diseases, can prevent a person from becoming an organ or tissue donor. However, nothing prevents someone from registering as a donor, regardless of their health status. Individuals are encouraged to register even if they have chronic conditions. This is because doctors who handle organ donation do not determine whether someone is medically suitable to donate until the time of death. 

Suitability for donation is determined on a case-by-case basis since circumstances can vary among patients. However, some examples of conditions that often preclude donation include the following: 

• HIV or AIDS
• Hepatitis 
• Pneumonia, sepsis or other infections at the time of death 
• Lymphomas
• Cancer 
• Autoimmune diseases 
• Cruetzfeldt-Jakob disease
• West Nile virus 
• Chagas
• Malaria 
• Herpes (active)
• Rabies 

Additionally, although some health conditions may affect the viability of specific organs, all organs and tissues are rarely unusable. For example, even if someone has a chronic disease that prevents the donation of an organ like a heart or kidneys, other organs or tissues can likely be used. Doctors will conduct tests and evaluate the viability of each of a potential donor’s organs and tissues to determine if there are any that may still be appropriate for donation if there has been substantial damage from a chronic disease. If, for example, a person had metastatic cancer within the previous five years, they may not be appropriate for donating organs or most tissues, but they could still donate their corneas. 

Sources 

“Organ donation: Don’t let these myths confuse you”. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/organ-donation/art-20047529 

“What Factors Disqualify People From Being Organ Donors?” Forbes. https://www.forbes.com/sites/quora/2018/12/14/what-factors-disqualify-people-from-being-organ-donors/?sh=740bf2a0759e 

“Would Certain Conditions or Diseases Make You Ineligible to Donate?” Life Source. https://www.life-source.org/latest/would-certain-conditions-or-diseases-make-you-ineligible-to-donate/ 

Organ donation usually isn’t feasible when someone dies at home, due to the logistics of transportation and coordination, and the short time most organs are viable after death. Vital organs such as the heart or liver only remain viable and appropriate for transplantation for a certain number of hours after a potential donor has died. Some examples of how long vital organs can remain viable include: 

• Heart: 4 to 6 hours
• Lungs: 2 to 4 hours
• Liver: 12 to 18 hours 
• Pancreas: 12 to 18 hours 
• Kidneys: up to 48 hours

Due to these extremely limited time frames, only people who are in the hospital on ventilator support are usually candidates for donating vital organs. 

Although organ donation isn’t possible, tissue donation may be an option when someone dies at home because tissues have a different timeline for viability. Tissues such as corneas, heart valves, veins, tendons and many others can typically be removed from the donor up to 24 hours after the person dies. Additionally, once removed from the donor, tissues have greater longevity than organs since they can be processed and stored for extended periods prior to transplantation. 

Ultimately, if donation is an interest and the potential donor has a preference of dying at home, it’s essential to develop a plan of how to properly handle the process ahead of time. This may include contacting a local tissue bank or organ procurement organization to ensure that they are equipped and qualified to handle the donation process. 

Organizations such as the National Donate Life Registry can also provide additional information on how to plan ahead for tissue or organ donations. By proactively researching these options, individuals may be able to ensure that their wishes are communicated and honored.

Sources

“Frequently Asked Questions About Organ Donation for Older Adults”. National Institute on Aging. https://www.nia.nih.gov/health/organ-donation/frequently-asked-questions-about-organ-donation-older-adults 

“What is the Time Frame for Transplanting Organs?”. Donor Alliance. https://www.donoralliance.org/newsroom/donation-essentials/what-is-the-time-frame-for-transplanting-organs 

“Tissue Donation”. Donate Life. https://donatelife.net/donation/organs/tissue-donation/ 

“National Donate Life Registry”. Donate Life. https://donatelife.net/donation/donor-registries/national-donate-life-registry/ 

As a rule, anyone who is over 18 can register to be an organ donor, and parents and guardians can authorize donation from children under 18. According to the Mayo Clinic, there are very few medical conditions that automatically disqualify a person from donating organs or tissue, and no one is automatically disqualified based on age. Additionally, since the passage of the HIV Organ Policy Equity (HOPE) Act in 2013, the organs from HIV-positive donors can now be transplanted into recipients with HIV. 

Living organ donors are generally screened for underlying medical conditions before they can donate because they will need to be healthy enough to tolerate the surgery and recovery period. Although very few conditions will automatically exclude you, a history of uncontrolled hypertension, diabetes, or certain infections could prevent you from donating until they are under control. 

Nor is age necessarily a factor in whether or not you can donate. The suitability of an elderly person’s organs might be evaluated more carefully than that of a younger donor, but transplants from people in their 60s and 70s have occurred. Even if you’re not suitable as an organ donor, your tissues may be used no matter what your age. Doctors will always try to use whatever organs and tissues they can to help save and improve lives. 

With that being said, it’s important to know that deceased organ donation is only possible when a person dies under certain limited circumstances. Because organs begin to die almost immediately after heart function stops, they will not remain viable unless breathing and circulation are continuously maintained through artificial means. To accomplish this, a person who has suffered a cardiac arrest must receive CPR within minutes of death and be admitted to a hospital and placed on a ventilator soon after that. They must then be maintained on ventilator support until the organs can be recovered, after brain death or cardiac death is declared.

Sources
“HIV Organ Policy Equity (HOPE) Act is Now Law”. The White House. https://obamawhitehouse.archives.gov/blog/2013/11/21/hiv-organ-policy-equity-hope-act-now-law 

There is no age limit for organ and tissue donation. Anyone who is at least 13 years of age can register online, although the final decision is that of the legal guardian(s) until age 18. Additionally, anyone of any age can select “YES” when applying for or renewing their driver’s license or ID at the DMV. Since age is not a factor, people should not rule themselves out as potential donors – there has been a 93-year-old kidney donor and a 99-year-old cornea donor! 

Though there is no set maximum age for being a donor, medical professionals will assess each organ individually at the time of death to determine if it is suitable for donation. Even if you are in your 70s, 80s or even 90s, you can still potentially donate your organs if they are in good working order. If an organ has been damaged by disease or aging, it might not be suitable for transplantation.

Further, donated organs and tissue from those aged 50 to over 80 are often in high demand by medical researchers. These may be donated through an organ procurement organization, which will arrange to have usable tissue removed within 24 hours of death. Whole body donation through a non-anatomical donation organization is another way to ensure that your or a loved one’s organs and/or tissues reach medical researchers. 

Sources 

“Organ Donation FAQ”. Health Resources & Services Administration. https://www.organdonor.gov/learn/faq 

“Consumer Health”. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/organ-donation/art-20047529 

“A 95-year-old man just became the oldest organ donor in US history”. CNN. https://www.cnn.com/2021/05/12/health/oldest-organ-donor-wellness-trnd/index.html 

“Organ Donation”. New York-Presbyterian. https://www.nyp.org/transplant/organ-donation/organ-donation-facts 

“5 Things to Know About Organ Donation After Age 50”. AARP. https://www.aarp.org/health/healthy-living/organ-donation-age-limit/ 

“​​Non-transplant Anatomical Donation”. AATB. https://www.aatb.org/nados