Living organ donation FAQs

The most common organ donated by living people is a kidney, as a healthy person can lead an almost completely normal life with only one functioning kidney. It is also possible for a living person to donate part of their liver (a liver lobe). In very rare circumstances, it may also be possible to donate a segment of a lung and also part of the small bowel. 

For all forms of living donation, the risk to the donor must be considered very carefully. Before a transplant can go ahead, there must have been a very thorough medical assessment. As with all surgery, there is an element of risk attached.

More recently there has been discussion of uterus (womb) donation; however, there is currently no programme in the UK. Womb donation is in its experimental stage in the UK and funded by the charity Womb Transplant UK. If you would like to know more about the process please visit the charity’s website.

For all forms of living donation, the risk to the donor must be considered very carefully. Before a transplant can go ahead, there must have been a very thorough medical assessment. As with all surgery, there is an element of risk attached. 

Firstly, we would suggest you read as much information as possible about living kidney donation to ensure you understand the medical procedures, the potential risks involved and what the implications are after donation.

Living Donation information is available to potential donors on the NHS Blood and Transplant Living Donation webpage.

There is also information available on various charity websites such as Give a Kidney, One’s Enough. Once you have read the information and would like to proceed to the next steps, you should contact the living donor coordinator (specialist nurse) at the nearest transplant centre.

Firstly, we would suggest you read as much information as possible about living liver lobe donation to ensure you understand the medical procedures, the potential risks involved and what the implications are after donation.

Information is available to potential donors on the NHS Blood and Transplant Living Donation webpage.

There is also information through various charities such as Give a Kidney, One’s Enough. Once you have read the information and would like to proceed to the next steps, you should contact the living donor coordinator (specialist nurse) at the nearest transplant centre. Contact details for the transplant teams across the country can be found here.

Once you have read the information and would like to proceed to the next steps, you should contact the living donor coordinator (specialist nurse) at the nearest transplant centre.

The Human Tissue Act 2004 (the HT Act) and Transplant Regulations place an obligation on the Human Tissue Authority (HTA) to assess all applications for living organ donation.

To grant approval under the Transplant Regulations in England, Wales and Northern Ireland, the Authority must be satisfied:

• That no reward has been given or is to be given; and that
• When transplantable material is removed, consent for its removal for the purpose of transplantation has been given, or its removal for that purpose is otherwise lawful.

In Scotland, to grant approval under the Regulations (Scotland), the Authority must be satisfied that:

• No reward has been or is to be given in contravention of section 20 of the Human Tissue (Scotland) Act 2006, which prohibits commercial dealings in parts of the human body for transplantation;
• There is no evidence of duress or coercion affecting the donor’s decision (and in the case of directed donation, the recipient’s decision to accept the organ); and
• The relevant requirements of the Regulations (Scotland) under the Human Tissue (Scotland) Act 2006 have been met.

For either legislative or policy purposes, the HTA distinguishes a number of different concepts in living organ donation which includes whether the donor and recipient have a genetic or pre-existing emotional relationship e.g. friends of long standing, before the need for a transplant arose.

The different types of donation are:

• Directed
• Paired/pooled
• Non-directed altruistic.
• Directed altruistic

NHS Blood and Transplant (NHSBT) are responsible for the allocation of organs from deceased donors, and from donors who have offered their organs altruistically and do not know who the recipient will be.

Find out more about the roles of the HTA and NHSBT

The Human Tissue Authority (HTA) has been responsible for regulating living organ donation since 1 September 2006. This is when the Human Tissue Act 2004 came into force.

The Human Tissue Authority also became the UK Competent Authority for the European Union Organ Donation Directive (EUODD) in August 2012. This gave the HTA responsibility for ensuring high standards (quality and safety) are met for living and deceased organ donation and transplantation. The standards cover both procurement (characterisation of donor; characterisation, retrieval, preservation and transport of an organ) and transplantation (organ characterisation, preservation, transport and implantation).

Copies of relevant human tissue legislation are available via the government legislation website.

• Human Tissue Act 2004 (the HT Act)
• Human Tissue Act 2004 (Persons who Lack Capacity to Consent and Transplants) Regulations 2006 (Transplant Regulations)
• Human Tissue (Scotland) Act 2006
• Human Organ and Tissue Live Transplants (Scotland) Regulations 2006
• Quality and Safety of Organs Intended for Transplantation Regulations 2012
• Human Transplantation Act (Wales) Act 2013

Directed donation is a common form of donation where a healthy person donates an organ to a specific, identified recipient with whom they have a genetic or pre-existing emotional relationship. Examples include: a mother donating to son or donation between friends of long standing. These cases are often straightforward, however, some directed donation cases require a higher level of scrutiny by the Human Tissue Authority, for example, where there may be an element of economic dependence e.g. tenant donating to their landlord.

Paired/pooled donation is achieved through the UK Living Kidney Sharing Scheme (UKLKSS) which is run by NHS Blood and Transplant (NHSBT). The UKLKSS is used in circumstances where:

• The donor and recipient are incompatible (or mismatched), either by blood group or HLA sensitisation, or
• The donor and recipient are compatible but are seeking a better age or HLA match

The pair may be matched to another couple in a similar situation so that both people in need of a transplant receive a matched organ or part organ.

Pooled donation is where more than two pairs of donors and recipients are involved in the swap.

All cases of paired and pooled donation are referred to a Human Tissue Authority (HTA) panel of three board Members for decision.

Further information on this scheme is available on the NHSBT website.

An altruistic donor chain is a form of donation where a non-directed altruistic donor chooses to donate their kidney into the UK Living Kidney Sharing Scheme (UKLKSS). By matching two or more donors and recipients, a chain of donations and transplants can be carried out. The remaining organ at the end of the chain is then donated to the best matched recipient on the national waiting list. This form of donation was implemented by NHS Blood and Transplant in January 2012. 

If a person is interested in becoming a non-directed altruistic donor, they will need to contact the living donor coordinator (specialist nurse) at their nearest transplant centre.

Further information can be found on the NHS Blood and Transplant website. 

An altruistic donor chain is a form of donation where a non-directed altruistic donor chooses to donate their kidney into the UK Living Kidney Sharing Scheme (UKLKSS). By matching two or more donors and recipients, a chain of donations and transplants can be carried out. The remaining organ at the end of the chain is then donated to the best matched recipient on the national waiting list. This form of donation was implemented by NHS Blood and Transplant in January 2012.

If a person is interested in becoming a non-directed altruistic donor, they will need to contact the living donor coordinator (specialist nurse) at their nearest transplant centre. Further information can be found on the NHS Blood and Transplant website.

The Human Tissue Authority (HTA) defines directed altruistic using the following criteria:

1. The donation is being directed to a specific individual, and
2. There is no evidence of a qualifying genetic relationship or evidence of a pre-existing emotional relationship between the donor and recipient.

In such cases, there may be an involvement of a third party or media campaign in bringing the donor and recipient together for the purpose of transplantation.

Examples of directed altruistic donation:

• Donor and recipient are genetically related, but have no established relationship e.g. cousins, estranged family members.
• Friend of a friend – the donor and recipient may have an awareness of each other e.g. through a mutual person, but no relationship has been formed between the donor and recipient before the need for a transplant arose.
• An organisation has campaigned for a donor e.g. a matching website or charity.
• Media campaigns bring a donor and recipient together e.g. through social media or newspaper articles / adverts.

These cases are often complex and require a higher level of HTA scrutiny. These cases may be referred to a HTA panel of three board Members for decision.

Potential donors and recipients considering directed altruistic donation are advised to read:

• HTA guidance on matching websites and social media
• British Transplantation Society guidelines for directed altruistic donation​.

The Human Tissue Act 2004 (the HT Act) makes it an offence to give or receive a reward for the supply or offer of human material for transplantation.

It is unlawful for donors to be paid or rewarded for donating an organ or part organ. Reward, in the context of the HT Act, is a financial or material advantage which induces a person to become a living donor. In practice, reward means any money, gift or other benefit with a financial value, which influences the decision to donate an organ.

The Human Tissue Authority’s (HTA) role in living organ donation is to ensure that there has been no reward sought or offered for a living organ donation and to provide an independent check to help protect the interests of living organ donors.

This is achieved through an independent assessment interview process with both the donor and recipient (separately and together). We ensure that each individual donor has an opportunity to speak freely to someone not connected with the transplant centre in order to confirm that their wish to donate is free from any pressure to act against their will.

Independent Assessors (IAs) are independent of the living donation process and transplant centres and their teams.  IAs undertake the interviews with both the donors and recipients (except in the case of non-directed altruistic donation where only the donor will be interviewed as the recipient will not be identifiable or in circumstances where the recipient may be too unwell). They carry out these interviews on behalf of the HTA and submit a report to the HTA for consideration.

The HTA makes a decision on whether the living donation and transplant can proceed, based on the evidence provided by the IA.

It is unlawful for donors to be paid or rewarded for donating an organ or part organ. Reward, in the context of the Human Tissue Act 2004 (The HT Act), is a financial or material advantage which induces a person to become a living donor. In practice, reward means any money, gift or other benefit with a financial value which influences the decision to donate an organ.

However, the HT Act does permit donors to receive reimbursement of reasonable expenses, such as travel costs and loss of earnings, which are reasonably attributable to and directly result from living organ donation.

The reimbursement of reasonable expenses incurred as a direct result of living organ donation can be made by the hospital trust; however, the NHS is not obliged to make such payments. Reimbursement of reasonable costs can also be made by other people and organisations.

It is acceptable for a recipient (or the family of the recipient) to directly reimburse the donor if circumstances necessitate this. In this circumstance, the donor and recipient must be able to provide evidence in order to prove that only direct travel costs were paid for, and that the donor has not materially or financially benefitted in any way.

Further information about the reimbursement of expenses.

No. The Human Tissue Act 2004 prohibits commercial dealing in all human material for transplants. Most importantly, it makes trafficking of organs, tissue and cells for transplantation an offence. If convicted of such an offence, the penalty can be imprisonment for up to three years; a fine, or both.

The buying or selling of organs or human tissue is illegal under the Human Tissue Act 2004. If convicted of such an offence, the penalty can be imprisonment for up to three years a fine, or both.

The process can be halted by the clinical team at any stage if there are concerns about coercion, payment or reward. In these circumstances, we would expect the relevant establishment that has concerns to notify the HTA and consider referral to the police for investigation.

If the HTA has concerns when reviewing a case, we will ask for more information and may decide not to approve the transplant. We may also refer the case to the police.

It is not illegal under the Human Tissue Act 2004 (the HT Act) to place an advert seeking a living donor, providing there is no offer of reward/payment or material advantage to the potential donor (commercial dealings in human material for transplants is not allowed).

It is not illegal under the HT Act for a newspaper to accept and place an advert of this nature, although consideration should be given to whether this is the type of advert the paper wants to run (e.g. it may generate complaints).

We would encourage those planning to advertise for a donor to proceed with caution and to liaise with your transplant centre about this as early as possible. Transplant centres are not obliged to consider all living donors and this approach may be problematic for the centre (e.g. logistics of working up those who may come forward as a potential donor). Transplant centres may offer advice on the best wording to use in the advert too.

It is not illegal under the Human Tissue Act 2004 to use social media to seek a living donor provided there is no offer of reward / payment or material advantage to the potential donor (commercial dealings in human material for transplants is not allowed). Anyone considering setting up such a website in the UK is strongly advised to discuss this with the Human Tissue Authority (HTA) (by emailing the transplant team or telephoning 020 7269 1900) before doing so.

The HTA has issued some guidance to help those who may be considering living donation to a recipient that they have found online, or for those recipients who may be approached by a potential donor via social media.

We would encourage those planning to use social media to find a potential donor or recipient to proceed with caution. Recipients planning to find a potential donor should liaise with your transplant centre on this as early as possible. Transplant centres are not obliged to consider all living donors and this approach may be problematic for the centre (e.g. logistics of working up those who may come forward as a potential donor). Transplant centres may offer advice on the best wording to use on a social media site.

It is not illegal under the Human Tissue Act 2004 to setup a matching service, or use one of these services to seek a living donor providing there is no offer of reward/payment or material advantage to the potential donor (commercial dealings in human material for transplants is not allowed). The Human Tissue Authority (HTA) has issued some guidance to help those considering signing up to websites offering a donor and recipient matching service.

The British Transplantation Society  (BTS) has issued guidance that transplant centres should not accept cases for living donor assessment that arise from websites where potential transplant recipients pay a fee to register their need for an organ transplant. People considering using these websites should be aware that even if a donor were to be found via this route, the transplant community has been advised not to proceed with such cases.