Organ Donation After Death: How It Works and How to Register

Organ donation after death means that organs, eye tissue and other tissue are recovered from someone who has died and given to people who need a transplant. It can only happen after a hospital care team that is not part of the transplant process has declared death. One donor can save up to 8 lives and help more than 75 people through tissue donation, and it costs the donor's family nothing. You can register online at RegisterMe.org or at your state's DMV.

How many people are waiting?

Donate Life America says more than 100,000 people in the US are waiting for a lifesaving organ transplant, and another person is added to the list every 8 minutes. About 13 people die each day while waiting. Around 86% of people on the list need a kidney, and the average wait for a kidney from a deceased donor is 3 to 5 years.

Who can donate?

Nearly anyone can be considered. Donate Life America says people of all ages and medical histories should consider themselves potential donors, because your condition at the time of death decides what can be used. There is no age limit. One in three deceased donors is over 50, and Donate Life California mentions a 93-year-old kidney donor and a 99-year-old cornea donor.

Children and teens have different rules. Donate Life America says a parent or legal guardian must authorize donation for anyone under 18. Teens aged 15 to 17 can register their intent, but parents or guardians make the final decision until age 18. Rules for signing up at the DMV vary by state.

What can be donated?

• Organs: heart, kidneys, liver, lungs, pancreas and intestines.
• Tissue: corneas, heart valves, bone, skin, tendons and veins. Donate Life America says one tissue donor can heal more than 75 people, and one cornea donor can restore sight to two.
• Living donation: a kidney or part of a liver can be given during life. This is a separate medical process, and living donors must be at least 18.

How does donation work, step by step?

1. The team tries to save the patient. Donation is only considered after every effort to save a life has been exhausted.
2. Death is declared. The clinicians who declare it are not part of the donation and transplant process.
3. The organ procurement organization (OPO) checks for a registration. It looks at state registries and the National Donate Life Registry. If you registered, the OPO informs and supports your family. If not, your family is asked whether to authorize donation and is asked for medical and social history.
4. A national system finds matches. It uses blood type, body size, tissue type and time on the waiting list. Donate Life America says race, income, gender, celebrity and social status are never considered.
5. The organs are recovered and sent to transplant hospitals. Your family is not billed for this.
6. The body is released for funeral arrangements. Families can go ahead with the funeral of their choice, including an open casket. See our guides on organ donation and open casket funerals and how donation affects funeral services.

Brain death and circulatory death

There are two routes to donation after death.

In both cases the person is declared legally dead before any organ is recovered.

Tissue and eye donation

Donate Life America says tissue donation must be initiated within 24 hours of death and that most people are eligible as potential tissue donors. An accredited recovery organization checks the registries, and if you are not registered your legal next of kin can authorize it. The Eye Bank Association of America says eye tissue is recovered within hours of death and that only the corneas are transplanted, though a whole eye may go to research or education.

How do I register?

• At the DMV. Donate Life America says DMV staff have helped 165 million people register. This signs you up with your state registry.
• Online at RegisterMe.org. This is the National Donate Life Registry. Donate Life America says it travels with you across state lines.
• Both are checked. The OPO checks your state registry and the national one, and the most recent registration is honored.

Once you are registered you can log in to add research or education options, choose more specific preferences, or remove yourself. Donate Life California says a "YES" on a driver license covers all organs, eyes and tissues, so use your registry profile if you want to exclude any.

Registering is only half the job. Donate Life America says that under the Uniform Anatomical Gift Act, a registered decision is legal and binding and no one else can change it. State rules differ, and donation has to happen quickly after death, so a will or funeral instructions found later won't help. Tell your family and your health care agent, and keep your advance directive consistent with your wishes.

What does it cost the family?

Nothing for the donation. Donate Life America says there is no cost to the donor's family or estate. Donate Life California explains that the OPO covers donation-related costs, while medical expenses before death and funeral costs remain the family's responsibility.

It is also illegal to sell organs. 42 U.S. Code 274e makes it unlawful to knowingly acquire, receive or transfer a human organ for valuable consideration for transplantation if the transfer affects interstate commerce, with a penalty of up to $50,000, five years in prison, or both.

Does donation fit with my faith?

Donate Life America says all major religions in the US support donation as a final act of compassion and generosity. Another OPO, Lifebanc, puts it slightly differently: they either support it or treat it as an individual decision. Views can vary within a tradition. In Judaism, for example, many rabbis accept brain stem death as death, while some Orthodox authorities hold that death occurs only when the heartbeat stops. If this matters to you, talk with your own clergy before you register.

Can I donate organs and my body to science?

Sometimes, but it depends on the program. Science Care says a registered organ donor can typically also donate their body. OHSU says it decides case by case when a donor has given organs, eyes or tissue first. Many programs want an intact body, so ask the program in advance. Our guides to body donation vs organ donation and how to donate your body to science explain the differences.

What to do next

1. Register at RegisterMe.org or your DMV, and check which state registry you are in.
2. Tell your family and your health care agent what you have chosen.
3. Write your wishes down somewhere your family can find them quickly.
4. If you are a family member being asked about donation, you can ask the OPO coordinator questions and take the time you need. Some OPOs, such as Lifebanc, offer grief support to donor families.