Types of Living Donation

Directed donation:

In the case of deceased donation, either the donor or the donor’s next of kin designate an individual or approved facility to receive one or more needed organs. According to UAGA Section 11, organs and tissue may be directed to:

(1) a hospital; accredited medical school, dental school, college, or university; organ procurement organization; or other appropriate person, for research or education;

(2) subject to subsection (b), an individual designated by the person making the anatomical gift if the individual is the recipient of the part;

(3) an eye bank or tissue bank.

In the case of Living Donation, the organ is designated to a specific transplant recipient.

Non-directed donation:

Organs or tissues donated without a specific recipient, either living or deceased.  Most deceased donations are non-directed. The small percentage of non-directed living donations are also known as ‘Good Samaritan’, ‘Anonymous’ or ‘Altruistic’ donations.

[note: Referring to Anonymous Donors as ‘altruistic’ implies that other living donors are not altruistic. It is a term coined by the transplant centers and organizations to persuade more people into non-directed living donation, and many Directed Living Donors find it insulting and disrespectful]

Paired living donation:

Two living kidney donor/recipient pairs (A->B, C->D) who cannot donate to each other due to blood type or HLA mismatch are matched with each other (A->D, C->B)

The largest barrier to the spread of Paired Donation was the concern that it violated NOTA’s ‘no compensation’ clause for living donors. In December, 2007, the Charlie W. Norwood Living Organ Donation Act (H.R.710/S.487 ) stipulates “that kidney paired donation does not involve the transfer of a human organ for valuable consideration.”

[Note: not all donor kidneys are the same.  One of the ethical questions of Paired Donations and Kidney Chains involves the inequity of ‘traded’ kidneys. In other words, one living donor might have relinquished an exceptionally high quality kidney whereby their intended transplant recipient receives one far inferior. No surgeon, transplant center or public policy official has been brave or honest enough to address this issue]

Kidney chain:

Similar to Paired Donation, only involving more than two living kidney donor/recipient pairs.  

[Note: In some cases, ABO/HLA incompatibility came as a relief to reluctant potential living donors. Feller (82) claimed 1/3 of donors ‘go along’ with the tests hoping to be excluded. The advent of Paired/Chain Donation removes this as a viable reason not to donate. Transplant centers have attempted to compensate for this ethical issue by providing potential living kidney donors ‘loopholes’ throughout the evaluation process. The problem, however, is that in Paired/Chain Donation, the loss of one person means the collapse of the entire Pair/Chain, and the subsequent disappointment of many people instead of just one.]

Wait List Paired Donation:

A prospective living kidney donor who cannot donate to their intended transplant recipient due to blood type or HLA mismatch provides a non-directed donation to the highest matched person on the waiting list. In return, their intended recipient is given priority on the list and given the first well-matched deceased kidney available.

This is a very controversial and ethically troublesome means of obtaining donor organs. A kidney from a living donor has an average longer graft survival rate than a deceased kidney, so is it fair for one recipient to receive a deceased kidney while the other gets a living one?

Secondly, and more importantly, in Paired Donation, two living kidney donors are sacrificing themselves for the sake of two transplant recipients. In Wait List Donation, the equation is unequal – only ONE living kidney donor is compromising their short and long-term well-being for the sake of TWO recipients. There is nothing ethically justifiable in this arrangement.

Last Updated: March 4, 2012