About Donation

Which organs can be donated?

When a person agrees to organ donation, this usually means donation of most “solid organs.” Those include the heart, lungs, both kidneys, liver, pancreas, and portions of the large intestine. Often people agree also to tissue donation (e.g., heart valves or skin) and corneas. Brains can be donated to research but are not transplanted. Reproductive organs such as the uterus are never transplanted without a separate request and consent process. On average, when someone donates organs, 3 or 4 organs end up being transplanted. Sometimes organs are not used if they are not healthy, if there are major logistical problems, or if the transplant team cannot find a suitable person who needs the organ at the time.

Who can donate organs?

People are often surprised to learn that most people who die are not able to donate organs, even if they gave their permission for organ donation. To understand this, think about what organ donation requires. It requires a person to be declared dead while those organs that will be transplanted are still healthy.

Under normal conditions, organs cannot stay healthy without blood circulating throughout the body, bringing fresh oxygen to the organs. So, what most organ donors share in common is that they are on mechanical ventilation before being declared dead. They are then declared dead using either neurological criteria—commonly called “brain death”—or circulatory criteria. Both of these are explained below.

Sometimes people assume that they are too old or too unhealthy to donate organs. In general, transplant professionals ask people not to make such assumptions. For example, an older adult may donate to another older adult, and a person living with HIV may donate to another person with HIV. If you want to donate organs, then it is best to indicate your willingness.

What is brain death?

Imagine that a person suffers an injury that causes circulation of blood to the brain to stop for 15 minutes or more. Even if circulation is restored, often the brain is so injured that the most important functions are lost and will never be regained. 

In the case of “brain death” the human body is permanently unconscious, cannot breathe without mechanical ventilation, and has no brainstem reflexes such as gagging or wincing in pain. Without mechanical ventilation, circulation throughout the whole body would also be lost.

This is different from the so-called permanent vegetative state (PVS), which has gained a lot of attention. Patients in a PVS can breathe on their own. And while they have lost full consciousness in the ordinary sense, they still have sleep-wake cycles with their eyes open when awake. Patients who are brain dead do not have any of these functions.

In all 50 states in the United States, doctors can declare a person dead when tests indicate that they are brain dead.

Most organ donors are declared dead using neurological or brain death criteria.

What is donation after a circulatory determination of death (DCD)?

Most people on ventilators are not brain dead–they still have brainstem reflexes. Yet, they may have lost consciousness and may have almost no chance of recovering. Some patients have advanced directives saying they do not want ventilator care if they will not recover consciousness. Sometimes physicians and family members make a decision that ventilator care is no longer appropriate. In these cases, patients are often removed from the ventilator. They are then pronounced dead using circulatory criteria. 

In these situations, organ donation may be possible using donation after a circulatory determination of death (DCD) protocols. The most common approach involves removing the ventilator and waiting 5 minutes after circulation is lost before declaring the patient dead. 

Because circulation is lost, transplant teams go to great efforts to make sure that the organs will not become too damaged to transplant. This may involve administering a drug such as Heparin to thin the blood before removing the ventilator. Sometimes an external pump is used to circulate blood throughout the body after death. Ethical issues related to these and other DCD activities will be explored in the Orthodox Christian FAQs section.

How does a person agree to be an organ donor?

A version of the Uniform Anatomical Gift Act has been enacted into law in all states in the US. This law treats organ donation as a gift that goes into effect when you die. Because organ donors are dead, and donation is a gift, ordinarily there is no "informed consent" process for medical procedures related to donation. But permission for organ donation is still needed. This can be expressed by the donor while living by joining the organ donor registry. (Most people who join do this through their drivers' license bureau.) For a dead or dying patient, family members or a healthcare power of attorney may grant permission.

Because there is no informed consent process for organ donation, it is important for Orthodox Christians to inform themselves about organ donation prior to making a decision, and to share their decisions with family members.