View source for Organ donation

{{Short description|Process of voluntarily giving away organs}}
{{Redirect|Organ donor|the film previously known as The Organ Donor|Spiral (2021 film)}}
{{Globalize|date=June 2022|2=US}}
{{Use mdy dates|date=November 2024}}

[[File:2016-06 Naarden donor 02.jpg|thumb|The National Donor Monument, [[Naarden]], the Netherlands]]
'''Organ donation''' is defined as the process when a person authorizes an [[organ (anatomy)|organ]] of their own to be removed and [[organ transplantation|transplanted]] to another person, [[#Legislation and global perspectives|legally]], either by consent while the donor is alive, through a [[Authorization|legal authorization]] for deceased donation made prior to death, or for deceased donations through the authorization by the [[De jure|legal]] next of [[Kinship|kin]].

Donation may be for research or, more commonly, healthy [[transplantable organs and tissues]] may be donated to be transplanted into another person.<ref name="MedlinePlus">{{cite web |title=Organ Donation |url=https://medlineplus.gov/organdonation.html |website=medlineplus.gov }}</ref> When the donor is still living, this is called a living organ donation; about 6,500 of these occur in the U.S. each year. <ref name="Womens">{{Cite web |date=January 2025 |title=Living Organ Donation |url=https://www.organdonor.gov/learn/process/living-donation |access-date=April 21, 2025 |website=Health Resources & Services Administration}}</ref>

Common transplantations include [[kidney transplantation|kidneys]], [[heart transplantation|heart]], [[liver transplantation|liver]], [[pancreas transplantation|pancreas]], [[intestine transplantation|intestines]], [[lung transplantation|lungs]], [[bone transplantation|bones]], [[bone marrow transplantation|bone marrow]], [[skin transplantation|skin]], and [[cornea transplantation|cornea]]s.<ref name=MedlinePlus/> Some organs and tissues can be donated by living donors, such as a kidney or part of the liver, part of the pancreas, part of the lungs or part of the intestines.<ref>{{cite web|last1=US Department of Health and Human Services|title=Living Organ Donation|url=https://organdonor.gov/about/process/living-donation.html|website=Organdonor.gov|access-date=October 17, 2017}}</ref>

In 2019, Spain had the highest [[International organ donor rates|donor rate]] in the world at 46.91 per million people, followed by the US (36.88 per million), [[Croatia]] (34.63 per million), [[Portugal]] (33.8 per million), and France (33.25 per million).<ref>{{cite news |title=Newsletter 2020 |url=https://www.irodat.org/img/database/pdf/Newsletter%20Dec%202020%20.pdf |archive-url=https://web.archive.org/web/20210123013002/https://www.irodat.org/img/database/pdf/Newsletter%20Dec%202020%20.pdf |archive-date=2021-01-23 |url-status=live |access-date=January 28, 2021 |publisher=International Registry in Organ Donation and Transplantation |date=December 2020}}</ref>

As of April 21, 2026, there were 103,223 people waiting for life-saving organ transplants in the United States.<ref name="HRSA2018">{{cite web|title=Organ Donation Statistics|url=https://www.organdonor.gov/learn/organ-donation-statistics|date=May 2025|website=Health Resources & Services Administration|access-date=April 21, 2026}}</ref> More than 48,000 organ transplants were performed in the U.S. in 2024.<ref name="HRSA2018" /> While views of organ donation are positive, there is a large gap between the numbers of registered donors compared to those awaiting organ donations on a [[World|global]] level.<ref>{{Cite web|url=http://www.organdonor.gov/statistics-stories/statistics.html|title=Organ Donation Statistics|website=Organ Donor|access-date=June 14, 2019}}</ref>

To increase the number of organ donors, especially among [[Underrepresented group|underrepresented populations]], current approaches include the use of optimized [[social network]] interventions, exposing tailored educational content about organ donation to target social media users.<ref name=Murphy2020>{{cite journal |last1=Murphy |first1=Michael Douglas |last2=Pinheiro |first2=Diego |last3=Iyengar |first3=Rahul |last4=Lim |first4=Gene |last5=Menezes |first5=Ronaldo |last6=Cadeiras |first6=Martin |title=A Data-Driven Social Network Intervention for Improving Organ Donation Awareness Among Minorities: Analysis and Optimization of a Cross-Sectional Study |journal=Journal of Medical Internet Research |date=January 14, 2020 |volume=22 |issue=1 |article-number=e14605 |doi=10.2196/14605 |pmid=31934867 |pmc=6996769 |doi-access=free }}</ref> August 13 is observed as [[World Organ Donation Day]] to raise [[awareness]] about the importance of organ donation.<ref>{{cite news |title=World Organ Donation Day: A brief history |url=https://www.hindustantimes.com/india-news/world-organ-donation-day-a-brief-history-101628815156959.html |work=Hindustan Times |date=August 13, 2021 }}</ref>

==Process in the United States==
{{main|Uniform Anatomical Gift Act}}
Organ donors are usually dead at the time of donation, but may be living. For living donors, organ donation typically involves extensive testing before the donation, including psychological evaluation to determine whether the would-be donor understands and consents to the donation. On the day of the donation, the donor and the recipient arrive at the hospital, just like they would for any other [[major surgery]].<ref name=old/>

For deceased donors, the process begins with verifying that the person is undoubtedly deceased, determining whether any organs could be donated, and obtaining consent for the donation of any usable organs. Normally, nothing is done until the person has already died, although if death is inevitable, it is possible to check for consent and to do some simple medical tests shortly beforehand, to help find a matching recipient.<ref name=old/>

The verification of death is normally done by a [[neurologist]] (a physician specializing in brain function) that is not involved in the previous attempts to save the patient's life. This physician has nothing to do with the transplantation process.<ref name=old>{{Cite web|url=http://www.livescience.com/36240-donate-organs.html|title=Can You Be Too Old to Donate Organs?|website=[[Live Science]]|date=May 30, 2013|access-date=August 6, 2016}}</ref> Verification of death is often done multiple times, to prevent doctors from overlooking any remaining sign of life, however small.<ref name=":4">{{Cite web|url=http://www.organdonor.gov/about/organdonationprocess.html|title=Organ Donation: The Process|publisher=U.S. Department of Health and Human Services|access-date=July 30, 2016|archive-url=https://web.archive.org/web/20160727234930/http://www.organdonor.gov/about/organdonationprocess.html|archive-date=July 27, 2016}}</ref> After death, the hospital may keep the body on a [[Mechanical ventilation|mechanical ventilator]] and use other methods to keep the organs in good condition.<ref name=":4"/> The donor's estate and their families are not charged for any expenses related to the donation.<ref>{{cite journal |last1=Walton-Moss |first1=Benita |last2=Taylor |first2=Laura |last3=Nolan |first3=Marie |title=Ethical analysis of living organ donation |journal=Progress in Transplantation |date=September 2005 |volume=15 |issue=S3 |pages=303–309 |doi=10.1177/152692480501500318|pmid=16252641 |pmc=8976442 }}</ref>

The surgical process depends upon which organs are being donated. The body is normally restored to as normal an appearance as possible, so that the family can proceed with funeral rites and either cremation or burial.

The lungs are highly vulnerable to injury and thus the most difficult to preserve, with only 15–25% of donated organs used.<ref>{{cite journal |last1=Keshavamurthy |first1=Suresh |last2=Rodgers-Fischl |first2=Peter |title=Donation after circulatory death (DCD)—lung procurement |journal=Indian Journal of Thoracic and Cardiovascular Surgery |date=September 2021 |volume=37 |issue=S3 |pages=425–432 |doi=10.1007/s12055-021-01156-7 |pmid=33821109 |pmc=8012413 }}</ref>

Potential vulnerabilities and opportunities related to the limits of reliably assessing consciousness in critically ill, behaviorally unresponsive patients undergoing controlled organ donation after circulatory determination of death have been identified, and neurologically informed safeguards in this setting were advanced.<ref>{{cite journal |last1=Young |first1=Michael J. |last2=Koch |first2=Christof |title=Consciousness and Controlled Donation After Circulatory Determination of Death |journal=JAMA |date=2026-01-26 |doi=10.1001/jama.2025.27045 |url=https://jamanetwork.com/journals/jama/article-abstract/2844447}}</ref>

==History==
{{Further|List of organ transplant donors and recipients}}
The first living organ donor in a successful transplant was Ronald Lee Herrick (1931–2010), who donated a kidney to his identical twin brother [[Richard Herrick|Richard]] (1931–1963) in 1954.<ref>{{cite news |last1=Batty |first1=David |title=World's first organ donor dies aged 79 |url=https://www.theguardian.com/society/2010/dec/30/first-organ-donor-dies-79 |work=[[The Guardian]] |date=December 30, 2010 }}</ref> The lead surgeon, [[Joseph Murray]], and the nephrologist, John Merrill, won the [[Nobel Prize in Physiology or Medicine]] in 1990 for advances in organ transplantation.

The youngest organ donor was a baby with [[anencephaly]], born in 2014, who lived for only 100 minutes and donated his [[kidney]]s to an adult with [[renal failure]].<ref name=":3">{{Cite news|url=https://www.theguardian.com/society/2015/apr/23/parents-uks-youngest-organ-donor-teddy-houlston-hope-others-inspired|title=Parents of UK's youngest organ donor hope others will be inspired|last=Weaver|first=Matthew|date=April 23, 2015|work=[[The Guardian]] |location=London|access-date=April 24, 2015}}</ref> The oldest known cornea donor was a 107-year-old Scottish woman, whose corneas were donated after her death in 2016.<ref>{{Cite news|url=http://www.12news.com/news/nation-now/107yearold-becomes-scotlands-oldest-organ-donor/264713183|title=107-year-old becomes Scotland's oldest organ donor|last=Wilson|first=Caroline|date=July 5, 2016|publisher=Evening Times (Glasgow, Scotland)|access-date=August 6, 2016|archive-date=August 8, 2016|archive-url=https://web.archive.org/web/20160808190944/http://www.12news.com/news/nation-now/107yearold-becomes-scotlands-oldest-organ-donor/264713183}}</ref> The oldest known organ donor for an internal organ was an Italian woman, who donated her liver after she died in 2022 in Florence at the age of 100 years, 10 month and one day.<ref>{{Cite web |date=2022-11-11 |title=Italian ultra-centenarian donates liver in world first - Science & Tecnology - Ansa.it |url=https://www.ansa.it/english/news/science_tecnology/2022/11/11/italian-ultra-centenarian-donates-liver-in-world-first_61a3963d-2356-4149-a50d-9f8a1068a820.html |access-date=2025-09-07 |website=Agenzia ANSA |language=it}}</ref><ref>{{Cite journal |last1=De Simone |first1=Paolo |last2=Ghinolfi |first2=Davide |last3=Palladino |first3=Simona |last4=Catalano |first4=Gabriele |last5=Martinelli |first5=Caterina |last6=Ducci |first6=Juri |last7=Bronzoni |first7=Jessica |last8=Tincani |first8=Giovanni |last9=Balzano |first9=Emanuele |last10=Carrai |first10=Paola |last11=Petruccelli |first11=Stefania |last12=Campani |first12=Daniela |last13=Crocetti |first13=Laura |last14=Lazzeri |first14=Chiara |last15=Biancofiore |first15=Giandomenico |date=February 2024 |title=First-in-human liver transplantation from a centenarian deceased donor after brain death |journal=American Journal of Transplantation|volume=24 |issue=2 |pages=304–307 |doi=10.1016/j.ajt.2023.09.014 |issn=1600-6143 |pmid=37757913}}</ref>

The oldest altruistic living organ donor was an 85-year-old woman in Britain, who donated a kidney to a stranger in 2014 after hearing how many people needed to receive a transplant.<ref>{{Cite news|url=http://www.express.co.uk/news/uk/462639/Woman-donates-kidney-to-complete-stranger-aged-85|title='I don't need two kidneys to knit': Woman, 85, becomes UK's oldest live donor|last=Wharton|first=Jane|date=March 2, 2014 |access-date=August 6, 2016|newspaper=The Daily Express}}</ref>

Researchers were able to develop a novel way to transplant human fetal kidneys into [[anephric]] rats to overcome a significant obstacle in impeding human fetal organ transplantations.<ref name=ChangGu2015/> The human fetal kidneys demonstrated both growth and [[function (biology)|function]] within the rats.<ref name=ChangGu2015>{{cite journal |last1=Chang |first1=N.K. |last2=Gu |first2=J. |last3=Gu |first3=S. |last4=Osorio |first4=R.W. |last5=Concepcion |first5=W. |last6=Gu |first6=E. |title=Arterial Flow Regulator Enables Transplantation and Growth of Human Fetal Kidneys in Rats |journal=American Journal of Transplantation |date=June 2015 |volume=15 |issue=6 |pages=1692–1700 |doi=10.1111/ajt.13149 |pmid=25645705 |s2cid=2409733 |doi-access=free }}</ref>

==Brain donation==
Donated [[human brain|brain tissue]] is a valuable resource for research into [[neuroscience|brain function]], [[neurodiversity]], [[neuropathology]] and possible treatments. Both divergent and healthy control brains are needed for comparison.<ref>{{cite web|url=https://www.hta.gov.uk/guidance-public/brain-donation|title=Brain donation – Human Tissue Authority|website=www.hta.gov.uk|access-date=February 18, 2017|archive-date=February 19, 2017|archive-url=https://web.archive.org/web/20170219004534/https://www.hta.gov.uk/guidance-public/brain-donation}}</ref> Brain banks typically source tissue from donors who had registered with them before their death,<ref name="brai_Brai">{{Cite web |title=Brain Net Europe |archive-date=July 25, 2017|access-date=January 16, 2020 |url= http://www.brainnet-europe.org/indexa29e.html?option=com_content&view=article&id=102&Itemid=102 |archive-url=https://web.archive.org/web/20170725081406/http://www.brainnet-europe.org/indexa29e.html?option=com_content&view=article&id=102&Itemid=102 }}</ref> since organ donor registries focus on tissue meant for transplantation. In the United States the nonprofit Brain Donor Project facilitates this process.<ref>{{Cite web |title=Leaving your brain to science: don't let myths dissuade you |work=National Geographic |date=October 2018 |access-date=June 21, 2020 |url= https://www.nationalgeographic.com/magazine/2018/10/embark-human-brain-organ-donation-science/|archive-url= https://web.archive.org/web/20181004173423/https://www.nationalgeographic.com/magazine/2018/10/embark-human-brain-organ-donation-science/|archive-date= October 4, 2018}}</ref><ref name="brai_TheB">{{Cite web |title=The Brain Donor Project |access-date=January 16, 2020 |url=https://braindonorproject.org/ }}</ref>

==Legislation and global perspectives==
{{update section|date=December 2020}}

The laws of different countries allow potential donors to permit or refuse donation, or give this choice to relatives. The frequency of donations varies among countries.

===Consent process===
The term consent is typically defined as a subject adhering to an agreement of principles and regulations; however, the definition becomes difficult to execute concerning the topic of organ donation, mainly because the subject is incapable of consent due to death or mental impairment.<ref name=":02"/> There are two types of consent being reviewed; explicit consent and presumed consent. Explicit consent consists of the donor giving direct consent through proper registration depending on the country.<ref name="Peltier">{{cite journal |last1=D'Alessandro |first1=Anthony M. |last2=Peltier |first2=James W. |last3=Dahl |first3=Andrew J. |title=Use of Social Media and College Student Organizations to Increase Support for Organ Donation and Advocacy: A Case Report |journal=Progress in Transplantation |date=December 2012 |volume=22 |issue=4 |pages=436–441 |doi=10.7182/pit2012920 |pmid=23187063 |s2cid=22015905 }}</ref> The second consent process is presumed consent, which does not need direct consent from the donor or the next of kin.<ref name="Peltier"/> Presumed consent assumes that donation would have been permitted by the potential donor if permission was pursued.<ref name="Peltier"/> Of possible donors an estimated twenty-five percent of families refuse to donate a loved one's organs.<ref>{{cite journal |last1=Siminoff |first1=Laura A. |last2=Agyemang |first2=Amma A. |last3=Traino |first3=Heather M. |title=Consent to Organ Donation: A Review |journal=Progress in Transplantation |date=March 2013 |volume=23 |issue=1 |pages=99–104 |doi=10.7182/pit2013801 |pmid=23448829 |pmc=6776471 }}</ref>

====Opt-in versus opt-out====
{{see also|Mandated choice}}

As medical science advances, the number of people who could be helped by organ donors increases continuously. As opportunities to save lives increase with new technologies and procedures, the demand for organ donors rises faster than the actual number of donors.<ref name="The Week (4)">{{cite web|title=Automatic organ donation: the pros and cons|url=http://www.theweek.co.uk/35635/automatic-organ-donation-the-pros-and-cons|archive-url=https://web.archive.org/web/20160124030032/http://www.theweek.co.uk/35635/automatic-organ-donation-the-pros-and-cons|archive-date=January 24, 2016|website=The Week: Science and Health|date=October 25, 2011 |access-date=September 1, 2016}}</ref> To respect individual autonomy, voluntary [[consent]] must be determined for the individual's disposition of their remains following death.<ref name="Cohen">{{cite journal |last1=Cohen |first1=Carl |title=The case for presumed consent to transplant human organs after death |journal=Transplantation Proceedings |date=October 1992 |volume=24 |issue=5 |pages=2168–2172 |pmid=1413020 }}</ref> There are two main methods for determining voluntary consent: "opt in" (only those who have given explicit consent are donors) and "opt out" (anyone who has not refused consent to donate is a donor). In terms of an opt-out or presumed consent system, it is assumed that individuals do intend to donate their organs to medical use when they die.<ref name="Cohen"/> Opt-out legislative systems dramatically increase effective rates of consent for donation as a consequence of the [[default effect]].<ref name="do defaults save lives">{{cite journal |last1=Johnson |first1=Eric J. |last2=Goldstein |first2=Daniel |title=Do Defaults Save Lives? |journal=Science |date=November 21, 2003 |volume=302 |issue=5649 |pages=1338–1339 |doi=10.1126/science.1091721 |pmid=14631022 |url=https://papers.ssrn.com/sol3/Delivery.cfm/SSRN_ID1324774_code1144166.pdf?abstractid=1324774&mirid=1 }}</ref> For example, Germany, which uses an opt-in system, has an organ donation consent rate of 12% among its population, while [[Austria]], a country with a very similar culture and economic development, but which uses an opt-out system, has a consent rate of 99.98%.<ref name="do defaults save lives"/><ref name="nytimes2009"/>

Opt-out consent, otherwise known as "deemed" consent, support refers to the notion that the majority of people support organ donation, but only a small percentage of the population are actually registered, because they fail to go through the actual step of registration, even if they want to donate their organs at the time of death. This could be resolved with an opt-out system, where many more people would be registered as donors when only those who object consent to donation have to register to be on the non-donation list.<ref name="Cohen"/>

For these reasons, countries, such as [[Wales]], have adopted a "soft opt-out" consent, meaning if a citizen has not clearly made a decision to register, then they will be treated as a registered citizen and participate in the organ donation process. Likewise, opt-in consent refers to the consent process of only those who are registered to participate in organ donation. Currently, the United States has an opt-in system, but studies show that countries with an opt-out system save more lives due to more availability of donated organs. The current opt-in consent policy assumes that individuals are not willing to become organ donors at the time of their death, unless they have documented otherwise through organ donation registration.<ref name="Cohen"/>

Registering to become an organ donor heavily depends on the attitude of the individual; those with a positive outlook might feel a sense of altruism towards organ donation, while others may have a more negative perspective, such as not trusting doctors to work as hard to save the lives of registered organ donors. Some common concerns regarding a presumed consent ("opt-out") system are sociologic fears of a new system, moral objection, sentimentality, and worries of the management of the objection registry for those who do decide to opt-out of donation.<ref name="Cohen"/> Additional concerns exist with views of compromising the freedom of choice to donate,<ref name="2012 National Survey of Organ Donation">{{cite journal |title=2012 National Survey of Organ Donation Attitudes and Behaviors|journal=U.S. Department of Health and Human Services: Health Research and Services Administration|date=September 2013|page=47<!--|pages=51-->}}</ref> conflicts with extant religious beliefs<ref name=Leins2016>{{cite news |last1=Leins |first1=Casey |title=Should the Government Decide if You're an Organ Donor? |url=https://www.usnews.com/news/articles/2016-02-12/presumed-consent-and-americas-organ-donor-shortage |work=U.S. News & World Report |date=February 12, 2016 }}</ref> and the possibility of posthumous violations of [[bodily integrity]].<ref>{{cite journal |last1=Qurashi |first1=G M |title=Opt-out paradigms for deceased organ donation are ethically incoherent |journal=Journal of Medical Ethics |date=December 2023 |volume=49 |issue=12 |pages=854–859 |doi=10.1136/medethics-2021-107630 |pmid=34509985 |s2cid=237490506 }}</ref> Even though concerns exist, the United States still has a 95 percent organ donation approval rate. This level of nationwide acceptance may foster an environment where moving to a policy of presumed consent may help solve some of the organ shortage problem, where individuals are assumed to be willing organ donors unless they document a desire to "opt-out", which must be respected.<ref name=Leins2016/>

Because of public policies, cultural, infrastructural and other factors, presumed consent or opt-out models do not always translate directly into increased effective rates of donation. The United Kingdom has several different laws and policies for the organ donation process, such as consent of a witness or guardian must be provided to participate in organ donation. This policy was consulted on by Department of Health and Social Care in 2018,<ref>{{cite web |url=https://engage.dh.gov.uk/organdonation/ |title=Archived copy |website=engage.dh.gov.uk |access-date=January 11, 2022 |archive-url=https://web.archive.org/web/20180123112022/https://engage.dh.gov.uk/organdonation/ |archive-date=January 23, 2018 }}</ref> and was implemented starting May 20, 2020.<ref>{{Cite journal |last=Mahenthran |first=Thakshayene |date=January 2021 |title=The new 'opt-out' organ donation English law: Is the NHS ready for this? |journal=Clinical Medicine |volume=21 |issue=1 |pages=e92–e93 |doi=10.7861/clinmed.2020-0675 |issn=1470-2118 |pmc=7850211 |pmid=33479084}}</ref>

In terms of effective organ donations, in some systems like Australia (14.9 donors per million, 337 donors in 2011), family members are required to give consent or refusal, or may veto a potential recovery even if the donor has consented.<ref name=mythbusting/> Some countries with an opt-out system like Spain (40.2 donors per million inhabitants),<ref name= infographic2017>{{cite web|url=https://www.edqm.eu/sites/default/files/infographic-eodd-2017-web.pdf|date=December 30, 2018|publisher=European Directorate for the Quality of Medicines & HealthCare|title=Bring back hope to patients on waiting lists all over Europe!|type=infographic|access-date=December 30, 2018|archive-url=https://web.archive.org/web/20170907022202/http://www.edqm.eu/sites/default/files/infographic-eodd-2017-web.pdf|archive-date=September 7, 2017}}</ref> [[Croatia]] (40.2 donors/million)<ref name= infographic2017/> or [[Belgium]] (31.6 donors/million)<ref name= infographic2017/> have high donor rates, however some countries such as [[Greece]] (6 donors/million) maintain low donor rates even with this system.<ref>{{cite journal |last1=Sotiropoulos |first1=Georgios C |last2=Machairas |first2=Nikolaos |title=Organ donation during the financial crisis in Greece |journal=The Lancet |date=September 2016 |volume=388 |issue=10048 |pages=957–958 |doi=10.1016/s0140-6736(16)31488-x |pmid=27598669 |s2cid=46419956 |doi-access=free }}</ref> The president of the Spanish [[National Transplant Organisation]] has acknowledged Spain's legislative approach is likely not the primary reason for the country's success in increasing the donor rates, starting in the 1990s.<ref name="ReferenceA">{{cite web|url=http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_090303.pdf|title=The potential impact of an opt out system for organ donation in the UK.|author=Organ Donation Taskforce|year=2008|publisher=[[Department of Health (United Kingdom)|Department of Health]]|location=United Kingdom|page=22|archive-url=http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_090303.pdf|archive-date=January 7, 2013|access-date=March 8, 2014|author-link=Organ Donation Taskforce}}</ref>

Looking to the example of Spain, which has successfully adopted the presumed consent donation system, [[intensive care units]] (ICUs) must be equipped with enough doctors to maximize the recognition of potential donors and maintain organs while families are consulted for donation. The characteristic that enables the Spanish presumed consent model to be successful is the resource of [[Organ transplantation|transplant]] coordinators; it is recommended to have at least one at each hospital where opt-out donation is practiced to authorize organ procurement efficiently.<ref>{{cite journal |last1=Rodríguez-Arias |first1=David |last2=Wright |first2=Linda |last3=Paredes |first3=David |title=Success factors and ethical challenges of the Spanish Model of organ donation |journal=The Lancet |date=September 2010 |volume=376 |issue=9746 |pages=1109–1112 |doi=10.1016/S0140-6736(10)61342-6 |pmid=20870101 |s2cid=46708934 }}</ref>

Public views are crucial to the success of opt-out or presumed consent donation systems. In a study done to determine if [[health policy]] change to a presumed consent or [[opt-out]] system would help to increase donors, an increase of 20 to 30 percent was seen among countries who changed their policies from some type of opt-in system to an opt-out system. Of course, this increase must have a great deal to do with the [[health policy]] change, but also may be influenced by other factors that could have impacted donor increases.<ref name="Rithalia (6)">{{cite journal |last1=Rithalia |first1=A |last2=McDaid |first2=C |last3=Suekarran |first3=S |last4=Norman |first4=G |last5=Myers |first5=L |last6=Sowden |first6=A |title=A systematic review of presumed consent systems for deceased organ donation |journal=Health Technol |date=2009 |volume=13 |issue=26 |pages=iii, ix–xi, 1–95 |doi=10.3310/hta13260|pmid=19422754 |doi-access=free }}</ref>

Transplant Priority for Willing Donors, also known as the "donor-priority rule", is a newer method and the first to incorporate a "non-medical" criterion into the priority system to encourage higher donation rates in the opt-in system.<ref name="Dai 2020 622–641">{{cite journal |last1=Dai |first1=Tinglong |last2=Zheng |first2=Ronghuo |last3=Sycara |first3=Katia |title=Jumping the Line, Charitably: Analysis and Remedy of Donor-Priority Rule |journal=Management Science |date=February 2020 |volume=66 |issue=2 |pages=622–641 |doi=10.1287/mnsc.2018.3266 |s2cid=54028044 }}</ref><ref>{{cite news |last1=Ofri |first1=Danielle |title=In Israel, a New Approach to Organ Donation |url=https://archive.nytimes.com/well.blogs.nytimes.com/2012/02/16/in-israel-a-new-approach-to-organ-donation/ |work=Well |publisher=The New York Times |date=February 16, 2012 }}</ref> Initially implemented in Israel, it allows an individual in need of an organ to move up the recipient list. Moving up the list is contingent on the individual opting-in prior to their need for an organ donation. The policy applies nonmedical criteria when allowing individuals who have previously registered as an organ donor, or whose family has previously donated an organ, priority over other possible recipients. It must be determined that both recipients have identical medical needs prior to moving a recipient up the list. While incentives like this in the opt-in system do help raise donation rates, they are not as successful in doing so as the opt-out, presumed consent default policies for donation.<ref name=mythbusting>{{cite web |title = Myth busting|url = http://www.donatelife.gov.au/discover/mythbusting|at = My family can overrule my decision to be a donor|access-date = May 15, 2013|archive-date = May 22, 2013 |archive-url = https://web.archive.org/web/20130522024547/http://www.donatelife.gov.au/discover/mythbusting|website = DonateLife|publisher = Australian Government Organ and Tissue Authority}}</ref>
{| class="wikitable"
|+
! colspan="2" |Country
!Policy
!Year implemented
|-
| colspan="2" |Argentina
|opt-out
|2005
|-
| colspan="2" |Austria
|opt-out
|
|-
| colspan="2" |Belarus
|opt-out
|2007<ref>{{cite web | url=http://center.gov.by/publikatsii-rabotnikov-tsentra/kommentarii-zakonodatel-stva/kommentarij-k-zakonu-respubliki-bela-7/ | title=Комментарий к Закону Республики Беларусь "О внесении изменений и дополнений в Закон Республики Беларусь "О трансплантации органов и тканей человека" | access-date=January 4, 2023 | archive-date=January 4, 2023 | archive-url=https://web.archive.org/web/20230104091918/http://center.gov.by/publikatsii-rabotnikov-tsentra/kommentarii-zakonodatel-stva/kommentarij-k-zakonu-respubliki-bela-7/ }}</ref>
|-
| colspan="2" |Belgium
|opt-out
|
|-
| colspan="2" |Brazil
|opt-in
|
|-
| colspan="2" |Czech Republic
|opt-out
|September 2002<ref>{{cite news |title=Enabling foreigners to become organ donors |url=https://english.radio.cz/enabling-foreigners-become-organ-donors-8561095 |work=Radio Prague International |date=August 22, 2011 }}</ref>
|-
| colspan="2" |Chile
|opt-out
|2010
|-
| colspan="2" |Colombia
|opt-out
|2017
|-
| colspan="2" |Guatemala
|opt-in
|February 2024<ref>{{Cite web |date=February 28, 2024 |title=¿Qué órganos se pueden donar y quiénes pueden ser donantes? |url=https://www.prensalibre.com/guatemala/politica/que-organos-se-pueden-donar-y-quienes-pueden-ser-donantes/ |access-date=2024-03-26 |language=es-GT}}</ref>
|-
| colspan="2" |Israel
|opt-in
|
|-
| colspan="2" |Netherlands
|opt-out
|2020<ref>[https://dutchreview.com/news/organ-donation-on-the-rise-in-the-netherlands/ The Netherlands is seeing more permissions for organ donation]</ref>
|-
| colspan="2" |Spain
|opt-out
|1979
|-
| colspan="2" |Ukraine
|opt-in
|<ref>{{cite news |last1=Panasytska |first1=Oleksandra |title=Donate An Organ And Save Your Neighbor's Life. What Is Happening With The Transplant System In Ukraine? |url=https://voxukraine.org/en/donate-an-organ-and-save-your-neighbor-s-life-what-is-happening-with-the-transplant-system-in-ukraine/ |work=Vox Ukraine |date=July 5, 2021 }}</ref>
|-
| rowspan="4" |United Kingdom
|Wales 
| rowspan="4" |opt-out
|December 1, 2015<ref>{{cite web |title=Organ donation law in Wales |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-wales/ |access-date=2024-10-10 |website=NHS Organ Donation |publisher=NHS Blood and Transplant}}</ref>
|-
|England 
|May 20, 2020<ref>{{cite web |title=Organ donation law in England |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-england/ |access-date=2024-10-10 |website=NHS Organ Donation |publisher=NHS Blood and Transplant}}</ref>
|-
|Scotland
|March 25, 2021<ref name=":6">{{cite web |title=Organ and tissue donation law in Scotland |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-scotland/ |access-date=2024-10-10 |website=NHS Organ Donation |publisher=NHS Blood and Transplant}}</ref>
|-
|Northern  Ireland
|June 1, 2023<ref name=":7">{{cite web |title=Organ donation law in Northern Ireland |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-northern-ireland/ |access-date=2024-10-10 |website=NHS Organ Donation |publisher=NHS Blood and Transplant}}</ref>
|-
| colspan="2" |United States
|opt-in
|
|}

===Argentina===
On November 30, 2005, the [[National Congress of Argentina|Congress]] introduced an opt-out policy on organ donation, where all people over 18 years of age will be organ donors unless they or their family state otherwise. The law was promulgated on December 22, 2005, as "Law 26,066".<ref>{{cite web |url=http://servicios.infoleg.gob.ar/infolegInternet/verNorma.do?id=112375 |title=Law 26,066 |website=InfoLEG}}</ref>

On July 4, 2018, the Congress passed a law removing the family requirement, making the organ donor the only person that can block donation. It was [[promulgated]] on July 4, 2018, as Law Justina or "Law 27,447".<ref>{{Cite news |url=https://www.infobae.com/politica/2018/07/26/el-gobierno-promulgo-la-ley-justina-que-modifica-el-regimen-de-donacion-de-organos/ |title=El Gobierno promulgó la "ley Justina" que modifica el régimen de donación de órganos |date=July 26, 2018 |work=[[Infobae]]}}</ref>

===Brazil===
A campaign by [[Sport Club Recife]] has led to waiting lists for organs in north-east Brazil to drop almost to zero; while according to the Brazilian law the family has the ultimate authority, the issuance of the organ donation card and the ensuing discussions have however eased the process.<ref>{{Cite news|url = https://www.bbc.com/news/magazine-27632527|title = How thousands of football fans are helping to save lives|last = Carneiro|first = Julia |date=June 1, 2014 |work = BBC News Magazine}}</ref>

===Canada===
In 2001, the Government of Canada announced the formation of the Canadian Council for Donation and Transplantation, whose purpose would be to advise the Conference of Deputy Ministers of Health on activities relating to organ donation and transplantation. The deputy ministers of health for all provinces and territories with the exception of [[Québec]] decided to transfer the responsibilities of the Canadian Council for Donation and Transplantation to [[Canadian Blood Services]].<ref>{{Cite web|url = http://publications.gc.ca/collections/collection_2018/bdp-lop/bp/YM32-2-2018-13-eng.pdf|title = Organ Donation and Transplantation in Canada|last = Norris|first = Sonya |date=February 14, 2018 |access-date= September 30, 2019}}</ref>

In Québec, an organization called Transplant Québec is responsible for managing all organ donation; Héma-Québec is responsible for tissue donation.<ref>{{Cite web|url =https://www.quebec.ca/en/health/blood-tissue-and-organ-donation/organ-and-tissue-donation/| date = July 15, 2019 |access-date = November 26, 2019|title = Organ and tissue donation | website = Québec}}</ref> Consent for organ donation by an individual is given by either registering with the organ donation registry established by the {{Lang|fr|Chambre des notaires du Québec|italic=no}}, signing and affixing the sticker to the back of one's health insurance card, or registering with either {{Lang|fr|Régie de l'assurance maladie du Québec|italic=no}} or {{Lang|fr|Registre des consentements au don d'organes et de tissus|italic=no}}.<ref>{{Cite web| url = https://www.transplantquebec.ca/en/how-register|access-date = November 26, 2019|title= How to Register| website = Transplant Québec}}</ref>

{{Pie chart
| thumb = left
| caption = Number of transplants by organ<ref name=BloodRpt>{{Cite web |url = https://blood.ca/sites/default/files/System_Progress_Report_2017_Update_FINAL-EN.pdf |title = Organ Donation and Transplantation in Canada System Progress Report |access-date = September 30, 2019 |website = Canadian Blood Services |archive-date = March 8, 2021 |archive-url = https://web.archive.org/web/20210308094856/https://www.blood.ca/sites/default/files/System_Progress_Report_2017_Update_FINAL-EN.pdf }}</ref>
| label1 =[[Kidney]]
| value1 =58.5
| color1 =#800080
| label2 =[[Liver]]
| value2 =19.8
| color2 =#0000FF
| label3 =[[Lung]]
| value3 =11.8
| color3 =#008000
| label4 =[[Heart]]
| value4 =7.3
| color4 =#FF0000
| label5 =[[Pancreas]]
| value5 =1.1
| color5 =#808080
| label6 =Kidney and Pancreas
| value6 =1.5
| color6 =#FF00FF
}} In 2017, the majority of transplants completed were kidney transplants.<ref name=BloodRpt/> Canadian Blood Services has a program called the kidney paired donation, where transplant candidates are matched with compatible living donors from all over Canada. It also gives individuals an opportunity to be a living donor for an anonymous patient waiting for a transplant. As of December 31, 2017, there were 4,333 patients on the transplant waitlist. In 2017, there were a total of 2,979 transplants, including multi-organ transplants; 242 patients died while on the waitlist. 250 Canadians die on average waiting for transplant organs every year.<ref>{{Cite web| url = https://blood.ca/sites/default/files/10880-ENG-KPD_Brochure_2019-03-01.pdf|title = Kidney Paired Donation|date = March 1, 2019|access-date = September 30, 2019 |website=Canadian Blood Services}}</ref>

Each province has different methods and registries for intent to donate organs or tissues as a deceased donor. In some provinces, such as [[Newfoundland and Labrador]] and [[New Brunswick]] organ donation registration is completed by completing the "Intent to donate" section when applying or renewing one's provincial medical care.<ref>{{Cite web|url = https://www2.gnb.ca/content/gnb/en/departments/health/Hospital-Services/content/organ_donation.html| title = New Brunswick Organ & Tissue Donation Program | website = Government of New Brunswick | date = September 2015 | access-date = November 26, 2019}}</ref><ref>{{Cite web|url = http://www.easternhealth.ca/Give.aspx?d=1&id=323&p=53|title = Organ Donation | website = Eastern Health Newfoundland and Labrador |access-date = September 30, 2019| date = April 18, 2017}}</ref> In [[Ontario]], one must be 16 years of age to register as an organ and tissue donor and register with [[ServiceOntario]].<ref>{{Cite web|url = https://www.ontario.ca/page/organ-and-tissue-donor-registration| access-date = November 26, 2019 | title = Organ and tissue donor registration | website = Province of Ontario | date = November 18, 2019}}</ref> [[Alberta]] requires that a person must be 18 years of age or older and register with the Alberta Organ and Tissue Donation Registry.<ref>{{Cite web| url = https://myhealth.alberta.ca/alberta/Pages/organ-and-tissue-donation-consent-to-donate.aspx| title = Organ and Tissue Donation in Alberta | date = March 28, 2019 |website = myhealthAlberta |access-date = November 26, 2019}}</ref>

====Opt-out donation in Canada====
[[Nova Scotia]], Canada, is the first jurisdiction in North America to introduce an automatic organ donation program unless residents opt out; what the province refers to as [[Informed consent|deemed consent]].<ref>{{Cite web|url=https://www.cbc.ca/news/canada/nova-scotia/presumed-automatic-consent-organ-donation-1.5081272|title=Nova Scotia to become 1st in North America with presumed consent for organ donation|last=Gorman|first=Michael|date=April 2, 2019|website=CBC News|access-date=November 26, 2019}}</ref> The Human Organ and Tissue Act was introduced on April 2, 2019.<ref>{{Cite web|url = https://novascotia.ca/news/release/?id=20190402003|title = Government Introduces Legislation to Increase Organ and Tissue Donation| date = April 2, 2019|access-date = November 26, 2019|website = Province of Nova Scotia}}</ref> With the legislation, all people who have been Nova Scotia residents for a minimum of 12 consecutive months, with appropriate decision-making capacity and are over 18 years of age are considered potential donors and will be automatically referred to donation programs if they are determined to be good candidates. In the case of persons under 18 years of age and people without appropriate decision-making capacity, they will only be considered as organ donors if their parent, guardian or decision-maker opts them into the program. The legislation took effect on January 18, 2021.<ref>{{cite web |title=Changes to organ and tissue donation |date=June 30, 2020 |url=https://novascotia.ca/organ-and-tissue-donation-changes/ |publisher=Nova Scotia Health |access-date=29 November 2024}}</ref>

===Chile===
On January 6, 2010, the "Law 20,413" was promulgated, introducing an opt-out policy on organ donation, where all people over 18 years of age will be organ donors unless they state their negative.<ref>[http://www.minsal.cl/introduccion-trasplantes/ Ministerio de Salud – Introducción Trasplantes]</ref><ref>{{cite web|url=https://www.leychile.cl/Navegar?idNorma=1010132|title=LEY-20413 15-ENE-2010 MINISTERIO DE SALUD, SUBSECRETARÍA DE SALUD PÚBLICA – Ley Chile – Biblioteca del Congreso Nacional|date=January 15, 2010}}</ref>

===Colombia===
On August 4, 2016, the [[Congress of Colombia|Congress]] passed the "Law 1805", which introduced an opt-out policy on organ donation where all people will be organ donors unless they state their negative.<ref>{{cite web|url=http://es.presidencia.gov.co/normativa/normativa/LEY%201805%20DEL%2004%20DE%20AGOSTO%20DE%202016.pdf |archive-url=https://web.archive.org/web/20161009215507/http://es.presidencia.gov.co/normativa/normativa/LEY%201805%20DEL%2004%20DE%20AGOSTO%20DE%202016.pdf |archive-date=2016-10-09 |url-status=live|title=Ley 1805}}</ref> The law came into force on February 4, 2017.<ref>{{cite web|url=https://www.publimetro.co/co/colombia/2017/02/04/donacion-organos-obligatoria.html|title=Desde hoy la donación de órganos es obligatoria|website=Publimetro Colombia|date=February 4, 2017 }}</ref>

===Europe===
[[File:IntlOrgan.png|thumb|Map showing the coverage of three international European organ donation associations:
{{legend|#990030|[[Balttransplant]]}}{{legend|#2F3699|[[Eurotransplant]]}}{{legend|#22B14C|[[Scandiatransplant]]}}]]
Within the European Union, organ donation is regulated by member states. As of 2010, 24 European countries have some form of presumed consent (opt-out) system, with the most prominent and limited opt-out systems in Spain, Austria, and Belgium yielding high donor rates.<ref name=huffingtonpost>{{cite news | first=Michael | last=Gormley | url=https://www.huffingtonpost.com/2010/04/27/new-york-to-be-first-orga_n_554234.html | title=New York To Be First Organ Donor Opt-Out State? | work=[[The Huffington Post]] | location=New York City | department=New York | access-date=March 7, 2014 | date=April 27, 2010 | url-status=live | archive-date=April 30, 2010 | archive-url=https://web.archive.org/web/20100430150649/http://www.huffingtonpost.com/2010/04/27/new-york-to-be-first-orga_n_554234.html}}</ref> Spain had the highest donor rate in the world, 46.9 per million people in the population, in 2017.<ref>{{cite news |title=Spain leads the world in organ donation. What's stopping other countries catching up? |url=https://mosaicscience.com/story/spain-uk-organ-donation-transplants-liver-kidney-heart-lungs-surgery-nhs/ |access-date=September 7, 2018 |publisher=Mosaic Science |date=August 6, 2018 |archive-date=September 8, 2018 |archive-url=https://web.archive.org/web/20180908054253/https://mosaicscience.com/story/spain-uk-organ-donation-transplants-liver-kidney-heart-lungs-surgery-nhs/ |url-status=dead }}</ref> This is attributed to multiple factors in the Spanish medical system, including identification and early referral of possible donors, expanding criteria for donors and standardised frameworks for transplantation after circulatory death.<ref>{{cite journal |last1=Matesanz |first1=R. |last2=Domínguez-Gil |first2=B. |last3=Coll |first3=E. |last4=Mahíllo |first4=B. |last5=Marazuela |first5=R. |title=How Spain Reached 40 Deceased Organ Donors per Million Population |journal=American Journal of Transplantation |date=June 2017 |volume=17 |issue=6 |pages=1447–1454 |doi=10.1111/ajt.14104 |pmid=28066980 |doi-access=free }}</ref>

In England, individuals who wish to donate their organs after death can use the Organ Donation Register, a national database. The government of Wales became the first constituent country in the UK to adopt presumed consent in July 2013.<ref name=BBCwalesOrgan>{{cite news |title=Organ donation opt-out system given go-ahead in Wales |url=https://www.bbc.com/news/uk-wales-politics-23143236 |work=[[BBC News]] |date=July 2, 2013 }}</ref> The opt-out organ donation scheme in Wales went live on December 1, 2015, and is expected to increase the number of donors by 25%.<ref>{{cite news|title=Organ donation law 'revolution' starts in Wales|url=https://www.bbc.co.uk/news/uk-wales-34964382|access-date=December 1, 2015 |publisher=BBC}}</ref> In 2008, the UK discussed whether to switch to an opt-out system in light of the success in other countries and a severe British organ donor shortfall.<ref name=bbc7358789>{{cite news |title=MEPs back Europe organ donor card |url=http://news.bbc.co.uk/2/hi/health/7358789.stm |work=[[BBC News]] |date=April 22, 2008 }}</ref> In Italy if the deceased neither allowed nor refused donation while alive, relatives will pick the decision on his or her behalf despite a 1999 act that provided for a proper opt-out system.<ref name="Ministry of Health (Italy)">{{cite news | url=http://www.trapianti.salute.gov.it/cnt/cntDettaglioMenu.jsp?id=5&area=cnt-generale&menu=menuPrincip... | language=it | title=Come donare |trans-title=How to Donate | publisher=Ministry of Health (Italy) | access-date=January 13, 2013 | archive-date=March 8, 2014 | archive-url=https://web.archive.org/web/20140308225612/http://www.trapianti.salute.gov.it/cnt/cntDettaglioMenu.jsp?id=5&area=cnt-generale&menu=menuPrincip...}}</ref> In 2008, the [[European Parliament]] overwhelmingly voted for an initiative to introduce an EU organ donor card to foster organ donation in Europe.<ref>{{Cite web |last=ADAMOU |first=Adamos |title=Report on organ donation and transplantation: Policy actions at EU level {{!}} A6-0090/2008 {{!}} European Parliament |url=https://www.europarl.europa.eu/doceo/document/A-6-2008-0090_EN.html |access-date=2024-02-09 |website=www.europarl.europa.eu |language=en}}</ref>

[[Landstuhl Regional Medical Center]] (LRMC) has become one of the most active organ donor hospitals in all of Germany, which otherwise has one of the lowest organ donation participation rates in the [[Eurotransplant]] organ network. LRMC, the largest U.S. military hospital outside the United States, is one of the top hospitals for organ donation in the [[Rhineland-Palatinate]] state of Germany, even though it has relatively few beds compared to many German hospitals. According to the German [[organ transplantation]] organization, {{Lang|de|Deutsche Stiftung Organtransplantation|italic=no}} (DSO), 34 American military service members who died at LRMC (roughly half of the total number who died there) donated a total of 142 organs between 2005 and 2010. In 2010 alone, 10 of the 12 American service members who died at LRMC were donors, donating a total of 45 organs. Of the 205 hospitals in the DSO's central region—which includes the large cities of [[Frankfurt]] and [[Mainz]]—only six had more organ donors than LRMC in 2010.<ref name=Jones2011>{{cite news | last=Jones | first=Meg | title=A Soldier's Death Gives Life to Another Man | publisher=Pulitzer Center on Crisis Reporting | location=United States | date=April 23, 2011 | url=http://pulitzercenter.org/articles/germany-us-hospital-landstuhl-organ-donations | access-date=March 8, 2014 | url-status=live | archive-date=August 26, 2013 | archive-url= https://web.archive.org/web/20130826220345/http://pulitzercenter.org/articles/germany-us-hospital-landstuhl-organ-donations}}</ref>

Scotland conforms to the Human Tissue Authority Code of Practice, which grants authority to donate organs, instead of consent of the individual.<ref name=":02">{{cite journal |last1=Vincent |first1=A. |last2=Logan |first2=L. |title=Consent for organ donation |journal=British Journal of Anaesthesia |date=January 2012 |volume=108 |pages=i80–i87 |doi=10.1093/bja/aer353 |pmid=22194436 |doi-access=free }}</ref> This helps to avoid conflict of implications and contains several requirements. To participate in organ donation, one must be listed on the Organ Donor Registry (ODR). If the subject is incapable of providing consent, and is not on the ODR, then an acting representative, such as a legal guardian or family member can give legal consent for organ donation of the subject, along with a presiding witness, according to the Human Tissue Authority Code of Practice. Consent or refusal from a spouse, family member, or relative is necessary for a subject is incapable.

Austria participates in the "opt-out" consent process, and have laws that make organ donation the default option at the time of death. In this case, citizens must explicitly "opt out" of organ donation. Yet in countries such as U.S.A. and Germany, people must explicitly "opt in" if they want to donate their organs when they die. In Germany and Switzerland there are [[Organ Donor Card]]s available.<ref>{{Cite news|url=https://service.Bzga.de/pdf.php?id=02649655674b4cc79d27d1ad75f99448|title=Organ Donor Card from Germany in English (PDF)}}</ref><ref>{{Cite news|url=https://www.Leben-ist-teilen.ch/uploads/order-shop/TalkAboutOrganDonation.pdf |archive-url=https://web.archive.org/web/20181125123152/https://www.leben-ist-teilen.ch/uploads/order-shop/TalkAboutOrganDonation.pdf |archive-date=2018-11-25 |url-status=live|title=Some Information about the Swiss Organ Donor Card in English(PDF)}}</ref>

In May 2017, Ireland began the process of introducing an "opt-out" system for organ donation. Minister for Health, Simon Harris, outlined his expectations to have the Human Tissue Bill passed by the end of 2017. This bill would put in place the system of "presumed consent".<ref>{{Cite news|url=https://www.irishtimes.com/news/health/harris-planning-organ-donation-opt-out-system-1.3075447|title=Harris planning organ donation 'opt-out' system|newspaper=The Irish Times|access-date=May 9, 2017}}</ref>

The Mental Capacity Act is another legal policy in place for organ donation in the UK. The act is used by medical professionals to declare a patient's mental capacity. The act claims that medical professionals are to "act in a patient's best interest", when the patient is unable to do so.<ref name=":02"/>

===India===
{{See also|Organ donation in India}}
India has a fairly well developed corneal donation programme; however, donation after brain death has been relatively slow to take off. Most of the transplants done in India are living related or unrelated transplants. To curb organ commerce and promote donation after brain death the government enacted a law called "[[Transplantation of Human Organs and Tissues Act, 1994|The Transplantation of Human Organs Act]]" in 1994 that brought about a significant change in the organ donation and transplantation scene in India.<ref name=vyas2013>{{cite news
 | url=http://timesofindia.indiatimes.com/city/bangalore/State-goes-slow-on-stiffer-jail-term-for-organ-scamsters/articleshow/18011712.cms | title=State goes slow on stiffer jail term for organ scamsters | work=[[The Times of India]] | date=January 14, 2013 | access-date=March 7, 2014 | author=Vyas, Hetel | url-status=live | archive-date=March 8, 2014| archive-url=https://web.archive.org/web/20140308003903/http://timesofindia.indiatimes.com/city/bangalore/State-goes-slow-on-stiffer-jail-term-for-organ-scamsters/articleshow/18011712.cms}}</ref><ref name="kurup2013">{{cite news | url=http://www.thehindu.com/news/cities/bangalore/expendable-cogs-in-a-welloiled-racket/article4270073.ece | title=Expendable cogs in a well-oiled racket | work=[[The Hindu]] | date=January 4, 2013 | access-date=March 7, 2014 | author=Kurup, Deepa | location=India | url-status=live | archive-url=https://web.archive.org/web/20130310060441/http://www.thehindu.com/news/cities/bangalore/expendable-cogs-in-a-welloiled-racket/article4270073.ece | archive-date=March 10, 2013 }}</ref><ref name="zeenews20110317">{{cite news
 | url=http://zeenews.india.com/news/nation/govt-amends-transplantation-of-human-organs-act_693974.html | title=Govt amends Transplantation of Human Organs Act | work=[[Zee News]] | date=March 17, 2011 | access-date=March 7, 2014 | location=India | url-status=live | archive-date=March 8, 2014| archive-url=https://web.archive.org/web/20140308005425/http://zeenews.india.com/news/nation/govt-amends-transplantation-of-human-organs-act_693974.html}}</ref><ref name=thehindu20130307>{{cite news | url=http://www.thehindu.com/sci-tech/health/policy-and-issues/national-workshop-of-transplant-coordinators-provides-guidelines/article4484428.ece | title=National Workshop of transplant coordinators provides guidelines | work=[[The Hindu]] | date=March 7, 2013 | access-date=March 7, 2014 | location=India | url-status=live | archive-date=May 11, 2013 | archive-url=https://web.archive.org/web/20130511001203/http://www.thehindu.com/sci-tech/health/policy-and-issues/national-workshop-of-transplant-coordinators-provides-guidelines/article4484428.ece}}</ref><ref name=dhar2009>{{cite news | url=http://www.thehindu.com/news/national/organ-transplant-bill-tabled/article67126.ece | title=Organ Transplant Bill tabled | work=[[The Hindu]] | date=December 19, 2009 | access-date=March 8, 2014 | author=Dhar, Aarti | url-status=live | archive-date=March 8, 2014 | archive-url=https://web.archive.org/web/20140308032121/http://www.thehindu.com/news/national/organ-transplant-bill-tabled/article67126.ece}}</ref><ref name="lks2011">{{cite act | title=The Transplantation of Human Organs (Amendment) Bill, 2011 | number=136-C | year=2009 | url=http://164.100.24.219/BillsTexts/LSBillTexts/PassedLoksabha/Transp%20136-C%202009%20ENG.pdf |archive-url=https://web.archive.org/web/20161101041712/http://164.100.24.219/BillsTexts/LSBillTexts/PassedLoksabha/Transp%20136-C%202009%20ENG.pdf |archive-date=2016-11-01 |url-status=live | access-date=March 8, 2014}}</ref><ref name="shroffiju2009">{{cite journal |last1=Shroff |first1=Sunil |title=Legal and ethical aspects of organ donation and transplantation |journal=Indian Journal of Urology |date=2009 |volume=25 |issue=3 |pages=348–355 |doi=10.4103/0970-1591.56203 |doi-access=free |pmid=19881131 |pmc=2779960 }}</ref> Many Indian states have adopted the law and in 2011 further amendment of the law took place.<ref name="hindu20110813">{{cite news |url=http://www.thehindu.com/news/national/illegal-organ-transplant-can-attract-10year-jail/article2351612.ece | title=Illegal organ transplant can attract 10-year jail |work=[[The Hindu]] |date=August 13, 2011 |access-date=March 8, 2014 |url-status=live |archive-date=March 8, 2014 | archive-url=https://web.archive.org/web/20140308035000/http://www.thehindu.com/news/national/illegal-organ-transplant-can-attract-10year-jail/article2351612.ece}}</ref><ref name=orgthoa2011>{{cite web | url=http://www.orbo.org.in/Doc/Ann%204%20THOA%20ACT%202011.pdf | access-date=March 8, 2014 | archive-date=March 8, 2014 | title=Ann 4 THOA ACT 2011 | publisher=Organ Retrieval Banking Organization | archive-url=https://web.archive.org/web/20140308192251/http://www.orbo.org.in/Doc/Ann%204%20THOA%20ACT%202011.pdf }}</ref><ref name=indiatoday20110813>{{cite news | url=https://www.indiatoday.in/india/north/story/lok-sabha-approves-tougher-organ-transplant-bill-139258-2011-08-12 | title=Lok Sabha approves tougher organ transplant Bill | date=August 13, 2011 | work=[[India Today]] | url-status=live |archive-date=August 21, 2013 | archive-url=https://web.archive.org/web/20130821014516/http://indiatoday.intoday.in/story/lok-sabha-approves-tougher-organ-transplant-bill/1/147983.html}}</ref><ref>{{cite news | title=RS seal on amendment to human organs bill | url=http://timesofindia.indiatimes.com/india/RS-seal-on-amendment-to-human-organs-bill/articleshow/9752631.cms | work=[[The Times of India]] | date=August 27, 2011 }}</ref><ref name="ens2011813">{{cite news | url=http://archive.indianexpress.com/news/ls-okays-amendments-to-organ-transplantation-bill/831356/ | title=LS okays amendments to organ transplantation Bill | work=[[The Indian Express]] | date=August 13, 2011 | access-date=March 7, 2014 | author=Express News Service | location=India | url-status=live | department=Archive | archive-date=March 8, 2014| archive-url=https://web.archive.org/web/20140308000716/http://archive.indianexpress.com/news/ls-okays-amendments-to-organ-transplantation-bill/831356/}}</ref> Despite the law there have been stray instances of organ trade in India and these have been widely reported in the press. This resulted in the amendment of the law further in 2011. Deceased donation after brain death have slowly started happening in India and 2012 was the best year for the programme.
[[File:India (orthographic projection).svg|thumb|India]]

{| style="width: 40%" border="1" class="organdonationtab"
|+ '''Table 1 – Deceased Organ Donation in India – 2012.'''
! State !! No. of Deceased Donors !! Total no. of Organs Retrieved !! Organ Donation Rate per Million Population
|- style="text-align:center"
| style="width:100pt;"| Tamil Nadu || 83 || 252 || 1.15
|- style="text-align:center"
| Maharashtra || 29 || 68 || 0.26
|- style="text-align:center"
| Gujarat || 18 || 46 || 0.30
|- style="text-align:center"
| Karnataka || 17 || 46 || 0.28
|- style="text-align:center"
| Andhra Pradesh || 13 || 37 || 0.15
|- style="text-align:center"
| Kerala || 12 || 26 || 0.36
|- style="text-align:center"
| Delhi-NCR || 12 || 31|| 0.29
|- style="text-align:center"
| Punjab || 12 || 24 || 0.43
|- style="text-align:center"
! Total !! 196 !! 530 !! 0.16
|}
* Source the Indian Transplant News Letter of the [[MOHAN Foundation]]<ref>{{cite web|url=http://www.mohanfoundation.org/regis/login.asp?sendto=../newsletters/pdf/Indian-Transplant-Newsletter-37.pdf|title=MOHAN Foundation – Member Login|website=www.mohanfoundation.org}}</ref>

The year 2013 has been the best yet for deceased organ donation in India. A total of 845 organs were retrieved from 310 multi-organ donors resulting in a national organ donation rate of 0.26 per million population(Table 2).
{| class="stats" style="width: 80%; text-align: center" border="1"
|+ '''Table 2 – Deceased Organ Donation in India – 2013'''
!State!!Tamil Nadu!!Andhra Pradesh!!Kerala!!Maharashtra!!Delhi!!Gujarat!!Karnataka!!Puducherry!!Total (National)
|-
|'''Donor'''|| ''131'' ||''40''||''35''||''35''||''27''||''25''||''18''||''2''||''313''
|-
|'''* ODR (pmp)'''|| ''1.80'' ||''0.47''||''1.05''||''0.31''||''1.61''||''0.41''||''0.29''||''1.6''||''0.26''
|-
|'''Heart'''|| ''16'' ||''2''||''6''||''0''||''–''||''0''||''1''||''0''||''25''
|-
|'''Lung'''|| ''20'' ||''2''||''0''||''0''||''–''||''0''||''0''||''0''||''22''
|-
|'''Liver'''|| ''118'' ||''34''||''23''||''23''||''23''||''20''||''16''||''0''||''257''
|-
|'''Kidney'''|| ''234'' ||''75''||''59''||''53''||''40''||''54''||''29''||''4''||''548''
|-
|'''Total'''|| '''388''' ||'''113'''||'''88'''||'''76'''||'''63'''||'''74'''||'''46'''||'''4'''||'''852'''
|}
'''* ODR (pmp) – Organ Donation Rate (per million population)'''

In the year 2000 through the efforts of a non-governmental organization called [[MOHAN Foundation]] state of [[Tamil Nadu]] started an organ sharing network between a few hospitals.<ref name="kannan200201">{{cite news | author=Kannan, Ramya | work=[[The Hindu]] | url=http://www.hindu.com/thehindu/2002/01/22/stories/2002012203130300.htm | title=Organ donation gains momentum | date=January 22, 2002 | access-date=March 8, 2014 | location=India | department=Southern States | archive-date=March 8, 2014 | archive-url=https://web.archive.org/web/20140308233702/http://www.hindu.com/thehindu/2002/01/22/stories/2002012203130300.htm}}</ref><ref name="kannan200302">{{cite news | url=http://www.hindu.com/2003/02/28/stories/2003022809430100.htm | title=High time to streamline organ transplants | work=[[The Hindu]] | date=February 28, 2003 | access-date=March 8, 2014 | author=Kannan, Ramya | location=India | department=Southern States | archive-date=December 13, 2013 | archive-url=https://web.archive.org/web/20131213165119/http://www.hindu.com/2003/02/28/stories/2003022809430100.htm}}</ref> The MOHAN Foundation also set up similar sharing network in the state of Andhra Pradesh and these two states were at the forefront of deceased donation and transplantation programme for many years.<ref name="raman200207">{{cite news |url=http://www.hindu.com/thehindu/mp/2002/07/25/stories/2002072501030100.htm |title=Living after death |work=[[The Hindu]] |department=Metro Plus Hyderabad |date=July 25, 2002 |access-date=March 8, 2014 |author=Raman, Usha |location=India |archive-date=November 29, 2010 |archive-url=https://web.archive.org/web/20101129141301/http://hindu.com/thehindu/mp/2002/07/25/stories/2002072501030100.htm}}</ref><ref name="joseph200401">{{cite news | url=http://timesofindia.indiatimes.com/city/hyderabad/Organ-transplantation-help-at-hand/articleshow/447835.cms | title=Organ transplantation help at hand | work=[[The Times of India]] | date=January 28, 2004 | author=Joseph, Lison | department=Hyderabad | url-status=live | archive-url=http://web.archive.org/web/20241202205417/https://timesofindia.indiatimes.com/city/hyderabad/Organ-transplantation-help-at-hand/articleshow/447835.cms | archive-date= 2024-12-02| access-date=October 31, 2016 }}</ref> As a result, retrieval of 1,033 organs and tissues were facilitated in these two states.<ref name="mohaninosfigs">{{cite web | url=http://www.mohanfoundation.org/cadaveric-organ-donation-figures.asp?state=Andhra%20Pradesh | title=Cadaveric Organ Donation Figures | publisher=MOHAN Foundation | access-date=March 8, 2014 | at=INOS Figures (2000–2009) | archive-date=January 2, 2014 | archive-url=https://web.archive.org/web/20140102231124/http://www.mohanfoundation.org/cadaveric-organ-donation-figures.asp?state=Andhra%20Pradesh }}</ref>

Similar sharing networks came up in the states of [[Maharashtra]] and [[Karnataka]]; however, the numbers of deceased donation happening in these states were not sufficient to make much impact. In 2008, the [[Government of Tamil Nadu]] put together government orders laying down procedures and guidelines for deceased organ donation and transplantation in the state.<ref name=mohan08>{{cite web |url=http://www.mohanfoundation.org/organ-donation-transplant-resources/government-orders-organ-donation-%20transplantation-tamil-nadu.asp |title=Government Orders on Organ Donation and Transplantation From Tamil Nadu Health Department |publisher=MOHAN Foundation |access-date=March 8, 2014 |author=Navin, Sumana |year=2008 |archive-date=December 11, 2013 |archive-url=https://web.archive.org/web/20131211084152/http://www.mohanfoundation.org/organ-donation-transplant-resources/government-orders-organ-donation-%20transplantation-tamil-nadu.asp }}</ref> These brought in almost thirty hospitals in the programme and has resulted in significant increase in the donation rate in the state. With an organ donation rate of 1.15 per million population, Tamil Nadu is the leader in deceased organ donation in the country. The small success of Tamil Nadu model has been possible due to the coming together of both government and private hospitals, non-governmental organizations and the State Health Department. Most of the deceased donation programmes have been developed in southern states of India.<ref name="srinivasan2013">{{cite journal |last1=Srinivasan |first1=S. |title=Has Tamil Nadu turned the tide on the transplant trade? |journal=BMJ |date=April 12, 2013 |volume=346 |article-number=f2155 |doi=10.1136/bmj.f2155 |pmid=23585066 |s2cid=31085086 }}</ref> The various such programmes are as follows:
{{columns-list|colwidth=30em|
* Andhra Pradesh – Jeevandan programme
* Karnataka – Zonal Coordination Committee of Karnataka for Transplantation
* Kerala – Mrithasanjeevani – The Kerala Network for Organ Sharing
* Maharashtra – Zonal Transplant Coordination Center in Mumbai
* Rajasthan – Navjeevan – The Rajasthan Network of Organ Sharing
* Tamil Nadu – Cadaver Transplant Programme

}}
In the year 2012 besides Tamil Nadu other southern states too did deceased donation transplants more frequently. An online organ sharing registry for deceased donation and transplantation is used by the states of Tamil Nadu and Kerala. Both these registries have been developed, implemented and maintained by MOHAN Foundation. However. National Organ and Tissue Transplant Organization (NOTTO) is a National level organization set up under Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India and only official organization.

Organ selling is legally banned in Asia. Numerous studies have documented that organ vendors have a poor ''quality of life'' (QOL) following kidney donation. However, a study done by Vemuru reddy ''et al'' shows a significant improvement in Quality of life contrary to the earlier belief.<ref name="PMC3114583">{{cite journal |last1=Vemuru Reddy |first1=SunilK |last2=Guleria |first2=Sandeep |last3=Okechukwu |first3=Okidi |last4=Sagar |first4=Rajesh |last5=Bhowmik |first5=Dipankar |last6=Mahajan |first6=Sandeep |title=Live related donors in India: Their quality of life using world health organization quality of life brief questionnaire |journal=Indian Journal of Urology |date=2011 |volume=27 |issue=1 |pages=25–29 |doi=10.4103/0970-1591.78411 |doi-access=free |pmid=21716885 |pmc=3114583 }}</ref> Live related renal donors have a significant improvement in the QOL following renal donation using the WHO QOL BREF in a study done at the [[All India Institute of Medical Sciences]] from 2006 to 2008. The quality of life of the donor was poor when the graft was lost or the recipient died.<ref name="PMC3114583"/>

In India, there are six types of life saving organs that can be donated to save the life of a patient. These include Kidneys, Liver, Heart, Lungs, Pancreas and Intestine. Off late, uterus transplant has also been started in India. However, uterus is not a life saving organ as per the Transplantation of Human Organs Act (2011).<ref name="The Health">{{cite news |title=Types of Organ Donation In India |url=https://thehealth.today/types-of-organ-donation-in-india/ |work=The Health |date=March 24, 2019 }}</ref>
Recently a scoring system, Seth-Donation of Organs and Tissues (S-DOT) score, has been developed to assess hospitals for best practices in tissue donation and organ donation after brain death.<ref>{{cite journal |last1=Seth |first1=AvnishKumar |last2=Singh |first2=Twinkle |title=Seth-donation of organs and tissues (S-DOT) score: A scoring system for the assessment of hospitals for best practices in organ donation after brain death |journal=Indian Journal of Transplantation |date=2020 |volume=14 |issue=1 |pages=19–24 |id={{Gale|A619446834}} |doi=10.4103/ijot.ijot_49_19 |doi-access=free }}</ref>

===Iran===
Only one country, Iran has eliminated the shortage of transplant organs—and only Iran has a working and legal payment system for organ donation. It is also the only country where organ trade is legal. The way their system works is, if a patient does not have a living relative or who are not assigned an organ from a deceased donor, apply to the nonprofit Dialysis and Transplant Patients Association (Datpa). The association establishes potential donors, those donors are assessed by transplant doctors who are not affiliated with the Datpa association. The government gives a compensation of $1,200 to the donors and aid them a year of limited health-insurance. Additionally, working through Datpa, kidney recipients pay donors between $2,300 and $4,500.<ref name=":0"/> Importantly, it is illegal for the medical and surgical teams involved or any 'middleman' to receive payment.<ref name=":2">{{cite journal |last1=Ghods |first1=Ahad J. |last2=Savaj |first2=Shekoufeh |title=Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation |journal=Clinical Journal of the American Society of Nephrology |date=November 2006 |volume=1 |issue=6 |pages=1136–1145 |doi=10.2215/CJN.00700206 |pmid=17699338 }}</ref> Charity donations are made to those donors whose recipients are unable to pay. The Iranian system began in 1988 and eliminated the shortage of kidneys by 1999. Within the first year of the establishment of this system, the number of transplants had almost doubled; nearly four-fifths were from living unrelated sources.<ref name=":2"/> Nobel Laureate economist [[Gary Becker]] and Julio Elias estimated that a payment of $15,000 for living donors would alleviate the shortage of kidneys in the U.S.<ref name=":0"/>

===Israel===
{{see also|Organ transplantation in Israel}}
Since 2008, signing an organ donor card in Israel has provided a potential medical benefit to the signer. If two patients require an organ donation and have the same medical need, preference will be given to the one that had signed an organ donation card. (This policy was nicknamed "Don't give, don't get".) Organ donation in Israel increased after 2008.<ref>{{Cite news |last=Chabin |first=Michele |date=2008-04-09 |title=Organ Donation: Legal, But Still Controversial |url=http://www.thejewishweek.com/viewArticle/c40_a7588/News/Israel.html |url-status=dead |archive-url=https://web.archive.org/web/20080416013029/http://www.thejewishweek.com/viewArticle/c40_a7588/News/Israel.html |archive-date=2008-04-16 |work=The Jewish Week}}</ref>

===Japan===
{{see also|Organ transplantation in Japan}}

The rate of organ donation in Japan is significantly lower than in Western countries.<ref name=Wicks>{{cite journal |last1=Wicks |first1=Mona Newsome |date=April 25, 2000 |title=Brain Death and Transplantation: The Japanese |journal=Medscape Transplantation |volume=1 |issue=1 |url=https://www.medscape.com/viewarticle/408769 }}</ref> This is attributed to cultural reasons, some distrust of [[western medicine]], and a controversial [[Organ transplantation in Japan|organ transplantation in 1968]] that provoked a ban on cadaveric organ donation that would last thirty years.<ref name=Wicks/> Organ donation in Japan is regulated by a 1997 organ transplant law, which defines "[[brain death]]" and legalized organ procurement from brain dead donors.

===Netherlands===
The Netherlands sends everyone living in the country a postcard when they turn 18 (and everyone living in the country when the 2020 law came into effect), and one reminder if they do not reply. They may choose to donate, not to donate, to delegate the choice to family, or to name a specific person. If they do not reply to either notice, they are considered a donor by default.<ref>{{Cite web|url=https://www.government.nl/topics/organ-tissue-donation/new-donor-act-active-donor-registration|title=The new Donor Act (active donor registration) – Organ and tissue donation – Government.nl|first=Welzijn en Sport|last=Ministerie van Volksgezondheid|date=June 14, 2018|website=www.government.nl}}</ref> A family cannot object unless there is reason to show the person would not have wanted to donate. If a person cannot be found in the national donor registry, because they are travelling from another country or because they are undocumented, their organs are not harvested without family consent. Organs are not harvested from people who die an [[unnatural death]] without the approval of the local attorney general.

===New Zealand===
[[File:Belisaire demandant l'aumone Jacques-Louis David.jpg|thumb|Altruism]]
New Zealand law allows live donors to participate in [[Altruism|altruistic]] organ donation only. In the five years to 2018, there were 16 cases of liver donation by live donors and 381 cases of kidney donation by live donors.<ref name=":5">{{Cite web|url=https://www.donor.co.nz/facts-and-myths/statistics/|title=Statistics|website=www.donor.co.nz|access-date=December 4, 2019}}</ref> New Zealand has low rates of live donation, which could be due to the fact that it is illegal to pay someone for their organs. The Human Tissue Act 2008 states that trading in human tissue is prohibited, and is punishable by a fine of up to $50,000 or a prison term of up to 1 year.<ref>{{Cite web|title = Human Tissue Act 2008|url = http://www.legislation.govt.nz/act/public/2008/0028/latest/DLM1154238.html|access-date=August 10, 2015 |publisher = New Zealand Legislature|date = July 1, 2013|id = Public Act 2008 No 28}}</ref> The Compensation for Live Organ Donors Act 2016, which came into force in December 2017, allows live organ donors to be compensated for lost income for up to 12 weeks post-donation.<ref>{{Cite web|url=https://www.health.govt.nz/our-work/hospitals-and-specialist-care/organ-donation-and-transplantation/compensation-live-organ-donors|title=Compensation for Live Organ Donors|website=Ministry of Health NZ|access-date=December 4, 2019}}</ref>

New Zealand law also allows for organ donation from deceased individuals. In the five years to 2018, organs were taken from 295 deceased individuals.<ref name=":5"/> Everyone who applies for a driver's licence in New Zealand indicates whether or not they wish to be a donor if they die in circumstances that would allow for donation.<ref name="NZTA">{{Cite web|url = http://www.nzta.govt.nz/driver-licences/getting-a-licence/organ-and-tissue-donation/|title = Organ and tissue donation|website = Getting a license|publisher = NZ Transport Agency}}</ref> The question is required to be answered for the application to be processed, meaning that the individual must answer yes or no, and does not have the option of leaving it unanswered.<ref name=NZTA/> However, the answer given on the drivers license does not constitute [[informed consent]], because at the time of drivers license application not all individuals are equipped to make an informed decision regarding whether to be a donor, and it is therefore not the deciding factor in whether donation is carried out or not.<ref name=NZTA/> It is there to simply give indication of the person's wishes.<ref name=NZTA/> Family must agree to the procedure for donation to take place.<ref name=NZTA/><ref>{{Cite web|url = http://njr.cdhb.health.nz/nephrology/kidney-donation.htm|title = Kidney Donation|date = October 2011|website = Nephrology Department, Christchurch Hospital, New Zealand|publisher = Canterbury District Health Board |archive-url=https://web.archive.org/web/20141129223137/http://njr.cdhb.health.nz/nephrology/kidney-donation.htm |archive-date=November 29, 2014}}</ref>

A 2006 bill proposed setting up an organ donation register where people can give informed consent to organ donations and clearly state their legally binding wishes.<ref>{{Cite web |url=http://www.parliament.nz/en-nz/pb/legislation/bills/00DBHOH_BILL7223_1/human-tissue-organ-donation-amendment-bill |title=New Zealand Parliament "Human Tissue (Organ Donation) Amendment Bill"|date=November 7, 2007 }}</ref> However, the bill did not pass, and there was condemnation of the bill from some doctors, who said that even if a person had given express consent for organ donation to take place, they would not carry out the procedure in the presence of any disagreement from grieving family members.<ref>{{cite news |last1=Johnston |first1=Martin |title=Doctors oppose organ donor bill |url=https://www.nzherald.co.nz/nz/doctors-oppose-organ-donor-bill/SB4LATA7K652AENU5PFVLQ26CA/ |work=[[The New Zealand Herald]] |date=February 18, 2024 |language=en-NZ }}</ref>

The indigenous population of New Zealand also have strong views regarding organ donation. Many [[Māori people|Maori]] people believe organ donation is morally unacceptable due to the cultural need for a dead body to remain fully intact.<ref name=MOAL>{{cite web |publisher=Mauri Ora Associates Limited |title=Māori Pacific Attitudes Towards Transplantation: Professional Perspectives |url=https://www.tewhatuora.govt.nz/assets/About-us/Who-we-are/Expert-groups/National-Renal-Advisory-Board/Papers-and-reports/Dialysis/Maori-Pacific-Attitudes-Towards-Transplantation-PDF-945-KB.pdf }}</ref> However, because there is not a universally recognised cultural authority, no one view on organ donation is universally accepted in the Maori population.<ref name=MOAL/> They are, however, less likely to accept a kidney transplant than other New Zealanders, despite being overrepresented in the population receiving dialysis.<ref name=MOAL/>

===South Korea===
In [[South Korea]], the 2006 provision of the Organ Transplant Act introduced a monetary incentive equivalent to US$4,500 to the surviving family of brain-death donors; the reward is intended as consolation and compensation for funeral expenses and hospital fees.<ref name="Pham" /><ref name="Lee Kim">{{cite journal |last1=Lee |first1=S.D. |last2=Kim |first2=J.H. |title=Changes in the Organ Procurement System in South Korea: Effects on Brain-Dead Donor Numbers |journal=Transplantation Proceedings |date=November 2009 |volume=41 |issue=9 |pages=3551–3555 |doi=10.1016/j.transproceed.2009.06.210 |pmid=19917342 }}</ref>

===Sri Lanka===
Organ donation in Sri Lanka was ratified by the Human Tissue Transplantation Act No. 48 of 1987. [[Sri Lanka Eye Donation Society]], a non-governmental organization established in 1961 has provided over 60,000 corneas for [[corneal transplantation]], for patients in 57 countries. It is one of the major suppliers of human eyes to the world, with a supply of approximately 3,000 corneas per year.<ref name="associatedpr">{{cite news | url=https://www.foxnews.com/health/sri-lanka-donates-eyes-to-the-world | title=Sri Lanka donates eyes to the world | agency=Associated Press | work=[[Foxnews.com]] | date=January 23, 2012 | access-date=March 9, 2014 | url-status=live | archive-date=January 23, 2014 | archive-url=https://web.archive.org/web/20140123131649/http://www.foxnews.com/health/2012/01/23/sri-lanka-donates-eyes-to-world/}}</ref>

===United Kingdom===
====Wales====
[[File:Vaughan Gething AM addresses the Kidney Research UK Annual Fellows day.webm|thumb|[[Vaughan Gething]], [[Welsh Government]] Health Minister, addresses the [[Kidney Research UK]] Annual Fellows Day; 2017]]
Since December 2015, [[Human Transplantation (Wales) Act 2013]] passed by the [[Welsh Government]] has enabled an opt-out organ donation register, the first country in the UK to do so. The legislation is 'deemed consent', whereby all citizens are considered to have no objection to becoming a donor, unless they have opted out on this register.<ref>{{cite web |title=Organ donation law in Wales |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-wales/ |website=NHS Wales |access-date=January 31, 2021}}</ref>

====England====
[[File:NHS Organ Donor Card.png|thumb|NHS England Organ Donor Card]]
The [[Organ Donation (Deemed Consent) Act 2019]] established opt-out organ donation in England, also known as Max and Keira's law, when came into effect in May 2020. It means adults in England will be automatically be considered potential donors unless they chose to opt out or are excluded.<ref>{{Cite web|date=March 15, 2019|title=Opt-out organ donation passed into law|url=https://nursingnotes.co.uk/news/workforce/opt-out-organ-donation-passed-into-law/|access-date=June 16, 2019|website=NursingNotes}}</ref>

==== Scotland ====
The [[Human Tissue (Authorisation) (Scotland) Act 2019]] established opt-out organ donation in Scotland in March 2021.<ref name=":6" /><ref>{{cite news |last1=Hutchison |first1=Caitlin |title=Scotland's organ donation law changed today—here's what it means for you |url=https://www.heraldscotland.com/news/19187565.opt-out-organ-donation-scotland-everything-need-know-scottish-law-changing/ |access-date=April 14, 2021 |work=HeraldScotland |publisher=Herald and Times Group |agency=Newsquest Media Group}}</ref>

==== Northern Ireland ====
The [[Organ and Tissue Donation (Deemed Consent) Act (Northern Ireland) 2022]] established opt-out organ donation in 2023.<ref name=":7" />

====Dependencies====
In Jersey, the Capacity and Self-Determination (Jersey) Law 2016 established an opt-out register on July 1, 2019.<ref>{{Cite news|url=https://www.bbc.com/news/world-europe-jersey-48763861|title=Opt-out organ donation comes into force|date=July 1, 2019|access-date=October 7, 2019}}</ref><ref>{{Cite web|url=https://www.itv.com/news/channel/2019-07-01/jerseys-opt-out-organ-donation-law-comes-into-effect-today/|title=Jersey's opt-out organ donation law comes into effect today|website=ITV News|date=July 2019|access-date=October 7, 2019}}</ref>

in Guernsey, the Human Tissue and Transplantation (Bailiwick of Guernsey) Law, 2020 established opt-out organ donation in 2023.<ref>{{Cite news |date=January 1, 2023 |title=Guernsey switches to 'opt-out' organ donation system |url=https://www.bbc.com/news/world-europe-guernsey-64139761 |access-date=2024-10-10 |work=[[BBC News]] |publisher=British Broadcasting Corporation}}</ref>

In the Isle of Man, the Human Tissue and Organ Donation Act 2021 has provisions to establish opt-out organ donation, which have not been enacted.<ref>{{Cite news |last=Brahde |first=Rebecca |date=February 5, 2024 |title=No timeline for huge change in organ donation rules in the Isle of Man |url=https://www.iomtoday.co.im/news/no-timeline-for-huge-change-in-organ-donation-rules-in-the-isle-of-man-663929 |access-date=2024-10-10 |work=Isle of Man Today}}</ref>

===United States===
Over 121,000 people in need of an organ are on the U.S. government waiting list.<ref>{{cite web|title=Organ Procurement and Transplantation Network|url=http://optn.transplant.hrsa.gov/converge/data/|publisher=U.S. Department of Health & Human Services|access-date=October 11, 2015|archive-url=https://web.archive.org/web/20151013182114/http://optn.transplant.hrsa.gov/converge/data/|archive-date=October 13, 2015}}</ref> This crisis within the United States is growing rapidly because on average there are only 30,000 transplants performed each year. More than 8,000 people die each year from lack of a donor organ, an average of 22 people a day.<ref>{{Cite web|url=https://organdonor.gov/statistics-stories/statistics.html|title=Organ Donation Statistics: Why be an Organ Donor? {{!}} organdonor.gov|website=organdonor.gov|access-date=June 22, 2017}}</ref><ref name="Dai 2020 622–641"/> Between the years 1988 and 2006 the number of transplants doubled, but the number of patients waiting for an organ grew six times as large.<ref>{{cite web|title=Need continues to grow|url=http://optn.transplant.hrsa.gov/converge/data/|publisher=U.S. Department of Health & Human Services|access-date=October 11, 2015|archive-url=https://web.archive.org/web/20151013182114/http://optn.transplant.hrsa.gov/converge/data/|archive-date=October 13, 2015}}</ref>

In the past, presumed consent was urged to try to decrease the need for organs. The [[Uniform Anatomical Gift Act]] of 1987 was adopted in several states, and allowed medical examiners to determine if organs and tissues of cadavers could be donated. By the 1980s, several states adopted different laws that allowed only certain tissues or organs to be retrieved and donated, some allowed all, and some did not allow any without consent of the family. In 2006 when the UAGA was revised, the idea of presumed consent was abandoned. In the United States today, organ donation is done only with consent of the family or donator themselves.<ref>{{cite journal |last1=Orentlicher |first1=David |title=Presumed Consent to Organ Donation: Its Rise and Fall in the United States |journal=Rutgers Law Review |date=Winter 2009 |volume=61 |issue=2 |pages=295–332 |hdl=10822/1026142 |ssrn=1207862 }}</ref>

In most states, residents can register to become organ donors through the Department of Motor Vehicles.  The driver's license will serve as a legal donor card for the registered donor.  U.S. Residents may also choose to register as organ, eye, and tissue donors through a national registry maintained by [[Donate Life America]].  The national website is RegisterMe.org The national registry allows residents to create a login, password, and edit their donation choice by organ.  The most common transplants consists of only six (6) organs:  heart, lungs, liver, kidney, pancreas, and small intestines.  One healthy donor can potentially save up to eight (8) lives through transplants, using the two lungs and two kidneys separately.  The most needed organ for transplants overall are kidneys, due to the high rate of hypertension (HTN) or high blood pressure and diabetes which can lead to end-stage renal disease.

According to economist Alex Tabarrok, the shortage of organs has increased the use of so-called expanded criteria organs, or organs that used to be considered unsuitable for transplant.<ref name=":0"/> Five patients that received kidney transplants at the [[University of Maryland School of Medicine]] developed cancerous or benign tumors which had to be removed. The head surgeon, Dr. Michael Phelan, explained that "the ongoing shortage of organs from deceased donors, and the high risk of dying while waiting for a transplant, prompted five donors and recipients to push ahead with the surgery."<ref name=":0">{{Cite news|url = https://www.wsj.com/articles/SB10001424052748703481004574646233272990474|title = The Meat Market|last = Tabarrok|first = Alex|date = January 8, 2010|work = [[Wall Str. J.|The Wall Street Journal]]|author-link = Alex Tabarrok|department = The Saturday Essay}}</ref> Several organizations such as the [[American Kidney Fund]] are pushing for opt-out organ donation in the United States.<ref>{{cite magazine|last1=Carney|first1=Scott|title=The Case for Mandatory Organ Donation|url=http://archive.wired.com/medtech/health/news/2007/05/india_transplants_donorpolicy|magazine=Wired|access-date=February 13, 2015|date=May 8, 2007|archive-url=https://web.archive.org/web/20150603112108/ttp://archive.wired.com/medtech/health/news/2007/05/india_transplants_donorpolicy|archive-date=2015-06-03|url-status=dead|quote=
''If mandatory donation is politically unfeasible now, the United States could consider an opt-out rather than the opt-in organ-donation policy, known as "presumed consent" and adopted in various guises in France, Spain, Australia, Belgium and Portugal. (At present, no country mandates that organs must be relinquished at death.) These laws vary in their details but in general assume that someone would want to be an organ donor unless they explicitly make their objections known by registering in a national online database. Organ-donation rates in all of these countries outstrip the U.S. rates. Powerhouse transplant organizations in the United States like the American Kidney Fund have lobbied for this system since 2004, but have yet to make headway in national policy. "Research shows that there would be a increase of between 16 percent to 50 percent in the availability of organs, and others have speculated that this would eliminate the shortage of organs in some categories," said Eric Johnson, professor of business at Columbia University and a proponent of presumed-consent policy.''
}}</ref>

====Donor Leave Laws====
In addition to their sick and annual leave, federal executive agency employees are entitled to 30 days paid leave for organ donation.<ref name="Fed Organ Leave Law">{{cite web|title=Fact Sheet: Bone Marrow or Organ Donor Leave|url=https://www.opm.gov/policy-data-oversight/pay-leave/leave-administration/fact-sheets/bone-marrow-or-organ-donor-leave/|website=Pay & Leave: Leave Administration|publisher=United States Office of Personnel Management|access-date=October 8, 2016}}</ref> Thirty-two states (excluding only [[Alabama]], [[Connecticut]], Florida, [[Kentucky]], [[Maine]], [[Michigan]], [[Montana]], [[Nebraska]], [[Nevada]], [[New Hampshire]], [[New Jersey]], [[North Carolina]], [[Pennsylvania]], [[Rhode Island]], [[South Dakota]], [[Tennessee]], [[Vermont]], and [[Wyoming]]) and the [[District of Columbia]] also offer paid leave for state employees.<ref name="Leave Laws Fact Sheet">{{cite web|title=Donor Leave Laws and Tax Deductions/Credits for Living Donors|url=https://www.kidney.org/sites/default/files/LDTaxDed_Leave.pdf|website=Donor Leave Laws and Tax Deductions/Credits for Living Donors|publisher=National Kidney Foundation|access-date=October 8, 2016|archive-url=https://web.archive.org/web/20161011122058/https://www.kidney.org/sites/default/files/LDTaxDed_Leave.pdf|archive-date=October 11, 2016}}</ref> Five states (California, Hawaii, [[Louisiana]], [[Minnesota]], and [[Oregon]]) require certain private employers to provide paid leave for employees for organ or bone marrow donation, and seven others ([[Arkansas]], Connecticut, Maine, Nebraska, New York, [[South Carolina]], and [[West Virginia]]) either require employers to provide unpaid leave, or encourage employers to provide leave, for organ or bone marrow donation.<ref name="Leave Laws Fact Sheet"/>

A bill in the US House of Representatives, the Living Donor Protection Act (introduced in 2016, then reintroduced in 2017<ref name=LDP17>{{cite web| url= https://www.myast.org/living-donor-protection-act-2017-reintroduced| website= myast.org| publisher= American Society of Transplantation| title= The Living Donor Protection Act of 2017 Reintroduced| date= March 1, 2017| access-date= March 17, 2018}}</ref>), would amend the [[Family and Medical Leave Act of 1993]] to provide leave under the act for an organ donor. If successful, this new law would permit "eligible employee" organ donors to receive up to 12 work weeks of leave in a 12-month period.<ref name="HR4616">{{cite web|title= H.R.4616 – Living Donor Protection Act of 2016|url=https://www.congress.gov/bill/114th-congress/house-bill/4616 |website= Congress.gov |access-date=October 8, 2016|date=February 26, 2016 }}</ref><ref>{{cite web| title= H.R.1270 – Living Donor Protection Act of 2017 – 115th Congress (2017–2018)| url= https://www.congress.gov/bill/115th-congress/house-bill/1270| website= Congress.gov |access-date= March 17, 2018| date= March 17, 2017}}</ref>

====Tax incentives====
Nineteen US states and the [[District of Columbia]] provide tax incentives for organ donation.<ref name="Leave Laws Fact Sheet"/> The most generous state tax incentive is [[Utah]]'s tax credit, which covers up to $10,000 of unreimbursed expenses (travel, lodging, lost wages, and medical expenses) associated with organ or tissue donation.<ref name="Leave Laws Fact Sheet"/> [[Idaho]] (up to $5,000 of unreimbursed expenses) and [[Louisiana]] (up to $7,500 of 72% of unreimbursed expenses) also provide donor tax credits.<ref name="Leave Laws Fact Sheet"/> [[Arkansas]], the [[District of Columbia]], [[Louisiana]] and [[Pennsylvania]] provide tax credits to employers for wages paid to employees on leave for organ donation.<ref name="Leave Laws Fact Sheet"/> Thirteen states ([[Arkansas]], [[Georgia (U.S. state)|Georgia]], [[Iowa]], [[Massachusetts]], [[Mississippi]], [[New Mexico]], New York, [[North Dakota]], [[Ohio]], [[Oklahoma]], [[Rhode Island]] and [[Wisconsin]]) have a tax deduction for up to $10,000 of unreimbursed costs, and [[Kansas]] and [[Virginia]] offer a tax deduction for up to $5,000 of unreimbursed costs.<ref name="Leave Laws Fact Sheet"/>

States have focused their tax incentives on unreimbursed costs associated with organ donation to ensure compliance with the [[National Organ Transplant Act of 1984]].<ref name="Larger Sacrifice">{{cite journal|last1=Molen|first1=M. Lane|title=Recognizing the Larger Sacrifice: Easing the Burdens Borne by Living Organ Donors through Federal Tax Deductions|journal=Brigham Young University Journal of Public Law|date=May 1, 2007|volume=21|issue=2|page=459|url=http://digitalcommons.law.byu.edu/cgi/viewcontent.cgi?article=1391&context=jpl|access-date=October 8, 2016}}</ref> NOTA prohibits, "any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation."<ref name="NOTA">{{cite web|title=42 U.S. Code § 274e – Prohibition of organ purchases|url=https://www.law.cornell.edu/uscode/text/42/274e|website=Legal Information Institute|publisher=Cornell University Law School|access-date=October 8, 2016}}</ref> However, NOTA exempts, "the expenses of travel, housing, and lost wages incurred by the donor of a human organ in connection with the donation of the organ," from its definition of "valuable consideration".<ref name="NOTA"/>

While offering income tax deductions has been the preferred method of providing tax incentives, some commentators have expressed concern that these incentives provide disproportionate benefits to wealthier donors.<ref name="CaseAgainstTaxIncentives">{{cite journal |last1=Milot |first1=Lisa |title=The Case Against Tax Incentives for Organ Transfers |journal=Willamette Law Review |date=2008 |volume=45 |pages=67–90 |url=https://willamette.edu/law/resources/journals/review/pdf/volume-45/wlr45-1-milot-11-18-08.pdf }}</ref> Tax credits, on the other hand, are perceived as more equitable since the after tax benefit of the incentive is not tied to the marginal tax rate of the donor.<ref name="CaseAgainstTaxIncentives"/>

Additional tax favored approaches have been proposed for organ donation, including providing: tax credits to the families of deceased donors (seeking to encourage consent), refundable tax credits (similar to the earned income credit) to provide greater tax equity among potential donors, and charitable deductions for the donation of blood or organs.<ref name="Lifeline">{{cite journal |last1=Clamon |first1=Joseph B. |title=Tax policy as a lifeline: encouraging blood and organ donation through tax credits |journal=Annals of Health Law |date=2008 |volume=17 |issue=1 |pages=67–99 |pmid=18365650 |url=https://lawecommons.luc.edu/annals/vol17/iss1/5/ }}</ref>

====Other financial incentives====
As stated above, under the [[National Organ Transplant Act of 1984]], granting monetary incentives for organ donation is illegal in the United States.<ref name="National Organ Transplant Act">{{citation|title=National Organ Transplant Act |publisher=US Code|ref=42 US Code 274e.}}</ref> However, there has been some discussion about providing fixed payment for potential live donors. In 1988, regulated paid organ donation was instituted in [[Iran]] and, as a result, the renal transplant waiting list was eliminated. Critics of paid organ donation argue that the poor and vulnerable become susceptible to transplant tourism. Travel for transplantation becomes transplant tourism if the movement of organs, donors, recipients or transplant professionals occurs across borders and involves organ trafficking or transplant commercialism. Poor and underserved populations in underdeveloped countries are especially vulnerable to the negative consequences of transplant tourism because they have become a major source of organs for the 'transplant tourists' that can afford to travel and purchase organs.<ref name="Br J Anaesth.">{{cite journal |last1=Rudge |first1=C. |last2=Matesanz |first2=R. |last3=Delmonico |first3=F.L. |last4=Chapman |first4=J. |title=International practices of organ donation |journal=British Journal of Anaesthesia |date=January 2012 |volume=108 |pages=i48–i55 |doi=10.1093/bja/aer399 |pmid=22194431 |doi-access=free }}</ref>

In 1994 a law was passed in Pennsylvania which proposed to pay $300 for room and board and $3,000 for funeral expenses to an organ donor's family. Developing the program was an eight-year process; it is the first of its kind. Procurement directors and surgeons across the nation await the outcomes of Pennsylvania's program.<ref>{{cite web|last1=Wiggins|first1=Ovetta|title=Pa. organ donors get $300 boost It pays for food or lodging for them or their family. A bigger plan's rejection rankles some |url=http://articles.philly.com/2002-05-27/news/25345733_1_organ-donation-life-donor-program-organ-transplants|archive-url=https://web.archive.org/web/20150402182503/http://articles.philly.com/2002-05-27/news/25345733_1_organ-donation-life-donor-program-organ-transplants|archive-date=April 2, 2015|website=Philly.com|publisher=Philadelphia Media Network|access-date=February 28, 2015}}</ref> There have been at least nineteen families that have signed up for the benefit. Due to investigation of the program, however, there has been some concern whether the money collected is being used to assist families.<ref name="PennLittle">{{cite web|last1=Conte|first1=Andrew|last2=Fabregas|first2=Luis|title=Drivers' $1 donation yields little for Pennsylvania organ donors and their families|url=http://triblive.com/news/allegheny/4540138-74/organ-donors-donor|website=Trib Live|publisher=Trib Total Media LLC|access-date=October 8, 2016}}</ref> Nevertheless, funeral aids to induce post-mortem organ donation have also received support from experts and the general public, as the incentives present more ethical values, such as honoring the deceased donor or preserving voluntariness, and potentially increase donation willingness.<ref name="Arnold et al">{{cite journal |last1=Arnold |first1=Robert |last2=Bartlett |first2=Steven |last3=Bernat |first3=James |last4=Colonna |first4=John |last5=Dafoe |first5=Donald |last6=Dubler |first6=Nancy |last7=Gruber |first7=Scott |last8=Kahn |first8=Jeffrey |last9=Luskin |first9=Richard |last10=Nathan |first10=Howard |last11=Orloff |first11=Susan |last12=Prottas |first12=Jeffrey |last13=Shapiro |first13=Robyn |last14=Ricordi |first14=Camillo |last15=Youngner |first15=Stuart |last16=Delmonico |first16=Francis L. |title=Financial incentives for cadaver organ donation: an ethical reappraisal1 |journal=Transplantation |date=April 2002 |volume=73 |issue=8 |pages=1361–1367 |doi=10.1097/00007890-200204270-00034 |pmid=11981440 |s2cid=29823737 |doi-access=free }}</ref><ref name="Pham">{{cite journal |last1=Pham |first1=Vinh |title=Cash, Funeral Benefits or Nothing at All: How to Incentivize Family Consent for Organ Donation|url=https://mpra.ub.uni-muenchen.de/111047/12/MPRA_paper_111047.pdf |journal=Review of Behavioral Economics |date=2021 |volume=8 |issue=2 |pages=147–192 |doi=10.1561/105.00000136 |s2cid=237705443 }}</ref>

Some organizations, such as the National Kidney Foundation, oppose financial incentives associated with organ donation claiming, "Offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values as a society."<ref name="KidneyFoundOppose">{{cite web|title=Financial Incentives for Organ Donation|url=https://www.kidney.org/news/newsroom/positionpaper03|website=National Kidney Foundation|access-date=October 8, 2016|date=August 12, 2014}}</ref> One argument is it will disproportionately affect the poor.<ref>{{cite journal|last1=Krauthammer|first1=Charles|title=Yes, Let's Pay for Organs|url=http://content.time.com/time/magazine/article/0,9171,990984,00.html|journal=Time|volume=153|issue=19|page=100|access-date=February 28, 2015|date=May 17, 1999|pmid=11645351}}</ref> The $300–3,000 reward may act as an incentive for poorer individuals, as opposed to the wealthy who may not find the offered incentives significant. The National Kidney Foundation has noted that financial incentives, such as this Pennsylvania statute, diminish human dignity.<ref name="KidneyFoundOppose"/>

=== Morocco ===
Organ and tissue donation in Morocco is governed by Law No. 16-98, enacted by Dahir No. 1-99-208 on 16 September 1999 (Official Bulletin No. 4726).

To ensure that donations are voluntary, the legislation forbids any financial remuneration and governs the donation, removal, and transplantation of human organs for medical or research purposes.Only close family members may make living contributions; posthumous donations are permitted if the donor gave their approval while still alive or if family members concur after two separate medical professionals have verified the donor's brain death.Any violation of the law, such as the illegal transplantation or organ sale, is penalized by jail time and hefty fines.<ref>{{Cite web |last=B.O n° 4726 |first=Kingdom of Morocco |date=1999 |title=Loi n° 16-98 relative au don, au prélèvement et à la transplantation d'organes et de tissus humains |url=https://www.sante.gov.ma/Reglementation/REGLEMENTATIONDESPRATIQUESMEDICALES/16-98.pdf}}</ref>

=== Saudi Arabia ===
According to its Human Organ Donation Law, the Kingdom of Saudi Arabia provides legal backing for both living and deceased donors, following Royal Decree published on 1 April 2021 by the Council of Ministers, which took place on 30 March 2021. The law includes provisions that outline  the organ donation process;  donor consent;  medical determination of death; hospital responsibilities; and penalties for non-compliance. Islamic law (Sharia) governs organ donation and prohibits any type of material or financial reward. Public donations from deceased individuals require either the express consent of the deceased or the consent of the next of kin if the deceased is unavailable to provide consent. All public activities, donor lists, and transplant logistics are held by the SCOT (Saudi Center for Organ Transplantation).<ref>{{Cite web |date=2024-11-12 |title=Human Organ Donation Law in Saudi Arabia |url=https://saudipedia.com/en/article/2947/government-and-politics/systems/human-organ-donation-law-in-saudi-arabia |access-date=2025-10-11 |website=Saudipedia |language=en}}</ref>

=== Egypt ===
Law No. 5 of 2010, which governs the regulation of organ and human tissue donation and transplantation in Egypt, strictly prohibits any trade in human organs while permitting donation whether from living or deceased donors under stringent legal and medical conditions.

In the case of posthumous donation, it may take place only if the donor has previously given explicit consent before death, and provided that a medical committee formally certifies death in accordance with the established criteria of brain death. However, because of administrative, moral, and religious barriers, the law has not yet been fully implemented. Discussions over the establishment of a national organ donor registry and the efficient enforcement of the law are still going on, and public awareness initiatives have been planned.<ref>{{Cite web |last=United Nations Human Rights Committee |first=United Nations Digital Library |title=Concluding observations on the fifth periodic report of Egypt (CCPR/C/EGY/5) |url=https://digitallibrary.un.org/record/3907281/files/CCPR_C_EGY_5-FR.pdf}}</ref>

==Bioethical issues==
===Deontological===
[[File:Lung transplant rejection - high mag.jpg|thumb|Lung transplant rejection]]
Deontological issues are issues about whether a person has an ethical duty or responsibility to take an action. Nearly all scholars and societies around the world agree that voluntarily donating organs to sick people is ethically permissible. Although nearly all scholars encourage organ donation, fewer scholars believe that all people are ethically required to donate their organs after death. Similarly, nearly all religions support voluntary organ donation as a charitable act of great benefit to the community. Certain small faiths such as [[Jehovah's Witnesses]] and [[Shinto]] are opposed to organ donation based upon religious teachings; for Jehovah's Witnesses, this opposition is absolute whereas there exists increasing flexibility among Shinto scholars. [[Romani people]] are also often opposed to organ donation based on prevailing spiritual beliefs and not religious views per se.<ref name=easterbrookbeliefnet>{{cite web | url=http://www.beliefnet.com/Faiths/2001/05/Organ-Donation-Where-Your-Religion-Stands.aspx?p=1 | work=[[BeliefNet]] |access-date=March 9, 2014 | title=Organ Donation: Where Your Religion Stands | last=Easterbrook | first=Gregg | url-status=live | archive-date=November 10, 2013 | archive-url=https://web.archive.org/web/20131110233120/http://www.beliefnet.com/Faiths/2001/05/Organ-Donation-Where-Your-Religion-Stands.aspx?p=1 | quote=Despite popular misconceptions, there are almost no religious rules against donating organs or receiving transplants. A few denominations ban these practices, and a few others have rules that are not models of clarity.}} ''This is the first of two pages.''</ref> Issues surrounding [[patient autonomy]], [[living will]]s, and [[guardianship]] make it nearly impossible for involuntary organ donation to occur.

From the standpoint of [[deontological ethics]], the primary issues surrounding the morality of organ donation are semantic in nature. The debate over the definitions of life, death, human, and [[Human body|body]] is ongoing. For example, whether or not a [[brain-dead]] patient ought to be kept artificially animate to preserve organs for donation is an ongoing problem in clinical [[bioethics]]. In addition, some{{who|date=September 2021}} have argued that organ donation constitutes an act of self-harm, even when an organ is donated willingly.<ref>{{cite journal |last1=Kishore |first1=R R |title=Human organs, scarcities, and sale: morality revisited |journal=Journal of Medical Ethics |date=June 2005 |volume=31 |issue=6 |pages=362–365 |doi=10.1136/jme.2004.009621 |pmid=15923488 |pmc=1734170 }}</ref>

Further, the use of [[cloning]] to produce organs with a [[genotype]] identical to the recipient is a controversial topic, especially considering the possibility for an entire person to be brought into being for the express purpose of being destroyed for organ procurement. While the benefit of such a cloned organ would be a zero-percent chance of [[transplant rejection]], the ethical issues involved with creating and killing a clone may outweigh these benefits. However, it may be possible in the future to use cloned stem-cells to grow a new organ without creating a new human being.

A relatively new field of transplantation has reinvigorated the debate. [[Xenotransplantation]], or the transfer of animal (usually pig) organs into human bodies, promises to eliminate many of the ethical issues, while creating many of its own.<ref>{{Cite book|title=Organ Donation (Opposing Viewpoints)|publisher=Greenhaven Press|year=2013|isbn=978-0-7377-6332-4|editor-last=Egendorf|editor-first=Laura|location=Detroit|pages=[https://archive.org/details/organdonation0000unse/page/130 130–147]|url=https://archive.org/details/organdonation0000unse/page/130}}</ref> While xenotransplantation promises to increase the supply of organs considerably, the threat of organ transplant rejection and the risk of [[xenozoonosis]], coupled with general [[anathema]] to the idea, decreases the functionality of the technique. Some animal rights groups oppose the sacrifice of an animal for organ donation and have launched campaigns to ban them.<ref>{{Cite book |author1=Institute of Medicine (US) Committee on Xenograft Transplantation: Ethical Issues and Public Policy |via=Institute of Medicine (US) Committee on Xenograft Transplantation: Ethical Issues and Public Policy|url=https://nap.nationalacademies.org/catalog/5365/xenotransplantation-science-ethics-and-public-policy |title=Xenotransplantation: Science, Ethics, and Public Policy |date=July 12, 1996 |publisher=National Academies Press |isbn=978-0-309-05549-9 |location=Washington, D.C. |doi=10.17226/5365 |pmid=20845555 |bibcode=1996nap..book.5365I }}{{page needed|date=February 2024}}</ref>

===Teleological===
On [[teleological]] or [[utilitarian]] grounds, the moral status of "black market organ donation" relies upon the ends, rather than the means.{{Citation needed|date=February 2012}} In so far as those who donate organs are often impoverished{{Citation needed|date=March 2011}} and those who can afford black market organs are typically well-off,{{Citation needed|date=February 2012}} it would appear that there is an imbalance in the trade. In many cases, those in need of organs are put on waiting lists for ''legal'' organs for indeterminate lengths of time—many die while still on a waiting list.

Organ donation is fast becoming an important [[bioethical issue]] from a social perspective as well. While most first-world nations have a legal system of oversight for organ transplantation, the fact remains that demand far outstrips supply. Consequently, there has arisen a [[black market]] trend often referred to as ''transplant tourism.''{{Citation needed|date=March 2011}} The issues are weighty and controversial. On the one hand are those who contend that those who can afford to buy organs are exploiting those who are desperate enough to sell their organs. Many suggest this results in a growing inequality of status between the rich and the poor. On the other hand, are those who contend that the desperate should be allowed to sell their organs and that preventing them from doing so is merely contributing to their status as impoverished. Further, those in favor of the trade hold that exploitation is morally preferable to death, and in so far as the choice lies between abstract notions of justice on the one hand and a dying person whose life could be saved on the other hand, the [[organ trade]] should be legalized. Conversely, surveys conducted among living donors postoperatively and in a period of five years following the procedure have shown extreme regret in a majority of the donors, who said that given the chance to repeat the procedure, they would not.<ref name=Zargooshi2001>{{cite journal |last1=Zargooshi |first1=Javaad |title=Quality of life of Iranian kidney 'donors' |journal=Journal of Urology |date=November 2001 |volume=166 |issue=5 |pages=1790–1799 |pmid=11586226 |doi=10.1016/S0022-5347(05)65677-7 }}</ref> Additionally, many study participants reported a decided worsening of economic condition following the procedure.<ref name=pmid12350189>{{cite journal |last1=Goyal |first1=Madhav |title=Economic and Health Consequences of Selling a Kidney in India |journal=JAMA |date=October 2, 2002 |volume=288 |issue=13 |pages=1589–1593 |doi=10.1001/jama.288.13.1589 |pmid=12350189 }}</ref> These studies looked only at people who sold a kidney in countries where organ sales are already legal.

A consequence of the black market for organs has been a number of cases and suspected cases of [[organ theft]],<ref name="sidner2011">{{cite news | url=http://www.cnn.com/2008/WORLD/asiapcf/01/29/india.transplant/ | title=Police hunt for doctor in kidney-snatching ring | publisher=[[CNN]] | date=January 29, 2008 | access-date=March 8, 2014 | first1=Sara | last1=Sidner | last2=Eastment | first2=Tess | url-status=live | archive-date=November 9, 2012 | archive-url=https://web.archive.org/web/20121109161632/http://www.cnn.com/2008/WORLD/asiapcf/01/29/india.transplant/}}</ref><ref name="bloodyharvest">{{cite web | url=http://organharvestinvestigation.net/report0701/report20070131-eng.pdf | title=Bloody Harvest: Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China | last1=Matas | first1=David | last2=Kilgour | first2=David | author-link1=David Matas | author-link2=David Kilgour | date=January 31, 2007 | access-date=March 8, 2014 | archive-date=February 15, 2014 | archive-url=https://web.archive.org/web/20140215212054/http://organharvestinvestigation.net/report0701/report20070131-eng.pdf }}</ref> including murder for the purposes of organ theft.<ref name="adams0305">{{cite news |url=https://www.thetimes.com/article/organ-trafficking-suspected-in-mass-murder-case-nbtbzkvspr7 |title=Organ trafficking suspected in mass murder case |work=[[The Times]] |date=May 27, 2003 |author=Adams, David |location=United Kingdom |url-status=live |archive-url=http://web.archive.org/web/20170106082031/http://www.thetimes.co.uk/tto/news/world/article1971361.ece |archive-date= 2017-01-06|access-date=October 31, 2016 }}</ref><ref name=Kelly2009>{{cite news |first=Annie | last=Kelly |url=https://www.theguardian.com/world/2009/sep/06/uganda-child-sacrifice-ritual-murder |title=Child sacrifice and ritual murder rise as famine looms |work=[[The Guardian]] |location=London |date=September 6, 2009 |access-date=March 7, 2014 |url-status=live |archive-date= February 14, 2014 |archive-url=https://web.archive.org/web/20140214183143/http://www.theguardian.com/world/2009/sep/06/uganda-child-sacrifice-ritual-murder}}</ref> Proponents of a legal market for organs say that the black-market nature of the current trade allows such tragedies and that regulation of the market could prevent them. Opponents say that such a market would encourage criminals by making it easier for them to claim that their stolen organs were legal.

Legalization of the organ trade carries with it its own sense of justice as well.<ref>{{Cite journal |last=Boyer |first=J. |date=2012-03-01 |title=Gifts of the Heart… and Other Tissues: Legalizing the Sale of Human Organs and Tissues |url=https://digitalcommons.law.byu.edu/lawreview/vol2012/iss1/6/ |journal=BYU Law Review |volume=2012 |issue=1 |pages=313–342 |issn=2162-8572}}</ref> Continuing black-market trade creates further disparity on the demand side: only the rich can afford such organs. Legalization of the international organ trade could lead to increased supply, lowering prices so that persons outside the wealthiest segments could afford such organs as well.

Exploitation arguments generally come from two main areas:
* ''Physical exploitation'' suggests that the operations in question are quite risky, and, taking place in third-world hospitals or "back-alleys", even more risky. Yet, if the operations in question can be made safe, there is little threat to the donor.
* ''Financial exploitation'' suggests that the donor (especially in the Indian subcontinent and Africa) are not paid enough. Commonly, accounts from persons who have sold organs in both legal and black market circumstances put the prices at between $150 and $5,000, depending on the local laws, supply of ready donors and scope of the transplant operation.<ref name=Carney2007>{{cite news | author=Carney, Scott | author-link=Scott Carney | url=https://www.wired.com/medtech/health/news/2007/05/india_transplants_prices | title=Why a Kidney (Street Value: $3,000) Sells for $85,000 | date=May 8, 2007 | work=[[Wired (website)|Wired]] | access-date=March 8, 2014 | url-status=live | archive-date=July 29, 2013 | archive-url=https://web.archive.org/web/20130729214639/http://www.wired.com/medtech/health/news/2007/05/india_transplants_prices}}</ref><ref name=jan200611>{{cite news | url=https://www.washingtonpost.com/wp-dyn/content/article/2006/11/12/AR2006111200375.html | newspaper=[[The Washington Post]] | title=Poor Pakistanis Donate Kidneys for Money | first=Sadaqat | last=Jan | agency=Associated Press | date=November 12, 2006 | url-status=live | archive-url=http://web.archive.org/web/20161101041320/http://www.washingtonpost.com/wp-dyn/content/article/2006/11/12/AR2006111200375.html | archive-date= 2016-11-01| access-date=October 31, 2016 }}</ref><ref name=bbc6090468>{{cite news | url=http://news.bbc.co.uk/2/hi/programmes/this_world/6090468.stm | work=[[BBC News]] |title=Iran's desperate kidney traders | date=October 31, 2006 | access-date=March 8, 2014 | first=Nima | last=Sarvestani | author-link=Nima Sarvestani | url-status=live | archive-date=November 13, 2013 | archive-url=https://web.archive.org/web/20131113071250/http://news.bbc.co.uk/2/hi/programmes/this_world/6090468.stm}}</ref> In Chennai, India, where one of the largest black markets for organs is known to exist, studies have placed the average sale price at little over $1,000.<ref name=pmid12350189/> Many accounts also exist of donors being postoperatively denied their promised pay.<ref name=autogenerated1>{{cite news |author=Carney, Scott | author-link=Scott Carney |url=https://www.wired.com/medtech/health/news/2007/05/india_transplants_rani | title=Inside 'Kidneyville': Rani's Story | work=[[Wired (website)|Wired]] | access-date=March 8, 2014 | date=May 8, 2007 | url-status=live | archive-date=June 23, 2013 | archive-url=https://web.archive.org/web/20130623192849/http://www.wired.com/medtech/health/news/2007/05/india_transplants_rani}}</ref>

''The New Cannibalism'' is a phrase coined by anthropologist [[Nancy Scheper-Hughes]] in 1998 for an article written for The [[New Internationalist]]. Her argument was that the actual exploitation is an ethical failing, a human exploitation; a perception of the poor as organ sources which may be used to extend the lives of the wealthy.<ref>{{cite web |url=http://sunsite.berkeley.edu/biotech/organswatch/pages/cannibalism.html |title=The new cannibalism |publisher=University of California, Berkeley |work=Berkeley Digital Library SunSITE |author=Scheper-Hughes, Nancy |author-link=Nancy Scheper-Hughes |archive-date=May 3, 2009 |archive-url=https://web.archive.org/web/20090503025108/http://sunsite.berkeley.edu/biotech/organswatch/pages/cannibalism.html}}</ref>

Economic drivers leading to increased donation are not limited to areas such as India and Africa, but also are emerging in the United States. Increasing funeral expenses combined with decreasing real value of investments such as homes and retirement savings which took place in the 2000s have purportedly led to an increase in citizens taking advantage of arrangements where funeral costs are reduced or eliminated.<ref name=stix2011>{{Cite journal | last=Stix | first=Gary | date=January 4, 2011 | title=Donate Your Brain, Save a Buck | journal=[[Scientific American]] | volume=304 | issue=1 | page=29 | doi=10.1038/scientificamerican0111-29a| bibcode=2011SciAm.304a..29S }}</ref>

===Brain death versus cardiac death===
[[File:Radionuclide Cerebral Blood Flow Scan.png|thumb|Brain death (Radionuclide Cerebral Blood Flow Scan)]]

[[Brain death]] may result in [[legal death]], but still with the [[heart]] beating and with [[mechanical ventilation]], keeping all other vital organs alive and functional for a certain period of time. Given long enough, patients who do not fully die in the complete biological sense, but who are declared brain dead, will usually start to build up toxins and wastes in the body. In this way, the organs can eventually dysfunction due to coagulopathy, fluid or electrolyte and nutrient imbalances, or even [[organ failure|fail]]. Thus, the organs will usually only be sustainable and viable for acceptable use up until a certain length of time. This may depend on factors such as how well the patient is maintained, any comorbidities, the skill of the healthcare teams and the quality their facilities.<ref name=DBD>{{cite web | url=http://surgery.about.com/od/proceduresaz/ss/OrganDonation_3.htm | work=[[About.com]] | last=Heisler | first=Jennifer | title=Organ Donation After Brain Death | date=June 29, 2013 | access-date=March 9, 2014 | archive-date=April 5, 2015 | archive-url=https://web.archive.org/web/20150405164630/http://surgery.about.com/od/proceduresaz/ss/OrganDonation_3.htm }}</ref>{{Unreliable medical source|date=March 2011}} A major point of contention is whether transplantation should be allowed at all if the patient is not yet fully biologically dead, and if brain death is acceptable, whether the person's whole brain needs to have died, or if the death of a certain part of the brain is enough for legal and ethical and moral purposes.

Most organ donation for organ transplantation is done in the setting of brain death. However, in Japan this is a fraught point, and prospective donors may designate either brain death or cardiac death – see [[organ transplantation in Japan]]. In some nations such as Belgium, France, Netherlands, New Zealand, Poland, Portugal, Singapore and Spain, everyone is automatically an organ donor unless they opt out of the system. Elsewhere, consent from family members or next-of-kin is required for organ donation. The non-living donor is kept on ventilator support until the organs have been surgically removed. If a brain-dead individual is not an organ donor, ventilator and drug support is discontinued and cardiac death is allowed to occur.

In the United States, where since the 1980s the [[Uniform Determination of Death Act]] has defined death as the irreversible cessation of the function of either the brain or the heart and lungs,<ref name=whendead2011>{{cite web | url=http://stanmed.stanford.edu/2011spring/article5.html | title=When Are You Dead? | first=John | last=Sanford | author2=Dubois, Gėrard | work=Stanford Medicine Magazine | publisher=Stanford University School of Medicine | location=United States | date=Spring 2011 | volume=28 | issue=1 | access-date=March 9, 2014 | archive-date=November 15, 2013 | archive-url=https://web.archive.org/web/20131115114424/http://stanmed.stanford.edu/2011spring/article5.html }}</ref> the 21st century has seen an order-of-magnitude increase of donation following cardiac death. In 1995, only one out of 100 dead donors in the nation gave their organs following the declaration of cardiac death. That figure grew to almost 11 percent in 2008, according to the [[Scientific Registry of Transplant Recipients]].<ref name=whendead2011/> That increase has provoked ethical concerns about the interpretation of "irreversible" since "patients may still be alive five or even 10 minutes after cardiac arrest because, theoretically, their hearts could be restarted, [and thus are] clearly not dead because their condition was reversible."<ref name=whendead2011/>

===Gender inequality===
The majority of organ donors are women.<ref>{{Cite journal |last1=Katz-Greenberg |first1=Goni |last2=Shah |first2=Silvi |date=March 2022 |title=Sex and Gender Differences in Kidney Transplantation |journal=Seminars in Nephrology |language=en |volume=42 |issue=2 |pages=219–229 |doi=10.1016/j.semnephrol.2022.04.011|pmid=35718368 |pmc=10065984 }}</ref> For example, in the United States, 62% of kidney donors and 53% of liver donors are women.  According to an international study published in 2023, which included countries from North America, Europe, and Central Asia, 60-65% of living donors in many countries are women.<ref>{{Cite journal |last1=Vilayur |first1=Eswari |last2=van Zwieten |first2=Anita |last3=Chen |first3=Mingxing |last4=Francis |first4=Anna |last5=Wyld |first5=Melanie |last6=Kim |first6=Siah |last7=Cooper |first7=Tess |last8=Wong |first8=Germaine |date=2023-08-24 |title=Sex and Gender Disparities in Living Kidney Donation: A Scoping Review |journal=Transplantation Direct |volume=9 |issue=9 |article-number=e1530 |doi=10.1097/txd.0000000000001530 |pmid=37636486 |pmc=10455160 |issn=2373-8731}}</ref> In the United States, for example, data from the Organ Procurement and Transplantation Network (UNOS) in 2021 showed that women represent about 63% of living organ donors. Only 22% of women on dialysis were placed on the kidney transplant waitlist, compared to 30% of men. This disparity persisted even though women had fewer medical comorbidities than men.<ref>{{Cite journal |last1=Salas |first1=Maria Aurora Posadas |last2=Chua |first2=Elizabeth |last3=Rossi |first3=Ana |last4=Shah |first4=Silvi |last5=Katz-Greenberg |first5=Goni |last6=Coscia |first6=Lisa |last7=Sawinski |first7=Deirdre |last8=Adey |first8=Deborah |date=December 2022 |title=Sex and gender disparity in kidney transplantation: Historical and future perspectives |journal=Clinical Transplantation |language=en |volume=36 |issue=12 |article-number=e14814 |doi=10.1111/ctr.14814 |pmid=36097741 |pmc=10069947 |issn=0902-0063}}</ref> In India, women constitute 74% of kidney donors and 60.5% of liver donors. Additionally, the number of female organ recipients is conspicuously lower than that of male recipients. In the U.S., 35% of liver recipients and 39% of kidney recipients are women. In India, the figures are 24% and 19% respectively.<ref>{{cite news |last1=Chattopadhyay |first1=Sohini |title=Why are the vast majority of Indian organ donors women? |url=https://www.thehindu.com/society/sum-of-her-parts-why-are-the-vast-majority-of-indian-organ-donors-women/article25271956.ece |work=The Hindu |date=October 20, 2018 |language=en-IN }}</ref>

A study published in 2022 partially explained these disparities through the higher prevalence of certain diseases in men, immune responses related to childbirth in women, and the mismatch in size between the donor and recipient.<ref>{{Cite journal |last1=Cozzi |first1=Emanuele |last2=Álvarez |first2=Marina |last3=Carmona |first3=Mar |last4=Mahíllo |first4=Beatriz |last5=Forsythe |first5=John |last6=Lomero |first6=Mar |last7=López-Fraga |first7=Marta |last8=Sapir-Pichhadze |first8=Ruth |last9=Cardillo |first9=Massimo |last10=Domínguez-Gil |first10=Beatriz |date=2022-07-19 |title=An Analysis by the European Committee on Organ Transplantation of the Council of Europe Outlining the International Landscape of Donors and Recipients Sex in Solid Organ Transplantation |journal=Transplant International |volume=35 |article-number=10322 |doi=10.3389/ti.2022.10322 |doi-access=free |pmid=35928348 |issn=1432-2277|pmc=9343585 }}</ref> These disparities may also be attributed to social and cultural factors, as women are often more willing to support family members, in addition to public health policies that have not given enough attention to addressing these disparities.

==Political issues==
There are also controversial issues regarding how organs are allocated to recipients. For example, some believe that livers should not be given to alcoholics in danger of reversion, while others view alcoholism as a medical condition like diabetes.{{Citation needed|date=March 2011}} Faith in the medical system is important to the success of organ donation. Brazil switched to an opt-out system and ultimately had to withdraw it because it further alienated patients who already distrusted the country's medical system.<ref name=BMJ>{{cite journal |last1=Bird |first1=S. M. |last2=Harris |first2=J. |title=Time to move to presumed consent for organ donation |journal=BMJ |date=May 4, 2010 |volume=340 |article-number=c2188 |doi=10.1136/bmj.c2188 |pmid=20442244 |s2cid=13764650 |url=https://pure.manchester.ac.uk/ws/files/26965165/POST-PEER-REVIEW-PUBLISHERS.PDF }}</ref> Adequate funding, strong political will to see transplant outcomes improve, and the existence of specialized training, care and facilities also increase donation rates. Expansive legal definitions of death, such as Spain uses, also increase the pool of eligible donors by allowing physicians to declare a patient to be dead at an earlier stage, when the organs are still in good physical condition. Allowing or forbidding payment for organs affects the availability of organs. Generally, where organs cannot be bought or sold, quality and safety are high, but supply is not adequate to the demand. Where organs can be purchased, the supply increases.<ref>{{cite news | url=https://www.economist.com/blogs/democracyinamerica/2011/12/organ-sales | access-date=March 9, 2014 | format=blog | author=R.M. (anonymous) | title=Organ sales: Paying to live | newspaper=[[The Economist]] | quote=Iran adopted a system of paying kidney donors in 1988 and within 11 years it became the only country in the world to clear its waiting list for transplants. | date=December 7, 2011 | url-status=live | archive-date=June 19, 2013 | archive-url=https://web.archive.org/web/20130619064116/https://www.economist.com/blogs/democracyinamerica/2011/12/organ-sales}}</ref>
{{blockquote|Iran adopted a system of paying kidney donors in 1988 and within 11 years it became the only country in the world to clear its waiting list for transplants.|''[[The Economist]]''}}

Healthy humans have two kidneys, but can live a healthy life with only one. This enables living donors (''[[inter vivos]]'') to give a kidney to someone who needs it, with little to no long-term risk.<ref name="d421">{{cite web | title=Living donor kidney transplant | website=[[National Health Service]] | url=https://www.nhsbt.nhs.uk/organ-transplantation/kidney/receiving-a-kidney/living-donor-kidney-transplant/ | access-date=May 11, 2024}}</ref><ref name="Ekholm_1997">{{cite journal |last1=Fehrman-Ekholm |first1=I |last2=Elinder |first2=C G |last3=Stenbeck |first3=M |last4=Tyden |first4=G |last5=Groth |first5=C G |display-authors=3 |date=October 15, 1997 |title=Kidney donors live longer |journal=Transplantation |volume=64 |issue=7  |pages=976–978 |doi=10.1097/00007890-199710150-00007 |pmid=9381544 }}</ref> The most common transplants are to close relatives, but people have given kidneys to other friends. The rarest type of donation is the undirected donation whereby a donor gives a kidney to a stranger. Less than a few hundred of such kidney donations have been performed{{Update inline|date=January 2026|reason=Cited source is 20 years old}}. In recent years, searching for altruistic donors via the internet has also become a way to find life saving organs. However, internet advertising for organs is a highly controversial practice, as some scholars believe it undermines the traditional list-based allocation system.<ref>{{cite journal | journal=[[Hastings Cent. Rep.]] | last=Appel |first=Jacob |author-link=Jacob M. Appel | title=Organ Solicitation on the Internet: Every Man for Himself? |volume=35 |issue=3 |date=May–June 2005 | pages=14–15 | pmid=16092393 |doi=10.1353/hcr.2005.0052 | s2cid=144121833 }}</ref>

=== Black market organ donation ===
The issue of the black market for organs being legalized has become a widespread debate because if this happens then individuals will most likely be coerced into selling their organs. Additionally, even if there were to become regulations against it most individuals who would be coerced into doing this would most likely be unable to afford legal protection.<ref>{{cite journal |last1=Taylor |first1=J S |title=Black markets, transplant kidneys and interpersonal coercion |journal=Journal of Medical Ethics |date=December 2006 |volume=32 |issue=12 |pages=698–701 |doi=10.1136/jme.2005.015859 |pmid=17145908 |pmc=2563357 }}</ref>

The [[National Transplant Organization]] of Spain is one of the most successful in the world (Spain has been the world leader in organ donation for decades),<ref>{{cite magazine | url=http://europe.newsweek.com/spain-has-become-world-leader-organ-donations-305841?rm=eu | access-date=August 24, 2016 | title=How Spain became the World Leader in Organ Donations| magazine=[[Newsweek]] | location=United States of america | date=February 11, 2015 }}</ref> but it still cannot meet the demand, as 10% of those needing a transplant die while still on the transplant list.<ref>{{cite web | url=http://www.ont.es/informacion/Paginas/Trasplante.aspx | access-date=March 9, 2014 | title=Trasplantes | trans-title=Transplants | at=Los españoles, un ejemplo imitado. | archive-date=January 6, 2014 | language=es | publisher=National Transplant Organization | location=Spain | archive-url=https://web.archive.org/web/20140106201155/http://www.ont.es/informacion/Paginas/Trasplante.aspx }}</ref> Donations from corpses are anonymous, and a network for communication and transport allows fast extraction and transplant across the country.{{citation needed|date=February 2024}} Spanish law uses an opt-out system, where every person is assumed to be a donor and must consciously opt out.<ref name="Lancet 1171">{{Cite journal |last=Lancet |first=The |date=2024-09-28 |title=Organ donation: lessons from the Spanish model |url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02128-7/fulltext |journal=The Lancet |language=English |volume=404 |issue=10459 |page=1171 |doi=10.1016/S0140-6736(24)02128-7 |issn=0140-6736 |pmid=39341631|url-access=subscription }}</ref> Because family members still can forbid the donation,<ref name="Lancet 1171"/> carefully trained doctors ask the family for permission, making it very similar in practice to the United States system.<ref>{{cite journal |last1=Spooner |first1=Mary Helen |title=More countries hoping to copy Spain's organ-donation success |journal=CMAJ |date=October 28, 2003 |volume=169 |issue=9 |page=952 |pmid=14581328 |pmc=219643 }}</ref>

In the overwhelming majority of cases, organ donation is not possible for reasons of recipient safety, match failures, or organ condition. Even in Spain, which has the highest organ donation rate in the world, there are only 35.1 actual donors per million people, and there are hundreds of patients on the waiting list.<ref name=BMJ/> This rate compares to 24.8 per million in Austria, where families are rarely asked to donate organs, and 22.2 per million in France, which—like Spain—has a presumed-consent system.{{citation needed|date=February 2024}}

===Prison inmates===
{{see also|Organ donation in the United States prison population}}
In the United States, prisoners are not discriminated against as organ recipients and are equally eligible for organ transplants along with the general population. A 1976 U.S. Supreme Court case<ref>Estelle v Gamble 429 U.S. 97, 97 S. Ct. 285 50l Ed 2d251 [1976]</ref> ruled that withholding health care from prisoners constituted "[[cruel and unusual punishment]]". [[United Network for Organ Sharing]], the organization that coordinates available organs with recipients, does not factor a patient's prison status when determining suitability for a transplant.<ref name=unos>{{cite web|url=http://www.unos.org/news/newsDetail.asp?id=112|title=U.S. Statement On Prison Status and Organ Allocation|publisher=United Network for Organ Sharing|date=June 2, 2002 |access-date=December 20, 2009 |archive-url=https://web.archive.org/web/20060926213230/http://www.unos.org/news/newsDetail.asp?id=112|archive-date=September 26, 2006}}</ref><ref name=Wiegand2002>{{cite news|title=State inmate gets new heart; 'Medically necessary care' is required by law, an official says|author=Wiegand, Steve|newspaper=The Sacramento Bee|date=January 25, 2002}}</ref>
An organ transplant and follow-up care can cost the prison system up to one million dollars.<ref name=Wiegand2002/><ref>{{cite web |last=Ingalls | first=Chris | author-link=Chris Ingalls | date=April 8, 2005 |url=http://www.awcnet.org/awcconf07/handoutspresentations/14PayOffenderMedicalKing5.pdf |title=Prison inmate awaits organ transplant |work=[[KING-TV]] |publisher=Association of Washington Cities |access-date=December 20, 2009 |archive-date=January 6, 2009 | archive-url=https://web.archive.org/web/20090106005915/http://www.awcnet.org/awcconf07/handoutspresentations/14PayOffenderMedicalKing5.pdf}}</ref> If a prisoner qualifies, a state may allow compassionate early release to avoid high costs associated with organ transplants.<ref name=Wiegand2002/> However, an organ transplant may save the prison system substantial costs associated with dialysis and other life-extending treatments required by the prisoner with the failing organ. For example, the estimated cost of a kidney transplant is about $111,000.<ref>{{cite journal |last1=Lesko |first1=Paul |last2=Buckley |first2=Kevin |title=Attack of the Clones… and the Issues of Clones |journal=Science and Technology Law Review |date=November 2, 2019 |volume=3 |doi=10.7916/stlr.v3i0.3623 |doi-broken-date=July 1, 2025 }}</ref> A prisoner's dialysis treatments are estimated to cost a prison $120,000 per year.<ref>{{cite news |title=Killer in Need of a Kidney Starts Ethics Row |first1=Lee |last1=Douglas |newspaper=Chicago Tribune |date=May 29, 2003 |page=10 }}</ref>

Because donor organs are in short supply, there are more people waiting for a transplant than available organs. When a prisoner receives an organ, there is a high probability that someone else will die waiting for the next available organ. A response to this ethical dilemma states that felons who have a history of violent crime, who have violated others' basic rights, have lost the right to receive an organ transplant, though it is noted that it would be necessary "to reform our justice system to minimize the chance of an innocent person being wrongly convicted of a violent crime and thus being denied an organ transplant".<ref>{{cite web|title=Should Violent Felons Receive Organ Transplants?|last=Perry|first=David L. |url=http://www.scu.edu/ethics/publications/submitted/Perry/transplant.html |publisher=Markkula Center for Applied Ethics |access-date=December 20, 2009}}</ref>

Prisons typically do not allow inmates to donate organs to anyone but immediate family members. There is no law against prisoner organ donation; however, the transplant community has discouraged use of prisoner's organs since the early 1990s due to concern over prisons' high-risk environment for infectious diseases.<ref>{{cite journal |title=Guidelines for preventing transmission of human immunodeficiency virus through transplantation of human tissue and organs. Centers for Disease Control and Prevention. |journal=MMWR. Recommendations and Reports |date=May 20, 1994 |volume=43 |issue=RR-8 |pages=1–17 |pmid=8183226 |url=https://stacks.cdc.gov/view/cdc/48131 }}</ref> Physicians and ethicists also criticize the idea because a prisoner is not able to consent to the procedure in a free and non-coercive environment,<ref name=amednews2007>{{cite news |last=O'Reilly |first=Kevin B. |url=http://www.amednews.com/article/20070409/profession/304099964/6/ |title=Prisoner organ donation proposal worrisome |work=[[American Medical News]] |date=April 9, 2007 |access-date=March 8, 2014 |archive-date=September 30, 2013 |archive-url=https://web.archive.org/web/20130930125139/http://www.amednews.com/article/20070409/profession/304099964/6/ }}</ref> especially if given inducements to participate. However, with modern testing advances to more safely rule out infectious disease and by ensuring that there are no incentives offered to participate, some have argued that prisoners can now voluntarily consent to organ donation just as they can now consent to medical procedures in general. With careful safeguards, and with over 2&nbsp;million prisoners in the U.S., they reason that prisoners can provide a solution for reducing organ shortages in the U.S.<ref>http://www.gavelife.org – Organization established to advocate for organ donations from prisoners.{{full citation needed|date=February 2024}}</ref>

While some have argued that prisoner participation would likely be too low to make a difference, one Arizona program started by former [[Maricopa County Sheriff's Office|Maricopa County Sheriff]] [[Joe Arpaio]] encourages inmates to voluntarily sign up to donate their heart and other organs.<ref name=sheriffjoe>{{cite web | url=http://www.sheriffjoe.org/index.php?option=com_content&task=view&id=4&Itemid=9 | title=Sheriff Teaches Inmates to "Have a Heart" By Volunteering To Give Up Theirs |date=June 13, 2007 | access-date=October 20, 2008 | publisher=Committee to Re-Elect Joe Arpaio 2008 |archive-date=January 14, 2009 | url-status=usurped |archive-url=https://web.archive.org/web/20090114025932/http://www.sheriffjoe.org/index.php?option=com_content&task=view&id=4&Itemid=9}}</ref> As of 2015, there have been over 16,500 participants.<ref>{{Cite web |url=https://www.mcso.org/Multimedia/PressRelease/Organ%20Donor.pdf |title=Archived copy |access-date=September 30, 2019 |archive-date=August 26, 2016 |archive-url=https://web.archive.org/web/20160826161448/https://www.mcso.org/MultiMedia/PressRelease/Organ%20Donor.pdf }}</ref><ref>{{cite web |url=http://www.msco.org |title=Arpaio's "I do" Program (Inmates Willing to Donate Their Organs) has them Joining National Drive |date=April 29, 2015 |type=press release }}</ref> Similar initiatives have been started in other US states. In 2013, Utah became the first state to allow prisoners to sign up for organ donation upon death.<ref>{{cite news |url=http://vitals.nbcnews.com/_news/2013/04/13/17674231-new-utah-law-allows-organ-donations-from-prisoners-nearly-250-sign-up |title=New Utah law allows organ donations from prisoners; nearly 250 sign up |date=April 13, 2013 |work=NBC News |first=Trent |last=Nelson |access-date=September 30, 2019 |archive-url=https://web.archive.org/web/20191225102842/http://vitals.nbcnews.com/_news/2013/04/13/17674231-new-utah-law-allows-organ-donations-from-prisoners-nearly-250-sign-up |archive-date=December 25, 2019 }}</ref>

==Religious viewpoints==
{{Main|Religious views on organ donation}}
{{see also|Organ donation in Jewish law}}

There are several different religions that have different perspectives. Muslims have a conflicting view regarding the issue, with half believing that it is against the religion. Muslims are commanded to seek medical attention when in need and saving life is a very important factor of the Islamic religion. Christianity is lenient on the topic of organ donation, and believe it is a service of life.<ref>{{cite journal |last1=Robson |first1=Noor Zurani Md Haris |last2=Razack |first2=Azad Hassan |last3=Dublin |first3=Norman |title=Review paper: Organ transplants: ethical, social, and religious issues in a multicultural society |journal=Asia-Pacific Journal of Public Health |date=July 2010 |volume=22 |issue=3 |pages=271–278 |doi=10.1177/1010539509357446 |pmid=20460294 |s2cid=1888836 }}</ref>
[[File:Organ Donor Sign, First Baptist Church, Nebraska City, 2026.jpg|alt=Sign next to U.S. and Christian flag reads: Be an organ donor, give your heart to Jesus|thumb|First Baptist Church sign promoting organ donation, Nebraska City, U.S.]]
All major religions accept organ donation in at least some form<ref>See Cycling Cleric initiative in support of organ donation http://www.thewhig.com/2015/05/28/raising-awareness-one-donor-at-a-time</ref> on either utilitarian grounds (''i.e.'', because of its life-saving capabilities) or deontological grounds (''e.g.'', the right of an individual believer to make his or her own decision).{{Citation needed|date=September 2011}} Most religions, among them the [[Roman Catholic Church]], support organ donation on the grounds that it constitutes an act of charity and provides a means of saving a life. One religious group, The [[Jesus Christians]], became known as "The Kidney Cult" because more than half its members had donated their kidneys altruistically. Jesus Christians claim altruistic kidney donation is a great way to "Do unto others what they would want you to do unto them."<ref name="sunherald2008">{{cite news |title=Inside the Kidney Cult | url=https://www.smh.com.au/news/national/inside-the-kidney-cult/2008/03/29/1206207482622.html | access-date=March 8, 2014 |work=[[The Sydney Morning Herald]] |date=March 30, 2008 |url-status=live |archive-date=April 17, 2012 | archive-url=https://web.archive.org/web/20120417180215/http://www.smh.com.au/news/national/inside-the-kidney-cult/2008/03/29/1206207482622.html}}</ref> Some religions impose certain restrictions on the types of organs that may be donated and/or on the means by which organs may be harvested and/or transplanted.<ref name="GLLppt">{{cite web |url=http://www.giveandletlive.co.uk/docs/ppt/RE%20PowerPoint.ppt |title=(untitled) |publisher=NHS Blood and Transplant |work=Give and Let Live |access-date=March 8, 2014 |location=United Kingdom |archive-url=https://web.archive.org/web/20140308035408/http://www.giveandletlive.co.uk/docs/ppt/RE%20PowerPoint.ppt |archive-date=March 8, 2014 |format=Microsoft PowerPoint }}</ref> For example, [[Jehovah's Witnesses]] require that organs be drained of any blood due to their interpretation of the [[Hebrew Bible]]/Christian [[Old Testament]] as prohibiting blood transfusion,<ref name="Religions">{{cite web | url=http://www.redcross.org/donate/tissue/relgstmt.html#Jehovahs | title=Statements from Religions |at=Jehovah's Witness | publisher=American Red Cross | access-date=July 22, 2008 | archive-date=September 17, 2008 |archive-url=https://web.archive.org/web/20080917172456/http://www.redcross.org/donate/tissue/relgstmt.html}}</ref> and [[Muslim]]s require that the donor have provided written consent in advance.<ref name="Religions"/> A few groups disfavor organ transplantation or donation; notably, these include [[Shinto]]<ref>{{cite web |url=http://www.bbc.co.uk/religion/religions/shinto/shintoethics/organs.shtml | title=Shinto: Organ donation | publisher=BBC |date=September 16, 2009<!--last update--> | access-date=March 8, 2014 | url-status=live | archive-date=December 29, 2013 |archive-url=https://web.archive.org/web/20131229153213/http://www.bbc.co.uk/religion/religions/shinto/shintoethics/organs.shtml}}</ref> and the [[Romani people|Romani]].<ref name="Religions"/>

[[Orthodox Judaism]] considers organ donation obligatory if it will save a life, as long as the donor is considered dead as defined by Jewish law.<ref name=Religions/> In both Orthodox Judaism and non-Orthodox Judaism, the majority view holds that organ donation is permitted in the case of irreversible cardiac rhythm cessation. In some cases, rabbinic authorities believe that organ donation may be mandatory, whereas a minority opinion considers any donation of a live organ as forbidden.<ref>{{cite book |last1=Sinclair |first1=Daniel B. |title=Jewish Biomedical Law: Legal and Extra-legal Dimensions |date=2003 |publisher=Oxford University Press |isbn=978-0-19-826827-7 |doi=10.1093/acprof:oso/9780198268277.001.0001 |page=242 }}</ref>

==Organ shortfall==
[[File:Patient receiving dialysis 03.jpg|thumb|left|Patient receiving dialysis]]
The demand for organs significantly surpasses the number of donors everywhere in the world. There are more potential recipients on organ donation waiting lists than organ donors.<ref>{{cite journal |last1=Howard |first1=David H |title=Producing Organ Donors |journal=Journal of Economic Perspectives |date=July 2007 |volume=21 |issue=3 |pages=25–36 |doi=10.1257/jep.21.3.25  |doi-access=free|pmid=19728420 }}</ref> In particular, due to significant advances in [[Kidney dialysis|dialysis]] techniques, patients with end-stage renal disease (ESRD) can survive longer than ever before.<ref>{{cite journal |last1=Massey |first1=E. K. |last2=Hilhorst |first2=M. T. |last3=Nette |first3=R. W. |last4=Smak Gregoor |first4=P. J. H. |last5=van den Dorpel |first5=M. A. |last6=van Kooij |first6=A. C. |last7=Zuidema |first7=W. C. |last8=Zietse |first8=R. |last9=Busschbach |first9=J. J. V. |last10=Weimar |first10=W. |title=Justification for a home-based education programme for kidney patients and their social network prior to initiation of renal replacement therapy |journal=Journal of Medical Ethics |date=November 2011 |volume=37 |issue=11 |pages=677–681 |doi=10.1136/jme.2011.042366 |pmid=21613647 |s2cid=35300096 }}</ref> Because these patients do not die as quickly as they used to, and as kidney failure increases with the rising age and prevalence of high blood pressure and diabetes in a society, the need especially for kidneys rises every year.<ref>{{cite journal|last1=Kaufman|first1=Sharon R.|last2=Russ|first2=Ann J.|last3=Shim|first3=Janet K.|title=Aged bodies and kinship matters: The ethical field of kidney transplant|journal=[[American Ethnological Society#American Ethnologist|American Ethnologist]]|date=February 2006|volume=33|issue=1|pages=81–99|doi=10.1525/ae.2006.33.1.81|pmid=18461150|pmc=2373268}}</ref>

{{As of|March 2014}}, about 121,600 people in the United States are on the waiting list, although about a third of those patients are inactive and could not receive a donated organ.<ref name=unostrendstable>{{cite web |url=http://www.unos.org/ |at=Transplant Trends |publisher=United Network for Organ Sharing | title=UNOS | access-date=March 8, 2014 |quote=Waiting list candidates as of today 2:24pm}}</ref><ref name=washingtonpost>{{cite news |url=https://www.washingtonpost.com/wp-dyn/content/article/2008/03/21/AR2008032102981_pf.html |title=A Third of Patients On The Transplant List Are Not Eligible |newspaper=[[The Washington Post]] |url-status=live |archive-url=http://web.archive.org/web/20250804112718/https://www.washingtonpost.com/wp-dyn/content/article/2008/03/21/AR2008032102981_pf.html |archive-date= 2025-08-04|access-date=October 31, 2016 |date=March 22, 2008 |first=Rob |last=Stein }}</ref> Wait times and success rates for organs differ significantly between organs due to demand and procedure difficulty. {{As of|2007}}, three-quarters of patients in need of an organ transplant were waiting for a kidney,<ref>{{cite web | url=http://www.ctdn.org/resources_public.php#Statistics |at=Waiting List Statistics | title=Resources – General Public | publisher=California Transplant Donor Network | access-date=March 31, 2011 | archive-date=August 19, 2010 | url-status=usurped | archive-url=https://web.archive.org/web/20100819174225/http://www.ctdn.org/resources_public.php}}</ref> and as such kidneys have much longer waiting times. As stated by the Gift of Life Donor Program website, the median patient who ultimately received an organ waited 4 months for a heart or lung—but 18 months for a kidney, and 18–24 months for a pancreas because demand for these organs substantially outstrips supply.<ref>{{cite web|url=http://www.donors1.org/patient/waitinglist/|title=Understanding the Organ Transplant Waiting List – Gift of Life Donor Program|website=www.donors1.org|access-date=February 17, 2018|archive-url=https://web.archive.org/web/20180521160101/http://www.donors1.org/patient/waitinglist/|archive-date=May 21, 2018}}</ref> An increased prevalence of [[self-driving car]]s could exacerbate this problem: In the US, 13% of organ donations come from car crash victims, and autonomous vehicles are projected to reduce the frequency of car crashes.<ref>{{cite journal|doi=10.1146/annurev-publhealth-040119-094035|title=Autonomous Vehicles and Public Health|year=2020|last1=Rojas-Rueda|first1=David|last2=Nieuwenhuijsen|first2=Mark J.|last3=Khreis|first3=Haneen|last4=Frumkin|first4=Howard|journal=Annual Review of Public Health|volume=41|pages=329–345|pmid=32004116|doi-access=free|hdl=10230/52903|hdl-access=free}}</ref>

In Australia, there are 10.8 transplants per million people,<ref>{{cite web|url=http://www.donatewest.health.wa.gov.au/documents/ReflectionsWinter_2005.pdf |title=Organ & Tissue Donation Western Australia (WA) |publisher=DonateLife in Western Australia |access-date=March 31, 2011 |archive-url=https://web.archive.org/web/20070927225555/http://www.donatewest.health.wa.gov.au/documents/ReflectionsWinter_2005.pdf |archive-date=September 27, 2007}}</ref> about a third of the Spanish rate. The [[Lions Eye Institute]], in Western Australia, houses the [[Lions Eye Bank]]. The Bank was established in 1986 and coordinates the collection, processing and distribution of eye tissue for transplantation. The Lions Eye Bank also maintains a waitlist of patients who require corneal graft operations.
About 100 corneas are provided by the Bank for transplant each year, but there is still a waiting list for corneas.<ref>{{cite web |url=http://www.lei.org.au/go/lions-eye-bank |title=Lions Eye Institute: Lions Eye Bank |publisher=Lei.org.au |date=June 30, 2011 |access-date=May 19, 2012 |archive-url=https://web.archive.org/web/20100107205639/http://www.lei.org.au/go/lions-eye-bank |archive-date=January 7, 2010 }}</ref> "To an economist, this is a basic supply-and-demand gap with tragic consequences."<ref name=Dubner2006>{{cite news|url=https://www.nytimes.com/2006/07/09/magazine/09wwln_freak.html|title=Flesh Trade|newspaper=New York Times|date=July 9, 2006 |first1=Stephen J.|last1=Dubner|first2=Steven D.|last2=Levitt}}</ref> Approaches to addressing this shortfall include:
* Donor registries and "primary consent" laws, to remove the burden of the donation decision from the legal next-of-kin. Illinois adopted a policy of "mandated choice" in 2006, which requires driver's license registrants to answer the question "Do you want to be an organ donor?" Illinois has a registration rate of 60 percent compared to 38 percent nationally.<ref name=nytimes2009>{{cite news |last1=Thaler |first1=Richard H. |title=Opting in vs. Opting Out |url=https://www.nytimes.com/2009/09/27/business/economy/27view.html |work=The New York Times |date=September 26, 2009 }}</ref> The added cost of adding a question to the registration form is minimal.
* Monetary incentives for signing up to be a donor. Some economists have advocated going as far as allowing the sale of organs. ''The New York Times'' reported that "Gary Becker and Julio Jorge Elias argued in a recent paper<ref>{{cite journal |last1=Becker |first1=Gary S |last2=Elías |first2=Julio Jorge |title=Introducing Incentives in the Market for Live and Cadaveric Organ Donations |journal=Journal of Economic Perspectives |date=Summer 2007 |volume=21 |issue=3 |pages=3–24 |doi=10.1257/jep.21.3.3  |doi-access=free|pmid=19728419 }}</ref> that 'monetary incentives would increase the supply of organs for transplant sufficiently to eliminate the very large queues in organ markets, and the suffering and deaths of many of those waiting, without increasing the total cost of transplant surgery by more than 12 percent.'"<ref name="Dubner2006"/> Iran allows the sale of kidneys and has no waiting list.<ref name=Ghods2006>{{cite journal |last1=Ghods |first1=Ahad J. |last2=Savaj |first2=Shekoufeh |title=Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation |journal=Clinical Journal of the American Society of Nephrology |date=November 2006 |volume=1 |issue=6 |pages=1136–1145 |doi=10.2215/CJN.00700206 |pmid=17699338 |doi-access=free }}</ref> [[Organ futures]] have been proposed to incentivise donation through direct or indirect compensation. The primary argument against such proposals is a moral one; as the article notes, many find such a suggestion repugnant.<ref name="Dubner2006"/> As the National Kidney Foundation puts it, "Offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values as a society. Any attempt to assign a monetary value to the human body, or body parts, either arbitrarily, or through market forces, diminishes human dignity."<ref>{{cite web | url=http://www.kidney.org/news/newsroom/positionpaper03.cfm | title=Financial Incentives for Organ Donation | archive-date=May 17, 2013 | archive-url=https://web.archive.org/web/20130517121252/http://www.kidney.org/news/newsroom/positionpaper03.cfm| date=August 12, 2014 }} ''After May 2013, this page was no longer available for archiving; in March 2014, searches of the kidney.org site did not reveal a comparable statement in current online materials.''</ref>
* An opt-out system ("dissent solution"), in which a potential donor or his/her relatives must take specific action to be excluded from organ donation, rather than specific action to be included. This model is used in several European countries, such as Austria, which has a registration rate eight times that of Germany, which uses an opt-in system.<ref name="nytimes2009"/>
* Social incentive programs, wherein members sign a legal agreement to direct their organs first to other members who are on the transplant waiting list. One historical example of a private organization using this model is LifeSharers, which is free to join and whose members agree to sign a document giving preferred access to their organs.<ref>{{cite journal |last1=Undis |first1=David J. |title=LifeSharers: Increasing Organ Supply Through Directed Donation |journal=The American Journal of Bioethics |date=July 2005 |volume=5 |issue=4 |pages=22–24 |doi=10.1080/15265160500194600 |pmid=16109688 |s2cid=34441333 }}</ref> "The proposal [for an organ mutual insurance pool] can be easily summarized: An individual would receive priority for any needed transplant if that individual agrees that his or her organs will be available to other members of the insurance pool in the event of his or her death. … The main purpose [of this proposal] is to increase the supply of transplantable organs in order to save or improve more lives."<ref name=Schwindt1998>{{cite journal |last1=Schwindt |first1=Richard |last2=Vining |first2=Aidan |title=Proposal for a Mutual Insurance Pool for Transplant Organs |journal=Journal of Health Politics, Policy and Law |date=October 1998 |volume=23 |issue=5 |pages=725–741 |doi=10.1215/03616878-23-5-725 |pmid=9803360 }}</ref>
* Encouraging more people in palliative care to become donors. Researcher suggests that 46% of patients in palliative care are eligible, but only 4% are approached to consider eye donation.<ref>{{Cite journal |last1=Long-Sutehall |first1=Tracy |last2=Bracher |first2=Mike |last3=Mollart |first3=Sarah |last4=Wale |first4=Jane |date=November 2, 2023 |title=Eye donation from palliative and hospice care contexts: the EDiPPPP mixed-methods study |url=https://www.journalslibrary.nihr.ac.uk/hsdr/KJWA6741/ |journal=Health and Social Care Delivery Research |language=EN |volume=11 |issue=20 |pages=1–159 |doi=10.3310/KJWA6741|doi-access=free |pmid=37929829 }}</ref><ref>{{Cite journal |date=April 16, 2024 |title=Hospice and palliative care services could encourage eye donation |url=https://evidence.nihr.ac.uk/alert/hospice-and-palliative-care-services-could-encourage-eye-donation/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_62809 |url-access=subscription }}</ref>
[[File:ABO blood type.svg|thumb|right|410px|Blood type (or blood group) is determined, in part, by the ABO blood group antigens present on red blood cells.]]
* Technical advances allows the use of donors that were previously rejected. For example, [[hepatitis C]] can be knowingly transplanted and treated in the organ recipient.<ref>{{cite news |last1=Harris |first1=Richard |title=Hepatitis C Not A Barrier For Organ Transplantation, Study Finds |url=https://www.npr.org/sections/health-shots/2019/04/03/709533047/hepatitis-c-not-a-barrier-for-organ-transplantation-study-finds |access-date=December 14, 2020 |work=[[NPR]] |date=April 3, 2019}}</ref>
In hospitals, organ network representatives routinely screen patient records to identify potential donors shortly in advance of their deaths.<ref name=NewZeal>{{cite news |last1=Stein |first1=Rob |title=New Zeal in Organ Procurement Raises Fears |url=https://www.washingtonpost.com/wp-dyn/content/article/2007/09/12/AR2007091202681.html |newspaper=The Washington Post |date=September 13, 2007 }}</ref> In many cases, organ-procurement representatives will request screening tests (such as [[blood typing]]) or organ-preserving drugs (such as [[Antihypertensive|blood pressure drugs]]) to keep potential donors' organs viable until their suitability for transplants can be determined and family consent (if needed) can be obtained.<ref name=NewZeal/> This practice increases transplant efficiency, as potential donors who are unsuitable due to infection or other causes are removed from consideration before their deaths, and decreases the avoidable loss of organs.<ref name=NewZeal/> It may also benefit families indirectly, as the families of unsuitable donors are not approached to discuss organ donation.<ref name=NewZeal/>

Doctors and patients are sometimes hesitant to accept organs from people who  died of brain tumours. However, an analysis of the UK donor registry found no evidence of cancer transmission across more than 750 donations, including people with high-grade tumours. This suggests that it may be safe to increase the use of organs from people who died of a brain tumour, which could help reduce organ shortfall.<ref>{{cite journal |last1=Greenhall |first1=George H. B. |last2=Rous |first2=Brian A. |last3=Robb |first3=Matthew L. |last4=Brown |first4=Chloe |last5=Hardman |first5=Gillian |last6=Hilton |first6=Rachel M. |last7=Neuberger |first7=James M. |last8=Dark |first8=John H. |last9=Johnson |first9=Rachel J. |last10=Forsythe |first10=John L. R. |last11=Tomlinson |first11=Laurie A. |last12=Callaghan |first12=Chris J. |last13=Watson |first13=Christopher J. E. |title=Organ Transplants From Deceased Donors With Primary Brain Tumors and Risk of Cancer Transmission |journal=JAMA Surgery |date=May 2023 |volume=158 |issue=5 |pages=504–513 |doi=10.1001/jamasurg.2022.8419 |doi-access=free |pmid=36947028 |pmc=10034666 }}</ref><ref>{{Cite journal |date=September 7, 2023 |title=Organs from people who died of a brain tumour may be safe to transplant |url=https://evidence.nihr.ac.uk/alert/organs-from-people-who-died-of-a-brain-tumour-may-be-safe-to-transplant/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_59694 |s2cid=261628146 |url-access=subscription }}</ref>

==Distribution==
The United States has two agencies that govern organ procurement and distribution within the country. The United Network for Organ Sharing and the [[Organ Procurement and Transplant Network]] (OPTN) regulate Organ Procurement Organizations (OPO) with regard to procurement and distribution ethics and standards. OPOs are non-profit organizations charged with the evaluation, procurement and allocation of organs within their Designated Service Area (DSA). Once a donor has been evaluated and consent obtained, provisional allocation of organs commences. UNOS developed a computer program that automatically generates donor specific match lists for suitable recipients based on the criteria that the patient was listed with. OPO coordinators enter donor information into the program and run the respective lists. Organ offers to potential recipients are made to transplant centers to make them aware of a potential organ. The surgeon will evaluate the donor information and make a provisional determination of medical suitability to their recipient. Distribution varies slightly between different organs but is essentially very similar. When lists are generated many factors are taken into consideration; these factors include: distance of transplant center from the donor hospital, blood type, medical urgency, wait time, donor size and tissue typing. For heart recipients medical urgency is denoted by a recipients "Status" (Status 1A, 1B and status 2). Lungs are allocated based on a recipients Lung Allocation Score (LAS) that is determined based on the urgency of clinical need as well as the likelihood of benefit from the transplant. Livers are allocated using both a status system and MELD/PELD score (Model for End-stage Liver Disease/Pediatric End-stage Liver Disease). Kidney and pancreas lists are based on location, blood type, Human Leukocyte Antigen (HLA) typing and wait time. When a recipient for a kidney or pancreas has no direct antibodies to the donor HLA the match is said to be a 0 ABDR mismatch or zero antigen mismatch. A zero mismatch organ has a low rate of rejection and allows a recipient to be on lower doses of [[immunosuppressive drug]]s. Since zero mismatches have such high graft survival these recipients are afforded priority regardless of location and wait time. UNOS has in place a "Payback" system to balance organs that are sent out of a DSA because of a zero mismatch.

Location of a transplant center with respect to a donor hospital is given priority due to the effects of Cold Ischemic Time (CIT). Once the organ is removed from the donor, blood no longer perfuses through the vessels and begins to starve the cells of oxygen ([[ischemia]]). Each organ tolerates different ischemic times. Hearts and lungs need to be transplanted within 4–6 hours from recovery, liver about 8–10 hours and pancreas about 15 hours; kidneys are the most resilient to ischemia.{{Citation needed|date=March 2011}} Kidneys packaged on ice can be successfully transplanted 24–36 hours after recovery. Developments in kidney preservation have yielded a device that pumps cold preservation solution through the kidneys vessels to prevent Delayed Graft Function (DGF) due to ischemia. Perfusion devices, often called kidney pumps, can extend graft survival to 36–48 hours post recovery for kidneys. Recently similar devices have been developed for the heart and lungs, in an effort to increase distances procurement teams may travel to recover an organ.

==Suicide==
People who die by suicide have a higher rate of donating organs than average. One reason is lower negative response or refusal rate by the family and relatives, but the explanation for this remains to be clarified.<ref name=fmf/> In addition, donation consent is higher than average from people who have died by suicide.<ref>{{cite journal |last1=Moraes |first1=B.N. |last2=Bacal |first2=F. |last3=Teixeira |first3=M.C.T.V. |last4=Fiorelli |first4=A.I. |last5=Leite |first5=P.L. |last6=Fiorelli |first6=L.R. |last7=Stolf |first7=N.A.G. |last8=Bocchi |first8=E.A. |title=Behavior Profile of Family Members of Donors and Nondonors of Organs |journal=Transplantation Proceedings |date=April 2009 |volume=41 |issue=3 |pages=799–801 |doi=10.1016/j.transproceed.2009.02.043 |pmid=19376356 }}</ref>

Attempted suicide is a common cause of [[brain death]] (3.8%), mainly among young men.<ref name=fmf>{{cite journal |last1=Figueiredo |first1=F.M. |last2=Capaverde |first2=F.B. |last3=Londero |first3=G.G. |last4=Costa |first4=M.G. |last5=Leães |first5=P.E. |last6=Oliveira |first6=D.M.S. |last7=Garcia |first7=C.D. |last8=Garcia |first8=V.D. |title=Organ Donation in Suicides |journal=Transplantation Proceedings |date=March 2007 |volume=39 |issue=2 |pages=344–345 |doi=10.1016/j.transproceed.2007.01.015 |pmid=17362725 }}</ref> Organ donation is more common in this group compared to other causes of death. Brain death may result in [[legal death]], but still with the [[heart]] beating, and with [[mechanical ventilation]] all other vital organs may be kept completely alive and functional,<ref name=DBD/> providing optimal opportunities for [[organ transplantation]].

==Controversies==
In 2008, California transplant surgeon Hootan Roozrokh was charged with [[dependent adult abuse]] for prescribing what prosecutors alleged were excessive doses of morphine and sedatives to hasten the death of a man with [[adrenoleukodystrophy|adrenal leukodystrophy]] and irreversible brain damage, to procure his organs for transplant.<ref name="urlSurgeon Accused of Speeding a Death to Get Organs - New York Times">{{cite news|url=https://www.nytimes.com/2008/02/27/us/27transplant.html|title=Surgeon Accused of Speeding a Death to Get Organs|author=Jesse McKinley|date=February 27, 2008 |work=The New York Times |access-date=May 2, 2008}}</ref> The case brought against Roozrokh was the first criminal case against a [[transplant surgeon]] in the US, and resulted in his acquittal. Further, Roozrokh successfully sued for [[defamation]] stemming from the incident.<ref>{{cite web|title=Transplant surgeon is defamed by surgical director at Loma Linda Medical Center|url=http://www.juryverdictalert.com/jury-verdicts/item/defamation/defamation-doctors|website=Jury Verdict Alert|publisher=Neubauer & Associates|access-date=April 16, 2017}}</ref>

At California's Emanuel Medical Center, neurologist Narges Pazouki said an organ-procurement organization representative pressed her to declare a patient brain-dead before the appropriate tests had been done.<ref name=NewZeal/> In September 1999, eBay blocked an auction for "one functional human kidney" which had reached a highest bid of $5.7&nbsp;million. Under United States federal laws, eBay was obligated to dismiss the auction for the selling of human organs, which is punishable by up to five years in prison and a $50,000 fine.<ref name="Human Organs and eBay">{{cite web|url=http://www.jhhuebert.com/articles/organs.html|title=Human Organs and Ebay: A Combination That Could Save Lives|author=J.H. Huebert|date=September 24, 1999 |work=The Collegian|access-date=November 17, 2009 |archive-url=https://web.archive.org/web/20070707071945/http://www.jhhuebert.com/articles/organs.html|archive-date=July 7, 2007 |url-status=unfit }}</ref>

On June 27, 2008, Indonesian Sulaiman Damanik, 26, pled guilty in a Singapore court for sale of his kidney to [[Tangs|CK Tang's]] executive chair, Tang Wee Sung, 55, for 150&nbsp;million [[rupiah]] (US$17,000). The Transplant Ethics Committee must approve living donor kidney transplants. Organ trading is banned in Singapore and in many other countries to prevent the exploitation of "poor and socially disadvantaged donors who are unable to make an informed choice and suffer potential medical risks."<ref>{{cite press release |date=June 27, 2008 |title=Investigation Into Suspected Organ Trading |url=https://www.moh.gov.sg/newsroom/investigation-into-suspected-organ-trading/ |publisher=Ministry of Health Singapore |access-date=April 1, 2026}}</ref> Toni, 27, the other accused, donated a kidney to an Indonesian patient in March, alleging he was the patient's adopted son, and was paid 186&nbsp;million rupiah (US$21,000).{{citation needed|date=February 2024}}

On October, 2021, Anthony Thomas "TJ" Hoover II, 36, was scheduled to have his organs harvested after being pronounced brain dead at the Baptist Health hospital of Richmond, Ky. According to whistleblower reports Hoover II woke up in the operating room right before the procedure and, after the surgeons assigned for the organ retrieval refused to proceed, a supervisor at Kentucky Organ Donor Affiliates (KODA) ordered the case coordinator Nyckoletta Martin to "find another surgeon or you’ll lose your job because we’re going to complete this case.".<ref>{{cite web|url=https://www.npr.org/sections/shots-health-news/2024/10/16/nx-s1-5113976/organ-transplantion-mistake-brain-dead-surgery-still-alive|title='Horrifying' mistake to take organs from a living person was averted, witnesses say|access-date=March 27, 2026|date=October 17, 2024|website=NPR|author=Rob Stein}}</ref> The case prompted a federal investigation though it was disputed by KODA.<ref>{{cite web|url=https://edition.cnn.com/2024/10/28/health/organ-donor-surgery-kentucky-investigation/index.html|date=October 28, 2024|access-date=March 27, 2026|title=A man was wheeled into surgery to harvest his organs. Weeks later, he left the hospital alive|website=CNN|author=Jen Christensen}}</ref>

==Public service announcements==
Marketing for organ donation must walk a fine line between stressing the need for organ donation and not being too forceful.<ref name="Reinhart, A. M 2012">{{cite journal |last1=Reinhart |first1=Amber M. |last2=Anker |first2=Ashley E. |title=An Exploration of Transportation and Psychological Reactance in Organ Donation PSAs |journal=Communication Research Reports |date=October 2012 |volume=29 |issue=4 |pages=274–284 |doi=10.1080/08824096.2012.704601 |s2cid=144725541 }}</ref> If the marketing agent is too forceful, then the target of the message will react defensively to the request. According to [[psychological reactance]] theory, a person will perceive their freedom threatened and will react to restore the freedom. According to Ashley Anker, the use of [[Transportation theory (psychology)|transportation theory]] has a positive effect on target reactions by marketing attempts.<ref name="Reinhart, A. M 2012"/> When public service announcements use recipient-focused messages, targets were more transported because potential donors experience empathy for the potential recipient.

Awareness about organ donation leads to greater social support for organ donation, in turn leading to greater registration. By starting with promoting college students' awareness of organ donation and moving to increasing social support for organ donation, the more likely people will be to register as organ donors.<ref>{{cite journal |last1=Peltier |first1=James W. |last2=D'Alessandro |first2=Anthony M. |last3=Dahl |first3=Andrew J. |last4=Feeley |first4=Thomas Hugh |title=A Sequential Decision Framework for Increasing College Students' Support for Organ Donation and Organ Donor Registration |journal=Progress in Transplantation |date=September 2012 |volume=22 |issue=3 |pages=323–332 |doi=10.7182/pit2012792 |pmid=22951511 |s2cid=25538087 }}</ref>

The United States Department of Health funded a study by the University of Wisconsin Hospital to increase efforts to increase awareness and the number of registered donors by pursuing members of the university and their family and friends through social media.<ref name="Peltier"/> The results of the study showed a 20% increase in organ donation by creating support and awareness through social media.<ref name="Peltier"/>

==See also==
{{columns-list|colwidth=30em|
* [[Australian Organ Donor Register]]
* [[Organ transplantation in Israel]]
* [[Organ transplantation in China]]
* [[MOHAN Foundation]]
* [[Sri Lanka Eye Donation Society]]
* [[Klaus Schäfer (catholic theologian)|Klaus Schäfer]]: [http://www.organspende-wiki.de/ Organ donation in Germany]
}}

==References==
{{reflist}}

==External links==
<!-- These links are supposed to be "encyclopedic in nature" and interesting to a worldwide audience. No local/state links, please! -->
* [https://www.medlineplus.gov/organdonation.html National Institute of Health's MedLine on Organ Donation]
* [https://www.organindia.org Organ Donation India]
* [https://www.organdonation.nhs.uk/ NHS Organ Transplant] (UK)
* [https://www.organdonor.gov/ OrganDonor.gov] (US)
* [https://web.archive.org/web/20111210050157/http://www.tc.umn.edu/~parkx032/P-ORGAN.html Portal for Organ Donation After Execution]
* [https://web.archive.org/web/20141221234804/http://www.tnnod.org/ Portal for The National Network of Organ Donors]
* [https://www.npr.org/series/156935894/human-tissue-donation Human Tissue Donation] – NPR News Investigation
* [https://web.archive.org/web/20140611131426/http://www.rn.org/courses/coursematerial-10014.pdf Organ and Tissue Donation What Every Nurse Needs to Know course on www.RN.org]
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[[Category:Organ donation| ]]
[[Category:Bioethics]]
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