triple transplant patient
Bodily Organ Image Gallery

Michael Gaynor received a new heart, liver and kidney in a triple transplant operation on May 21, 2003. The three organs came from a single donor. See bodily organ pictures.

Tim Boyle/Getty Images

Introduction to How Organ Donation Works

In December 1954, Ronald Herrick became the world's first organ donor in a successful transplant procedure. Ronald had just been discharged from the Army when he received news that his twin brother Richard was dying from chronic nephritis -- an inflammation of the kidney

Watching his twin die was overwhelming to Ronald. He asked the doctors if he could donate one of his own kidneys to save Richard's life. The doctors told him that would be impossible -- doctors had attempted organ transplantation before, but the recipient's body always rejected the donated, foreign organ. But this case was a little different. The genetic makeup and tissue types of identical twins would be one and the same, thus offering the highest chances for a successful transplant.

While Ronald was eager to donate, he had concerns. Would having an organ removed ruin his good health? What would life be like with only one kidney?

And the doctors had to grapple with their own medical and ethical dilemmas. Could they perform an operation on a person (the donor) that, at best, served no medical purpose for him and, at worst, actually harmed or killed an otherwise healthy person? Is it OK to risk harming the donor if doing so will save the life of another? What is an acceptable risk? After the doctors consulted with a wide range of fellow doctors, lawyers and clergy members of all denominations, they decided the greater good of donating an organ outweighed the relatively low risk of extracting it from Ronald.

­The night before the experimental operation, Richard, in a moment of lucidity, tried to talk his brother out of it. He sent Ronald a note, reading, "Get out of here and go home." Undeterred, Robert responded in a note of his own: "I am here and I am going to stay" [source: Murray].

The next day, Ronald became the first living donor whose organ successfully saved another human's life. Richard recovered and later married and had two children -- and Ronald recovered to live a long, healthy life with one kidney.

Since that operation, there have been more than 500,000 organ-transplant surgeries performed. Ronald made a revolutionary decision to donate an organ, but today, organ donation is much more common. Learn the fundamentals of donation on the next page.

kidney transplant

A donated kidney from a live donor is flushed in preparation for transplant surgery.

Christopher Furlong/Getty Images

The Importance of Organ Donation

Organs are systems of cells and tissues that perform a specific task -- respiration, for example, or ridding the body of waste. Organs are equipped with higher than necessary capacity. For instance, a 20-year-old's heart can pump 10 times more than the amount of blood needed [source: NLM]. This reserve capacity diminishes as we age, however. The heart, lungs and kidneys especially diminish over time, more so than other organs.

While organs deteriorate over a lifetime along with the rest of your body, disease or genetics may ultimately destroy one specific organ while the rest of your body remains relatively healthy. Depending on which organ is wearing down, there are many life-sustaining measures short of transplantation that can be taken to improve your health. For instance, dialysis helps a person with damaged kidneys. However, the rest of the body is negatively affected by these measures. A person on dialysis has a higher risk of cardiovascular disease because the process can reduce the amount of antioxidants that normally fight toxins within the body.

In many cases, the best (and sometimes the only) answer is to replace the damaged organ with a healthy one. Healthy organs aren't easy to come by, though. As of 2015, there were more than 116,000 people on waiting lists for organs [source: OPTN]. The wait period for 53.2 percent of the people added to transplant waiting lists in 2006 was longer than one year [source: UNOS].

Each organ has its own waiting list, but the lists share a common characteristic -- there are more organs needed than are available. Though many lives are saved through organ donation, many people die while waiting on a list. On average, about 106 people are added to an organ waiting list every day, and 18 people die each day waiting for an organ [source: LifeShare].

A person, living or dead, who provides an organ is called a donor. The person into whom the organ will be transplanted is the recipient. Collecting an organ from a donor is known as retrieval or procurement.

Almost anyone of nearly any age and average health can donate an organ. Anyone who has cancer, HIV or disease-causing bacteria in the bloodstream or body tissues is exempt from donation. Decisions about an organ's usability are made at the donor's time of death or, in the case of living donors, in the process leading to donation.

Most religious and spiritual groups either strongly endorse the act of donating organs or believe it's up to the donor to decide. Only a very few -- namely gypsies and Shinto -- are opposed to organ donation. (Gypsies do not have a formalized religion but do have a shared belief system in which the body is still needed in the first year of the afterlife as the soul retraces its steps.) The Amish support organ donation if there's a relative certainty of success for the recipient, but they're more reluctant if the probable outcome is questionable. Jehovah's Witnesses are not opposed to organ donation or transplantation, so long as the organs are first emptied of all blood [source: [Transplant for Life].

So how can you become an organ donor? And what organs you can donate before you give up the ghost? We'll find out next.

heart transplant patient

Tee Hui Yi waits at the National Heart Institute in Kuala Lumpur for a heart donor match.

STR/AFP/Getty Images

Registering as an Organ Donor

While making the decision to become an organ donor takes some time and thought, actually registering as a donor requires little effort. Most states let you register as an organ donor when you register or renew your driver's license or state ID. Additionally, the majority of states have organ donation registries that can be accessed online. Signing and carrying an organ donation card will also provide consent for organ donation in the case of your death.

When registering, you'll designate whether you wish to donate all of your organs upon death, or just certain ones, as well as your tissues and eyes. Being a designated or potential organ donor will not affect medical care that's provided to you. And once your organs have been removed, the incisions are sewn back up and your body remains visually unaltered for viewing in open casket.

When registering as an organ donor, it's important to notify your family about your decision. That way, your family won't be surprised by the news shortly after your time of death. If you're planning a whole-body donation, you'll need a designated person to contact the institution you've selected once you have died.

There are two different types of donors: living and deceased. Deceased donations result from either cardiac death or brain death. These donations require prior consent from the potential donor or the donor's family. In some states, the medical examiner can provide consent in the case of an unclaimed body. To date, there have been more deceased donations than living donations [source: OPTN].

Donations following a cardiac death are the least common type of deceased-donor transplants. Once a donor dies, the organs must be quickly removed, packaged and transported. In the case of cardiac death, organs begin to lose function quickly, sometimes resulting in imperfectly matched donations -- and, it's a scramble to find a match for the organs.

When it's determined that the brain has ceased working (no electrical activity, blood flow or function in the brain) and the condition is irreversible, a person is declared brain dead. It's possible to sustain organ function through use of a respirator and other means. For this reason, more donations are made in the case of brain death because it offers time to find matches for the organs as well as to prepare for the removal of the organs while maintaining their functional capacity. Organ donation doesn't affect the medical care or considerations given to a brain-dead patient.

Between 1998 and 2008, there were more than 91,000 living donations. In 2006, nearly 46 percent of organ donors were living donors, and accounted for 21.6 percent of all organs donated [source: Burdick]. Organs you can donate while still alive include: a kidney, part of the pancreas, part of a lung, part of the liver or part of the intestine. The majority of living donations are made up of single kidneys. Overall, more females than males become living donors, although there are more males on organ waiting lists. The 35-to-49 year demographic contributes the most living donors, followed by 18-to-34-year-olds and 50-to-64-year-olds [source: OPTN]. Living donors should not be afflicted with H.I.V., diabetes, high blood pressure, cancer, heart or kidney disease, or other infectious diseases.

Why do donated kidneys have so much company in their new homes? Next, we'll learn more about donated organs.

heart transplant display

Heart transplant patient Jennifer Sutton admires her old heart at the Wellcome Collection's Heart Exhibition in London. She donated her heart to promote awareness about organ donation and restrictive cardiomyopathy -- a disease that nearly killed her.


Organ Donation Statistics

Let's take a closer look at the different organs that can be donated and examine the organ donation statistics for each one. There are six organs that can be donated and transplanted:

1.  Kidney -- The functioning lifespan of a transplanted kidney is about nine years. Of all organs, kidneys are most in demand and the most frequently donated [source: LifeShare]. Most diseases that affect the kidneys affect both at the same time, so a living donor is generally not at a greater health risk with only one kidney.

  • Number of people added to list between July 2006 and June 2007: 33,981
  • Total number of people on kidney waiting list as of June 2007: 73,850
  • Number of deceased-donor transplants between July 2006 and June 2007: 10,571
  • Number of living-donor transplants between July 2006 and June 2007: 6,164
  • Mortality rate while waiting for kidney: 7 percent [source: SRTR].

2.  Liver -- The liver is necessary for vitamin storage, removing waste from blood and digestion.

  • Number of people added to list between July 2006 and June 2007: 10,887
  • Total number of people on kidney waiting list as of June 2007: 17,142
  • Number of deceased-donor transplants between July 2006 and June 2007: 6,274
  • Number of living-donor transplants between July 2006 and June 2007: 258
  • Mortality rate while waiting for liver: 13 percent [source: SRTR] .

3.  Heart -- A heart will beat about 2.5 billion times in the course of an average lifetime. Once removed from the donor's body, a heart can only survive for about four hours.

  • Number of people added to list between July 2006 and June 2007: 3,011
  • Total number of people on heart waiting list as of June 2007: 2,673
  • Number of deceased-donor transplants between July 2006 and June 2007: 2,224
  • Mortality rate while waiting for heart: 15 percent [source: SRTR]

4.  Lungs -- Single or double-lung transplants can be performed. Additionally, living donors can donate a single lobe from the lungs, though it will not regenerate.

  • Number of people added to list between July 2006 and June 2007: 1,886
  • Total number of people on lung waiting list as of June 2007: 2,743
  • Number of deceased-donor transplants between July 2006 and June 2007: 1,391
  • Number of living-donor transplants between July 2006 and June 2007: 4
  • Mortality rate while waiting for lung: 12 percent [source: SRTR]

5.  Pancreas -- It's possible to make a living donation of a portion of the pancreas and still retain pancreas functionality.

  • Number of people added to list between July 2006 and June 2007: 827
  • Total number of people on pancreas waiting list as of June 2007: 1,570
  • Number of deceased-donor transplants between July 2006 and June 2007: 449
  • Mortality rate while waiting for pancreas: 4 percent [source: SRTR].

6.  Intestine -- Although quite rare, a living donor can donate a portion of the intestine.

  • Number of people added to list between July 2006 and June 2007: 299
  • Total number of people on intestine waiting list as of June 2007: 231
  • Number of deceased-donor transplants between July 2006 and June 2007): 180
  • Mortality rate while waiting for intestine: 22 percent [source: SRTR].

Now that we know more about the organs that can be donated, in the next section we'll see just how recyclable a human body is. 

blood donor

A member of the Basic Christian Community in Hyderabad, India, donates blood. Volunteer blood donors in India make up only 50 percent of the necessary eight million units needed to fill the annual requirement for blood.


Donating Blood and Body

In addition to organs, you can also donate tissue, blood stem cells, blood and platelets, and even your body. 

Tissue is composed of layers of cells that function together to serve a specific purpose. It must be donated within 24 hours of death. Some types of tissue donations include:

  • Cornea: One of the most commonly transplanted tissues each year (more than 45,000) is the cornea [source: Cigna]. The cornea -- a transparent covering over the eye -- is the eye's primary focusing component. A cornea transplant restores sight to recipients blinded by an accident, infection or disease. Corneas can be transplanted whole or in parts and require no anti-rejection drugs in the recipient [source: Levy]. Corneas from a 75-year-old donor are just as effective as younger corneas.
  • Bones: Donated bones can be used to replace cancerous bones in the arm or leg in lieu of amputation.
  • Skin: Among its many uses, skin can be used in grafts for burn victims or for post-mastectomy breast reconstruction.
  • Other donated tissue includes tendons, ligaments, heart valves and cartilage. 

Blood stem cells are immature blood cells that can produce more blood-forming stem cells, or mature into white blood cells, red blood cells or platelets. Blood stem cells can be taken from bone marrow, the bloodstream or the umbilical cord. Stem cells within bone marrow -- the spongy tissue inside of bones -- produce blood cells. Donated bone marrow can be infused into the blood stream to fill cavities in depleted bones and resume production of normal blood cells.

The most common donation made is blood and platelets. In addition to donating blood for others, you can also donate blood to yourself before going into surgery. Donated blood (after being screened for disease or abnormalities) is separated by blood type and can be transplanted whole, or separated into plasma, platelets or red blood cells.

You may donate your full body to science (or more precisely, the research institute or university of your choice) by legally inserting the wish to do so in your will. Full body donations are used for training doctors, studying the human body and perfecting forensic research and investigative techniques. In most cases, organs cannot be removed from a body that is to be used for research purposes. At the time of your death, the institute is notified, and a representative will inquire about the cause of death and the state of the body to determine if the donation can be accepted. Funeral ceremonies are often encouraged, but require a slightly different embalming process. Afterward, the body is shipped to the institution.

Getting the right organs to the right person is a complicated process. What organizations help streamline organ donation?

organ donation success story

Sisters Carol and Tracey Playfair recover together after surgery. Tracey donated a kidney to save Carol's life.

Christopher Furlong/Getty Images

Organ Donation Organizations

Organ donation is a very complicated and well-coordinated process. At any given moment, organs become available, and a series of individuals, groups and organizations must swing into action. Organs cannot be stored, and most die within 4 to 24 hours of being removed from the human body. In order to maintain a streamlined, efficient and lawful process, several nonprofit entities have been established to facilitate organ donation.

Organ Procurement Organizations (OPOs) are federally designated, nonprofit local entities throughout the United States. They're responsible for organ donor awareness, donor recruitment and evaluation, organ removal and its subsequent transportation. Each state has its own OPO, often with a central location as well as satellite offices throughout the state. When a patient dies, hospitals are required to contact the local OPO. A representative determines whether the person is registered as an organ donor and if his or her organs can be used. If consent is given -- either by the patient prior to death or by the next of kin after the patient's death -- the OPO collects the donor's relevant medical history and arranges to have the organ or organs removed from the body in the operating room, packaged and shipped to the receiving hospital.

The United Network of Organ Sharing (UNOS) is responsible for placing donated organs as well as maintaining the national waiting lists for them. It's based in Richmond, Va., and is open 24 hours a day, 365 days a year. On an average day, organ placement specialists at UNOS find 15 recipients for organs, match 12 organ donors with local OPOs and take 350 phone calls relating to organ donation and transplantation logistics.

In 1984, the Organ Procurement and Transplantation Network (OPTN), a unified transplant network, was established. UNOS is responsible for administering the OPTN. The OPTN collects organ donation and transplantation data, drafts organ transplant policies and maintains a national computer network that matches donors with recipients. The OPTN maintains organ waiting lists, determines who has priority on the lists in each individual case and contacts the appropriate transplant hospitals.

The Scientific Registry of Transplant Recipients (SRTR) is a statistical database for organ transplant information. The SRTR maintains data on every facet of the donation and transplantation process that it collects from hospitals, the OPTN and local OPOs. This information is used by researchers, analysts, doctors and policy-makers to determine priorities and possible improvements in the organ donation process. The database is maintained by the Arbor Research Collaborative for Health in Ann Arbor, Mich.

Continue reading to find out the exact route your donated organ will take once it's removed from your body.

medical examination

Organ donors must be especially vigilant about maintaining good health and getting medical examinations.


A Donated Organ's Path

When any patient dies, the hospital is required to contact the local Organ Procurement Organization (OPO). A member of that organization then determines if you are a designated donor or a potential donor and whether your organs are candidates for donation. Your family is contacted about donation, asked for consent if you didn't register as an organ donor and asked about your medical history.

If it's determined that your organ can be used, it's removed, carefully packaged and delivered to the transplant hospital. If the transplant hospital is in the same geographic area as the location of your body, a representative from the OPO transports your organ in a cooler. However, if the organ's destination is farther away, a contracted team from that hospital or OPO will fly to the organ, take possession of it and deliver it to the transplant hospital. Your organ will then be transplanted into the waiting recipient.

Though you won't be paid for a living donation, the National Living Donor Assistance Center helps people who can't afford the expenses they may incur when donating. This isn't done as an incentive or payment for the donation itself but rather to remove financial obstacles for interested donor candidates. Available assistance includes reimbursement for travel costs and certain nonmedical expenses (such as lodging or meals). Assistance isn't provided for cases in which expenses have been or will be paid by any other state or federal agency, insurance policy or the organ recipient. The organ recipient carries some expectation of compensation for the donor's expenses. However, if the recipient's income is under 300 percent of the federal poverty guidelines or if hardship can be determined on a case-by-case basis, the program will compensate the donor. Additionally, in some states it's possible to receive a state income tax deduction for lost wages.

Living donors must strive toward good health get regular medical checkups to stay on top of any potential side effects that may develop from donation. And living donors continue to be at financial risk well after the expenses affiliated with donation are paid off. Most health and life insurance companies will not change rates for a donor, although a living donor may encounter higher rates if seeking to change policies or insurers. Additionally, health conditions resulting from organ donation may not be covered by insurance companies. If a living donor ever needs an organ donation himself or herself, the United Network of Organ Sharing (UNOS) will designate the person with points for more immediate attention. While this provides some preference toward the donor, he or she will still have to wait behind more pressing cases.

If you're short on this month's rent, the next section might be of interest to you.

Alistair Cooke

Alistair Cooke was among the victims of a tissue black market scam.

Central Press/Getty Images

The Organ Black Market

Though the organ and tissue donation market are highly regulated in the United States, underhanded dealings between shadowy operators are not unheard of. It's illegal in the U.S., and most other nations, to offer or receive compensation for an organ donation. But a black market for human organs does exist.

Citizens of impoverished nations or regions are often tempted to sell one of their kidneys on the black market. In some cases, these entrepreneurial donors are recruited (or learn through word-of-mouth and volunteer) and flown to another nation, where the organ is removed in a makeshift operating room. In 2003, an illegal kidney-procurement network was uncovered in South Africa. The donors were recruited mostly from the slums of Brazil, flown to South Africa where the operation was performed, compensated between $6,000 to $10,000 and returned home [source: Rohter]. The South African middlemen were then able to sell the organs for as much as $100,000 [source: Handwerk].

Villagers in a destitute part of India who sold their kidneys in a similar scheme received about $800 for their organs [source: Handwerk]. At one time, Israeli organ brokers were obtaining kidneys from people in former Soviet-bloc nations and transplanting them into patients who traveled to Turkey for the operation. For the broker, there was money to be made -- one Israeli middleman in the organ trade made $4 million before being caught [source: Rohter].

In the U.S., a black market for human tissue exists. It usually involves bodies about to be cremated. A black market broker may enter into a financial arrangement with a criminally minded funeral home director and carve up the bodies before they're cremated. Falsified papers -- such as consent forms and death certificates -- are produced, and the tissue can then be sold to an American research facility. Sometimes, the tissue may be from a body with an infectious disease, but is sold with documents that claim a different cause of death or medical history. Illegally obtained tissue from just one cadaver has been known to reach 90 tissue recipients [source: Bauer].

In one high-profile case, Michael Mastromarino, an oral surgeon in New York, opened Biomedical Tissue Services with an embalmer, Joseph Nicelli, in 2000. For many years, they harvested human tissue from bodies provided by funeral homes and sold it to research facilities. One of the plundered bodies belonged to Alistair Cooke, host of "Masterpiece Theatre." The "body snatchers" were eventually arrested and charged with numerous crimes.

For more information on organ donation and related topics, transplant yourself to the links on the next page.

Lots More Information

Related HowStuffWorks ArticlesMore Great LinksSources
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  • BBC. "Surgeons sever transplant hand." February 3, 2001 (April 25, 2008).
  • Burdick, James. Director, Division of Transplantation
  • Healthcare Systems Bureau. Testimony before Committee on Oversight and Government Reform, Subcommittee on Information Policy, Census and National Archives, U.S. House of Representatives. September 25, 2007 (April 25, 2008).
  • Central New York Eye and Tissue Bank.
  • Cigna Health Corporation. "Cigna Healthcare Coverage Position; Subject: Corneal Transplant." September 15, 2007 (May 1, 2008).
  • Claggett, Amanda K., Communications Specialist at UNOS. Phone interview and email correspondence, April 24, 2008.
  • Handwerk, Brian. "Organ Shortage Fuels Illicit Trade in Human Parts." National Geographic Ultimate Explorer, January 16, 2004 (April 25, 2008).
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  • Rohter, Larry. " The Organ Trade: A Global Black Market; Tracking the Sale of a Kidney On a Path of Poverty and Hope." New York Times, May 23, 2004 (April 25, 2008).
  • Russo, Karen. "Indian Victims Relate Horror of Kidney Theft." ABC News, Feb. 1, 2008 (April 25, 2008).
  • Sample, Ian. "Man rejects first penis transplant." The Guardian, September 18, 2006 (April 25, 2008).
  • Science Daily, "Kidney Exchange: Computer Scientist Invents Software To Arrange Matches For Kidney Transplants," October 1, 2007 (April 25, 2008).
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