What is deceased donation?
Deceased donation means a kidney is donated from someone who has died. There are not enough deceased kidney donations to help everyone who needs a kidney transplant. People have to wait years for a deceased donor transplant.
How does deceased donation work?
The matching process for deceased donors and living donors is the same. The blood group must be compatible and a crossmatch is done between donor and recipient.
Before the donation, a deceased donor is on life support in an intensive care unit, usually because of a severe brain injury or severe illness. This person will die when the life support machine is taken off. Deceased donor kidney donation can be done if the donor dies from a:
- circulatory (heart and blood vessel) death (called donation after cardiovascular death or DCD)
- brain death (called donation after neurologically-determined death or NDD)
When there is no chance of recovery, the transplant team will talk to the person’s family about the decision to stop life support and allow the person to die naturally. After the family decides to stop life support, the transplant team will ask them about organ donation.
Organ donation happens after the person has died. It doesn’t cause the death of that person, or affect a family’s decision to stop life support.
Organ donation criteria is very strict. Because of this, about 1 of every 100 people who die will be able to donate their organs.
What does the recipient learn about the deceased donor?
When you get the call for a deceased donor transplant, you’ll be told about the type of kidney being offered. You won’t get any other information about the donor. The categories used for all deceased donor kidneys are standard criteria, expanded criteria, and increased risk (also called exceptional distribution).
Standard criteria is a kidney from a donor who is less than 60 years old and has no significant health problems.
Expanded criteria is a kidney from a donor who is older than 60 years and who may have problems with high blood pressure or high creatinine, or who may have died from a stroke. These transplanted kidneys don’t tend to last as long as standard criteria kidneys. Some recipients will still benefit from this type of kidney transplant. Please talk to your transplant team if you have questions about this type of kidney.
Exceptional distribution donor isn’t about the quality of the kidney, but rather the donor’s medical and/or social history. For example, there may be no one who can give information about the donor’s history, previous blood transfusions, or previous surgery. But the kidney is working well enough to be considered for transplant. (The transplant doctor wouldn’t offer a kidney that won't work well enough.)
Some examples of an exceptional distribution donor include a donor:
- whose travel history is unknown and may have been exposed to Zika virus, TB (tuberculosis), or other infectious diseases but at the time of donation there is no evidence of active infection with any of them.
- with a remote history of low-risk cancer.
- who tested positive for a particular infection that can be treated
- with high risk sexual or substance abuse behaviors. This may put the recipient at a very small risk (less than 0.5%) of certain infections such as hepatitis B, hepatitis C, or human immunodeficiency virus (HIV).
- who is a man that has sex with other men
- who uses intravenous (IV) drugs
- who is a commercial sex worker
- who has traveled or lived in certain countries with high risks of infectious diseases
- who has spent time in jail
If you are offered a kidney from a donor with an increased risk of passing an infection to you, you won’t be told why the kidney is in this category. But remember that these donors have had 2 types of screening to look for infections. All of these tests must be negative (show no sign of infection) for the transplant doctor to offer a kidney from a donor with an increased risk.
You’ll get all the information about the risks so that you can decide whether or not to accept the kidney. You can say no if you feel it’s too risky for you. There are no penalties for saying no (e.g., you don’t go to the bottom of the list). The decision to go ahead with the transplant is yours. If you decide to accept the offer of a kidney from a deceased donor, you will be closely watched for signs of an infection. In the unlikely event you develop an infection, you will get treatment for it.